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Sajaratul Syifaa’ Binti Ibrahim
Batch 6
0313887
Physiology Seminar ( 16th April 2015)
Products Exocrine Part by of Pancreas
Provide Digestive Enzymes
1. Proteolytic enzymes
- Trypsin
- Chymotrypsin
- Carboxyp...
Functions of Pancreatic Enzymes
• Pancreatic Amylase
- The chyme empties from the stomach
- Chyme mixes with the pancreati...
• Pancreatic Protease
‐ The pancreas secretes several proteases (trypsinogen,
chymotrypsinogen and procarboxypeptidase)
‐ ...
What is Pancreatic Insufficiency ?
Exocrine Pancreatic
Insufficiency (EPI)
Characterized by deficiency of
the exocrine pan...
• Maldigestion
Impaired breakdown of nutrients (carbohydrates, protein, fat) to
absorbable split-products
• Malabsorption
...
Etiology of Pancreatic Insufficiency
Pancreatitis
- Alcohol drinking
- Cystic fibrosis
- Gallstones
Pancreatectomy
- Due t...
Overview of Exocrine Pancreatic Insufficiency Symptoms
Exocrine Pancreatic
Insufficiency
Steatorrhea
Abdominal
Distension
...
Clinical Features of Exocrine Pancreatic Insufficiency
1. Diarrhea
- Results from undigested contents settling inside the ...
3. Malabsorption of lipid-soluble vitamin
Vitamin Functions Deficiency
A • Components of the visual pigments -
Rhodopsin
•...
4. Abdominal distension
‐ Deficiency in pancreatic enzyme secretions lead to poor digestion and
absorption of foods in the...
6. Oedema
Chronic protein
malabsorption due
to pancreatic
enzyme insufficiency
Decrease the
serum albumin
level-
Hypoalbum...
7. Exacerbate motility disorders
- Exocrine pancreatic insufficiency itself can cause motility
disorders.
- Maldigestion a...
8 . Deficiency of vitamin B12
‐ When vitamin B12 enters stomach, it binds to Haptocorrin
‐ Haptocorrin and vitamin B12 com...
Test Confirming Exocrine Pancreatic Insufficiency
1. 72 Hour Fecal Fat Test
- Consume diet containing 100 g of fat
- For 3...
2. 13C-Labelled Mixed Triglyceride Breath Test ( 13C MTG-BT)
• A labelled substrate is given orally together with test mea...
References
• Textbook of Medical Physiology, Guyton and Hall ( 11th Edition) Page : 799-802
• Textbook of gastroenterology...
Questions
• What kind of diet that should be taken for pancreatic insufficient patient
1. Low fat diet as fat is more comp...
Effects of deficiency of exocrine pancreatic secretion
Effects of deficiency of exocrine pancreatic secretion
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Effects of deficiency of exocrine pancreatic secretion

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Effects of deficiency of exocrine pancreatic secretion

  1. 1. Sajaratul Syifaa’ Binti Ibrahim Batch 6 0313887 Physiology Seminar ( 16th April 2015)
  2. 2. Products Exocrine Part by of Pancreas Provide Digestive Enzymes 1. Proteolytic enzymes - Trypsin - Chymotrypsin - Carboxypeptidase 2. Lipid digesting enzymes - Pancreatic lipase - Phospholipase - Cholesterol esterase 3. Pancreatic Amylase 4. Ribonucleases & deoxyribonucleases Provide Electrolytes 1. Cl- secreted by acinar cells— with small volume of water 2. HCO3 - is secreted by ductular cells–with larger volume of water
  3. 3. Functions of Pancreatic Enzymes • Pancreatic Amylase - The chyme empties from the stomach - Chyme mixes with the pancreatic amylase - Carbohydrates → maltose or glucose before passing beyond the duodenum
  4. 4. • Pancreatic Protease ‐ The pancreas secretes several proteases (trypsinogen, chymotrypsinogen and procarboxypeptidase) ‐ Trypsin and chymotrypsin will break down protein → peptides ‐ Carboxypeptidase will split off individual amino acids of peptides • Lipid Digesting Enzyme ‐ Most of triglycerides → monoglycerides & fatty acids by pancreatic lipase ‐ Cholesterol esterase & phospholipase hydrolyse phospholipids & cholesterol esters → free fatty acids
  5. 5. What is Pancreatic Insufficiency ? Exocrine Pancreatic Insufficiency (EPI) Characterized by deficiency of the exocrine pancreatic enzymes, resulting in the inability to digest and absorb nutrients from the diet
  6. 6. • Maldigestion Impaired breakdown of nutrients (carbohydrates, protein, fat) to absorbable split-products • Malabsorption Defective mucosal uptake and transport of adequately digested nutrients including vitamins and trace elements.
  7. 7. Etiology of Pancreatic Insufficiency Pancreatitis - Alcohol drinking - Cystic fibrosis - Gallstones Pancreatectomy - Due to pancreatic cancer - Severe pancreatitis
  8. 8. Overview of Exocrine Pancreatic Insufficiency Symptoms Exocrine Pancreatic Insufficiency Steatorrhea Abdominal Distension Weight loss Oedema Exacerbate motility disorders Deficiency of vitamin B12 Malabsorption of lipid- soluble vitamins Diarrhea
  9. 9. Clinical Features of Exocrine Pancreatic Insufficiency 1. Diarrhea - Results from undigested contents settling inside the intestines. - Excessive amounts of solutes tend to retain water inside the intestines causing diarrhea ( Osmotic Diarrhea ) 2. Steatorrhea - Hallmark of malabsorption - Due to excess presence of fat in stools - As a results of deficient amount of pancreatic lipase
  10. 10. 3. Malabsorption of lipid-soluble vitamin Vitamin Functions Deficiency A • Components of the visual pigments - Rhodopsin • Acts as antioxidant to prevent injury to cellular membrane • Visions problems • Xeropthalmia - a pathologic dryness of conjunctiva and cornea • Skin problems ( scaling skin’ psoriasis and acne) D • Aids in absorption of calcium and phosphate for bone growth • Rickets and osteomalacia • Malabsorption lead to secondary hyperthyroidism E • Acts as antioxidant which prevents the injury to cellular membrane • Rarely occur as large amount stored in the adipose tissues • Neurological disorder may occur K • Required in the formation of hepatic synthesized blood clotting factors ( II, VII, IX and X) and prothrombin • Bleeding disorders
  11. 11. 4. Abdominal distension ‐ Deficiency in pancreatic enzyme secretions lead to poor digestion and absorption of foods in the duodenum ‐ More undigested food reach the bacteria in the colon ‐ The bacteria will react with the undigested contents inside the colons and cause production of gas 5. Weight loss - Malabsorption cause deficiencies of sugar, fats, proteins and selective vitamins and minerals. - Lack of nutrients provided to meet the requirements
  12. 12. 6. Oedema Chronic protein malabsorption due to pancreatic enzyme insufficiency Decrease the serum albumin level- Hypoalbuminemia Loss of protein into the intestinal lumen Reduced plasma protein (albumin) in the blood thus reducing the osmotic pressure- reduces pulling of fluid into vessels Enhances retention of fluid in the tissue space OEDEMA
  13. 13. 7. Exacerbate motility disorders - Exocrine pancreatic insufficiency itself can cause motility disorders. - Maldigestion and malabsorption of lipid and protein may lead to inability to stimulate the secretion cholecystokinin (CCK) by the I cells of duodenum and jejunum - CCK act as inhibitor of gastric emptying - With the absence of CCK, gastric emptying will be rapid
  14. 14. 8 . Deficiency of vitamin B12 ‐ When vitamin B12 enters stomach, it binds to Haptocorrin ‐ Haptocorrin and vitamin B12 complex can’t be broken down by pancreatic enzyme in exocrine pancreatic insufficiency ‐ Vitamin B12 will be unable to bind with intrinsic factors Megaloblastic Anaemia - Most pronounced in rapidly dividing cells such as erythropoietic tissue of bone marrow - Leads to insufficient DNA synthesis in the red blood cell synthesis—vitamin B12 Neurological Manifestations - Abnormal fatty acids will accumulate and become incorporated into cell membrane including those of the nervous system
  15. 15. Test Confirming Exocrine Pancreatic Insufficiency 1. 72 Hour Fecal Fat Test - Consume diet containing 100 g of fat - For 3-5 days and collect all stool for 72 hours during this period. - Presence of an amount of fat in the stool greater than 7% of the total amount of fat consumed in the diet during this period is indicative of fat malabsorption
  16. 16. 2. 13C-Labelled Mixed Triglyceride Breath Test ( 13C MTG-BT) • A labelled substrate is given orally together with test meal • After intraduodenal hydrolysis of the substrate by specific pancreatic enzymes, 13C- marked metabolites are released, absorbed from the gut and metabolized within the liver. • As a consequence of the hepatic metabolism, 13CO2 is released and thereafter eliminated with the expired air The amount of 13CO2 expired, which indirectly reflects the exocrine pancreatic function, can be measured by means of mass spectrometry or infrared analysis
  17. 17. References • Textbook of Medical Physiology, Guyton and Hall ( 11th Edition) Page : 799-802 • Textbook of gastroenterology, Tadataka Yamada ( 5th Edition) Page : • Journal of Gastroenterology and Hepatology : Pancreatic exocrine insufficiency: Diagnosis and Treatment by Enrique Domínguez-Muñoz • http://www.merckmanuals.com/professional/gastrointestinal- disorders/malabsorption-syndromes/overview-of-malabsorption • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132852/pdf/ceg-4-055.pdf • http://www.everydayhealth.com/health-report/exocrine-pancreatic- insufficiency/know-the-symptoms-of-epi.aspx • http://emedicine.medscape.com/article/2121028-clinical
  18. 18. Questions • What kind of diet that should be taken for pancreatic insufficient patient 1. Low fat diet as fat is more complex to be digested and it can’t be compensated if there is insufficiency. With taking low fat diet, steatorrhea incidence can be reduced. 2. Include whole grains in your diet as it can bulk up the fatty stool which is the results of malabsorption of fat 3. Milk or any sources of calcium as in exocrine pancreatic insufficiency, patients are not able to absorb calcium due to deficient vitamin D absorption.

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