pancreas 25.07 copy nursing

8/11/2019 Pancreas 25.07 Copy nursing

1/65

13th CNE PROGRAMME

Dept. of MEDICAL SURGICAL NURSING

Presented by

Mrs. E. Sujitha, M.Sc. Nursing,

Lecturer,Faculty of Nursing,

Sri Ramachandra University,

Porur, Chennai-600116

PANCREAS

Two sides of a coin- Collaborative care


2/65


3/65

THE PANCREAS

The pancreasis an organlocated in the abdomen

retro-peritoneum, 2ndlumbar vertebral level

tucked behind the stomach.

shaped somewhat like a tadpole

is around 25 cm in length, 60-100 g

surrounded by other organs including the

small intestine, liver, and spleen.


4/65

PARTS

The wide part, -head -toward the center of the abdomen;

the middle section -the neck and the body of the pancreas;

the thin end -the tail and extends to the left side.

Several major blood vessels surround the pancreas, -

superior mesenteric artery,

the superior mesenteric vein,

the portal vein

the celiac axis,

supplying blood to the pancreas and other abdominal organs.


5/65

HORMONAL REGULATION

Pancreas plays an essential role in converting the food we

eat into fuel for the body's cells.

The pancreas has two main functions:

an exocrinefunction that helps in digestion and

an endocrinefunction that regulates blood sugar. ,

Thyroxin- regulates O2 consumption

Growth hormone- protein

Insulin- glucose


6/65


7/65

PANCREAS- DUAL ROLES

THE DIGESTIVE SYSTEM

contains exocrine glands that produce enzymesimportantto digestion

Once food has been mulched and partially digested by the

stomach, it is pushed into the duodenum

The pancreas adds its own digestive juices and enzymes to

the food, via a small duct attached to the duodenum.

This process is said to belong to the exocrine role

THE HORMONAL SYSTEM.produces the hormone insulin & glucagon- help to control

the amount of sugar in the blood. (endocrine role)


8/65

PANCREAS

six inches long


9/65

EXOCRINE PORTION- PANCREATIC DUCT

Main duct (Wirsung) runs the entire length ofpancreas

Joins CBD at the ampulla of Vater 24 mm in diameter, 20 secondary branches

Ductal pressure is 1530 mm Hg (vs. 717 inCBD) - preventing damage to pancreatic duct

Lesser duct (Santorini) drains superior portion ofhead and empties into 2ndportion of duodenum


10/65

LIVER AND PANCREAS

The pancreatic duct joins the common bile ductto formthe ampulla of Vater

located at the first portion of the small intestine, called the

duodenum.

The common bile duct originates in the liver and thegallbladderand produces another

important digestive juice called bile.

The pancreatic juices and bile that

are released into the duodenum,

help the body to digest fats,

carbohydrates, and proteins


11/65


12/65

HEPATICOPANCREATIC AMPULLA(AMPULLA OF VATER)


13/65

L2


14/65


15/65

makes HCO3

PANCREAS- MICROSCOPIC STRUCTURE


16/65


17/65

DISORDERS OF THE PANCREAS

Congenitalo Agenesis

o Pancreas Divisum

o Annular Pancreas

o Ectopic Pancreas

Inflammatory

Acute

Chronic Cysts

Neoplasms

Diabetes mellitus


18/65

ACUTE PANCREATITIS

Causes

Alcoholism

Bile reflux

Medications (thiazides) Hypertriglyceridemia,

hypercalcemia

Acute ischemia

Trauma, blunt, iatrogenic

Genes: PRSS1, SPINK1

Idiopathic, 10-20%

Abdominal pain

Extreme emergency

situation

High mortality

But most important lab

test is.Amylase


19/65

MORPHOLOGY

EDEMA

FAT NECROSIS

ACUTE INFLAMMATORY

INFILTRATE

PANCREAS AUTODIGESTION

BLOOD VESSEL

DESTRUCTION

SAPONIFICATION (stearates,

Na+, Ca++)


20/65


21/65

CLINICAL FEATURES

Abdominal Pain

Vague abdominal

symptoms

CT calcifications

amylase elevated ( >500

IU/L) chronic diarrhea (chronic

pancreatic insuffiency )

high likelihood of

pseudocysts

Can cause obstruction

Can get infected


22/65


23/65

CYSTADENOMA


24/65

SYMPTOMS OF PANCREATICPROBLEMS

The symptoms depend on the underlying cause,

Pain in the upper abdomen

Loss of appetite

Yellowing of the skin and eyes (jaundice)

Back pain

Bloating

Nausea

Vomiting Digestive upsets

Passing foul-smelling and fatty faeces


25/65

DIAGNOSIS OF PANCREATICPROBLEMS

General tests

Ultrasound

Computed tomography (CT) scan Magnetic resonance imaging (MRI)

Endoscopy

Laparoscopy

Biopsy


26/65

TREATMENT FOR PANCREATICPROBLEMS

Acute pancreatitishospitalisation in intensive care;

fasting and intravenous fluids;

surgery to remove gallstones or damaged sections of pancreas;

lifestyle changes, -eliminating alcohol.

Chronic pancreatitislong-term treatment mayreducing dietary fats;

supplementing digestion with pancreatic enzyme tablets;

eliminating alcohol;

taking regular insulin injections for reduced endocrine function.

Pancreatic cancersurgery to remove the cancer and associated tissue;radiotherapy and

chemotherapy.

Diabetesa carefully controlled diet.

regular medications or injections of insulin


27/65


28/65

ENDOCRINE FUNCTION-

PANCREASConsists of islet cells that create and release important

hormonesdirectly into the bloodstream.

Two of the main pancreatic hormones are

insulin, which acts to lower blood sugar,

glucagon, which acts to raise blood sugar.


29/65

PRODUCTION OF PANCREATICHORMONES

.Three Cell Types

A - Alpha cells

produce glucagon. B - Beta cells produce

insulin.

D- Delta cells produce

somatostatin


30/65

INSULIN AND GLUCAGON-REGULATE METABOLISM

: Metabolism is controlled by insulin and glucagon


31/65

ROLES OF INSULIN

Acts on tissues except brain (liver, skeletal muscle,adipose) to increase uptake of glucose and amino acids.

Glucose enters the brain by facilitated diffusion

Increases glycogen production (glucose storage) in the

liver and muscle.

Stimulates lipid synthesis from free fatty acids and

triglycerides in adipose tissue.

Also stimulates potassium uptake by cells (role in

potassium homeostasis).

SPECIFIC TARGETS OF INSULIN


32/65

SPECIFIC TARGETS OF INSULINACTION:

CARBOHYDRATES

Moves glucose into cells

Converts glucose to

glycogen.Inhibits gluconeogenesis

LIPIDS

Stimulates production of

free fatty acids from acetyl

CoA.

(increases breakdown of

triacylglycerol in the

circulation


33/65

REGULATION OF INSULINRELEASE

Major stimulus: increased blood glucose levels

1 After a meal, blood glucose

increases

2 Insulin is released

3 Insulin causes uptake of glucose

into tissues

4 Blood glucose levels decrease

5 Insulin levels decline


34/65

INSULIN: SUMMARY AND CONTROLREFLEX LOOP


35/65

INSULIN RELEASE

Stimulated by

Amino acids

Keto acids

Glucagon

negative feedback.

inhibited by

stress-induced increase inadrenal epinephrine

Growth hormone


36/65

GLUCAGON ACTION ON CELLS:DOMINATES IN FASTING STATE

METABOLISM


37/65

TARGETS OF GLUCAGON ACTION

release a glucose molecule off of glycogen.

less glycogen synthesis.

gluconeogenesis

Activates lipases, breaks down triglycerides. decrease free fatty acid formation from acetyl CoA

Result:more production of glucose and substratesfor metabolism

Inhibited by

Increased blood glucose

Insulin

Stimulated by

Stress

Amino acids


38/65

REGULATION OF INSULIN AND GLUCAGONSECRETION (CONTINUED)


39/65


40/65

DIABETES MELLITUS

Chronic high blood

glucose.

2 forms of diabetes

mellitus: Type I: insulin

dependent diabetes

(IDDM).

Type II: non-insulindependent diabetes

(NIDDM).

COMPARISON OF TYPE I AND


41/65

COMPARISON OF TYPE I ANDTYPE II DIABETES MELLITUS

Insert table 19.6


42/65

CONSEQUENCES OF UNCORRECTED DEFICIENCY


43/65

CONSEQUENCES OF UNCORRECTED DEFICIENCYIN TYPE I DIABETES MELLITUS

Insert fig. 19.11


44/65

TYPE II DIABETES MELLITUS

Slow to develop.

Genetic factors

Occurs mostly inoverweight.

Decreased sensitivity toinsulin

Do not usually developketoacidosis.

May have high or normalinsulin.

Insert fig. 19.12


45/65

TREATMENT IN DIABETES

Change in lifestyle:

-- Insulin, OHA

Increase exercise:

Increases the amount of membrane GLUT-4 carriers

in the skeletal muscle cells.

Weight reduction.

Increased fiber in diet. Reduce saturated fat.


46/65

HYPOGLYCEMIA

Over secretion ofinsulin.

Reactivehypoglycemia:

Caused by anexaggeratedresponse to arise in bloodglucose.

Occurs inpeople who aregenetically

predisposed to

type II diabetes.

Insert fig. 19.13


47/65

STIMULATION OF PANCREATIC SECRETION DURING THE INTESTINALPHASE

Frank Boumphrey, M.D., wikimedia commons

PANCREATIC BICARBONATE OUTPUT INCREASES IN
http://commons.wikimedia.org/wiki/File:Pancreas_secretion.pnghttp://commons.wikimedia.org/wiki/File:Pancreas_secretion.png


48/65

PANCREATIC BICARBONATE OUTPUT INCREASES INRESPONSE TO LOW DUODENAL p

Fig. 9-5 Johnson, L. Gastrointestinal Physiology, 6thed. Mosby Elsevier, St. Louis, MO; 2001: 102.


49/65

GLUCOSE CONTENT OF FOOD

What % of the carbohydrates consumed breaksdown into glucose?

100%

What % of the protein consumed breaks down intoglucose?

58%

What % of the fat consumed breaks down intoglucose?

10%


50/65

SOMATOSTATIN

A hormone secreted by the delta cells of the Islets

of Langerhans

Secreted in response toHyperglycemia

Action

Interferes with glucagonInterferes with growth hormone

Has a hypoglycemic effect


51/65

DIAGNOSTIC TESTS

Blood glucose /

Fasting blood glucose

2 hr PPG Glucose tolerance Test

Glycosylated

Hemoglobin Assay


52/65

FASTING BLOOD GLUCOSE

Measures blood

glucose levels after

fasting

Results

Normal70-115 mg/dL

Diabetic level > 126

mg/dL Critical > 400 mg/dL

Critical < 50 mg/dL

Nurses Role

Fast 6-8 hours

Water OK No insulin or anti-

diabetic meds

Exercise will affectresults

Meds that interfere`


53/65

2-hours post-prandial glucose

Measure blood

glucose 2 hours after a

meal

Normal

70-140 mg/dL

Diabetic level

> 140 mg/dL

Nurses Role

Eat entire meal

Dont eat anythingmore until blood draw

Water OK

Notify lab when mealis finished

Exercise with effect

results


54/65

ORAL GLUCOSE TOLERANCE TEST

Measurement of theability of b cells tosecrete insulin.

Ability of insulin tolower bloodglucose.

Normal persons

rise in blood[glucose] afterdrinking solution isreversed to normalin 2 hrs.

Insert fig. 19.8

GLUCOSE TOLERANCE TEST


55/65

GLUCOSE TOLERANCE TEST

Normal

Blood glucose

S < 140mg/dL at 2 hours Urine negative for

glucose (all times)

Diabetic level

Blood glucose > 140mg/dL at 2 hours

Glucose in urine

Nursing responsibility

6-8 hours before test

Hold meds that interfere

A glucose load

Evaluates blood glucoseand urine glucose

30 minutes before

1 hour after

2 hours after 3 hours after

4 hours after

Administer meal and meds

afterwards


56/65

EMBRYOLOGICAL DEVELOPMENT OF PANCREAS


57/65

EMBRYOLOGICAL DEVELOPMENT OF PANCREAS


58/65

Ventral Bud


59/65


60/65


61/65


62/65

Use of glycated haemoglobin (HbA1c) in

the diagnosis of diabetes mellitus

Abbreviated report of a WHO consultation

Editors: WHOPublication date: 2011

Conclusion: WHO has concluded that Hb A1C can be used as

a diagnostic criteria for DM with cut off value 6.5%

I di J E d i l M b 2014 M 18(3) 379 85 d i 10 4103/2230


63/65

Indian J Endocrinol Metab.2014 May;18(3):379-85. doi: 10.4103/2230-

8210.131191.

Knowledge and awareness of diabetes in urban and rural India: The IndianCouncil of Medical Research India Diabetes Study (Phase I): Indian Council

of Medical Research India Diabetes 4(Dr. Mohan et al.,)

Only 43.2% (6160/14,274) of the overall study population

had heard about a condition called diabetes. Overall urban

residents had higher awareness rates (58.4%) compared torural residents (36.8%) (P < 0.001). About 46.7% of males

and 39.6% of females reported that they knew about a

condition called diabetes (P < 0.001). Of the general

population, 41.5% (5726/13,794) knew about a conditioncalled diabetes

N k ti Th d J l 24 2014


64/65

Newyork times: Thursday, July 24, 2014

Diabetes Diet - Type I

Carbohydrates should provide 45 - 65% of total daily calories. The type andamount of carbohydrate are both important. Best choices are vegetables, fruits,

beans, and whole grains. These foods are also high in fiber.

Fats should provide 25 - 35% of daily calories. Monounsaturated (such asolive, peanut, and nuts) and omega-3 polyunsaturated (such as fish, flaxseed

oil, and walnuts) fats are the best types. Limit saturated fat (red meat, butter) to

less than 7% of daily calories. Choose nonfat or low-fat dairy instead of whole

milk products. Limit trans-fats (such as hydrogenated fat found in snack foods,

fried foods, and commercially baked goods) to less than 1% of total calories.

Protein should provide 12 - 20% of daily calories, although this may varydepending on a patients individual health requirements. Patients with kidney

disease should limit protein intake to less than 10% of calories. Fish, soy, and

poultry are better protein choices than red meat.

Lose weight if body mass index (BMI) is 25 - 29 (overweight) or higher

(obese).


65/65

pancreas 25.07 copy nursing

Documents