Pancrea and Diabetes

1. Mrs. Ashley
Medical Assistant Science

3. PANCREAS ANATOMY
stomach
esophagus
ductus choledocus
duodenum
duct of
Santorini
duct of
Wirsung
pancreas

4.  Exocrine and endocrine cells
 90% of pancreas related to exocrine (digestive
function)
 10% endocrine (homeostasis for glucose
levels in the body)

5. 5

6. ◦ Both an exocrine and endocrine organ
◦ Cells with exocrine function release
an alkaline fluid containing sodium
bicarbonate and enzymes →
 pancreatic duct → small intestine
◦ Pancreatic “juice” aids in breakdown
and digestion of food in the small
intestine
◦ Pancreatic exocrine cells = acinar
cells

7.  Acinar cells - exocrine cells of the pancreas
that produce and transport digestive enzymes
 Amylase, lipase, phospholipase, proteases
(trypsinogen, chymotrypsinogen)

8. PANCREATIC SECRETIONS
1. PROTEASES (70%)
Endopeptidases (trypsin, chymotrypsin, elastases)
Exopeptidases (carboxypeptidases)
trypsinogen trypsin activates all other precursors
enterokinase
(duct walls)
2. NUCLEASES (DNAase, RNAase)
3. PANCREATIC AMYLASE (hydrolyse starch and gl;ycogen)
4. PANCREATIC LIPASE (triglycerides fatty acids and glycerol)

9. PANCREAS (PANORAMIC)
pancreatic acini
islet of
Langerhans
islet of
Langerhans
BV
pancreatic lobe

10.  Islets of Langerhans - endocrine cells of the
pancreas that produce and secrete
hormones into the bloodstream
 Glucagon - Alpha cells (A cells) - raises the
level of glucose (sugar) in the blood by
causing liver to break down stored glycogen
 Insulin - Beta cells (B cells) - stimulates
cells to use glucose and reduce glucose
levels in blood
 Antagonistic Hormones

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Endocrine Function :
Cells of the Islet of Langerhans synthesize
and release hormones into the circulation.
Hormones travel through the bloodstream to
target tissues (especially liver and muscle)
At the target cells, hormones bind specific
receptors and cause cell changes that control
metabolism

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 Chemically – high levels of glucose and amino
acids in the blood
 Hormonally – beta cells are sensitive to
several hormones that may inhibit or cause
insulin secretion
 Neurally – stimulation of the parasympathetic
nervous system causes insulin to be secreted.

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 Transported through the blood to target tissues
where it binds to specific receptors
 The binding of insulin to target cells:
◦ Acts as a biochemical signal to the inside of the cell
 Overall, cell metabolism is stimulated
 There is increased glucose uptake into the cell
 Regulation of glucose breakdown within the
cell
 Regulation of protein and lipid breakdown
within the cell

15.  Blood glucose is decreased because insulin
causes glucose to leave the bloodstream and
enter the metabolizing cells.
 With the exception of brain, liver and
erythrocytes, tissues require membrane
glucose carriers.

16.  Inflammation of the pancreas

17.  Pancreas suddenly becomes inflamed
 Causes: Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hyperlipidaemia, hypothermia ↑Ca2+
Drugs

18. Symptoms
 epigastric and central abdominal pain
 vomiting and nausea
 swollen and tender abdomen
 fever
 dehydration and low blood pressure
Diagnosis
 medical history and physical exam
 blood test: ↑ amylase, lipase
 abdominal ultrasound, Endoscopic
Ultrasound, CT scan

19. Treatment
 nothing to eat or drink
 intravenous fluids
 analgesia
 ERCP and gallstone removal
Complications
 shock, Acute respiratory distress syndrome,
renal failure, Disseminated intravascular
coagulation, sepsis, ↓Ca2+
 pancreatic necrosis, pseudocyst, abscesses,
bleeding, thrombosis

20.  inflammation of the pancreas - gets worse
over time and leads to permanent damage
Causes: many years of alcohol use
hereditary disorders of the
pancreas
cystic fibrosis
haemochromatosis
autoimmune conditions

21. Symptoms
 nausea and vomiting
 weight loss
 diarrhea
 steatorrhea

22. Treatment
 drugs - analgesia, lipase, fat-soluble
vitamins
 diet
 surgery – pancreatectomy
pancreaticojejunostomy
Complications
 pseudocyst, diabetes, biliary obstruction,
local arterial aneurysm, splenic vein
thrombosis

24.  The single most common endocrine disorder
– group of glucose intolerance disorders
 Incidence is estimated at 8.3% of the North
American population
 35% are pre-diabetic
 Many of these cases are undiagnosed

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Historically - distinguished by weight loss,
excessive urination, thirst, hunger
Excessive urination = polyuria
Excessive thirst = polydipsia
Excessive hunger = polyphagia
Modern characterization is by hyperglycemia
and other metabolic disorders

26.  increased level of glucose in the blood
(normal blood glucose level 3.5-6.0 mmol/l)
90 mg/100ml
Type 1 ( insulin-dependent DM, IDDM)
 destruction of insulin-secreting pancreatic β
cells (autoimmune response)
 juvenile diabetes-tends to begin in early
childhood
 patient always needs insulin

27. Type 2 (non-insulin dependent DM, NIDDM)
 insulin resistance
 Β cell dysfunction, ↓insulin secretion
Causes of insulin resistance:
 metabolic syndrome (central obesity, hyperglycaemia,
hypertension, ↓HDL cholesterol, ↑triglycerides)
 renal failure
 pregnancy
 cystic fibrosis
 polycystic ovarian syndrome

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Glucose in urine- Because when insulin is not
present, glucose is not taken up out of the
blood at the target cells.
So blood glucose is very highly increased →
increased glucose filtered and excreted in the
urine (exceeds transport maximum)

29. Mechanisms of insulin
resistance:
 post-receptor defects
in insulin action
 gene mutation
 circulating
autoantibodies

31. Diagnosis
 blood glucose level
 urine sample
 HbA1c test

32. Treatment:
 diet
 oral
hypoglycaemics

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Control diet
Carbohydrates should make up about
55-60% of patient’s total calories
Fats should make up <30% of patient’s
total calories
Proteins should make up about 15-20%
of patient’s total calories

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Monitor exercise
Remember: muscles are a target tissue of
insulin, and metabolize much glucose for
energy
Sometimes exercise →irregular blood glucose
levels So diabetic patients should be
monitored when they are exercising

35.  insulin injections (long-acting, short-
acting, rapid-acting)
 insulin pen
 insulin pump therapy

36. Complications

37.  diabetec ketoacidosis
 hypoglycaemia
 diabetic retinopathy

38.  atherosclerosis (heart disease and stroke)
 neuropathy (diabetic foot care)

39.  Age over 40 years
 Diabetes during a previous pregnancy
 Excess body weight
 Family history of diabetes
 Dyslipidaemia (large amount of lipids in
body)
 Hypertension
 Low activity level
 Metabolic syndrome
 Polycystic ovarian syndrome
 Acanthosis nigricans- darkening and
thickening of skin