pancreas
TRANSCRIPT
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The Pancreas
Felicity Clark
Speciality Registrar
New Cross Hospital
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Why is it important ?
Pancreatitis
Diabetes
Common primary FRCA question
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What you need to Know
Exocrine Function Endocrine function Insulin Glucagon Somatostatin
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Structure of the Pancreas
Loblues 2 types of parenchymal tissue Acinus (80%) Islets of Langherhans (2%) Blood vessels and ducts (15%)
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Exocrine Pancreas
Lumen of Acini produce pancreatic secretions
Accumulate in intralobular ducts Drain to the main pancreatic duct Drains directly into the duodenum
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Exocrine Pancreas
Control is via hormones gastrin, cholecystokinin and secretin secreted by cells in the stomach and
duodenum in response to distension and/or food
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Exocrine Pancreas
2 main classes of exocrine pancreatic secretions Bicarbonate ions – centroacinar cells – Secretin Neutralise acidic chyme Digestive enzymes – Basophilic cells –
Cholecystokinin Proteases – trypsinogen & chymotrypsinogen Pancreatic lipase Pancreatic amylase Secreted as inactive enzymes - zymogens Enteropeptidase activates
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Endocrine Pancreas
Islets of Langherhans Insulin Glucagon Somatostatin Pancreatic polypeptide
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Insulin
Anabolic 51 amino acids pro- insulin – C peptide removed 2 polypeptide chains – disulphide bridges Beta cells Binds to alpha sub unit of insulin receptor Autophosphorylation of tyrosine kinase Activates protein kinases Gene on short arm of chromosome 11
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Effects of Insulin
Carbohydrate metabolism Glucose uptake – liver /skeletal muscle Glycogen storage Glucose utilisation as energy source
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Effects of Insulin
Protein metabolism Stimulates amino acid uptake by cells Stimulates protein synthesis Inhibits Gluconeogenesis
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Effects of Insulin
Lipid metabolism Inhibits lipolysis Stimulates fatty acid synthesis from
glucose Stimulates glycerol synthesis Promotes carbohydrate metabolism /
sparing fat
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Controlling factors - Insulin
Secretion stimulated Hyperglycaemia Amino acids Beta agonists Acetylcholine Glucagon
Secretion inhibited Hypoglycaemia Beta blockers alpha agonists Somatostatin Diazoxide Thiazides Volatiles
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Insulin Deficiency
Type 1 DM – Autoimmune Type 2 DM – Insulin resistance Secondary Diabetes –
increased cortisol – cushings increased growth hormone increased glucagon
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Insulin deficiency – think DKA
Carbohydrate decreased glucose uptake Hyperglycaemia, Glycosuria Osmotic diuresis
Protein Increased amino acids in plasma Nitrogen loss in urine Dehydration Ketoacidosis Respiratory alkalosis Coma Death
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Insulin deficiency – think DKA
Lipids increased Lipolysis Increased free fatty acids Ketogenesis Ketonuria
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Insulin excess
Insulinoma (rare) Iatrogenic (can measure C-peptide) Hypoglycaemia Tremor Sweating Tacchycardia Coma Death
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Glucagon
Catabolic 29 amino acids Alpha cells Acts as a second messenger via cyclic
AMP Opposes insulin
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Effects of Glucagon
Carbohydrate Metabolism Increased Gluconeogenesis Increased glycogenolysis Glucose sparing – beta oxidation of fatty
acids for energy – ketone bodies
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Effects of Glucagon
Lipid Metabolism Stimulates Lipolysis
Other effects Increases catecholamine production Direct positive inotrope
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Controlling factors- Glucagon
Secretion Stimulated hypoglycaemia increased amino acids beta agonists sepsis stress trauma
Secretion Inhibited Hyperglycaemia decreased amino
acids increased free fatty
acids insulin somatostatin alpha agonists
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Somatostatin
delta cells hypothalamus also called growth hormone inhibiting
hormone inhibits insulin and glucagon release inhibits gastric acid production inhibits gallbladder contraction Neurotransmitter – SG - pain