pancreas -enzyme and function

7/27/2019 Pancreas -Enzyme and Function

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Enzymes


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Pancreas: large gland, 2nd to the liver in size. Elongated organ in theabdomen lies beneath the stomach connected to the small

intestine at the doudenum. A yellowish organ, about 7 incheslong and 1.5 inches wide. Involve in digestive process,compose of two morphologically and functionally differenttissue.


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3 regions of pancreas: 1. head

2. body3. tail


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Pancreatic Functions:1. Release of hormones endocrine tissue

secrete hormones such as insulin, glucagon, gastrin, somatostatin maintain sugar Islets of Langerhans 1. glucagon- increase glucose in blood (cells)

2. insulin- decrease glucose in blood ( cells)3. somatostatin- regulate the secretion of

glucagon and insulin ( cells)

2. To produce pancreatic digestive enzyme exocrine tissue

help digest the food we eat

proteolytic enzyme trypsin, chymotrypsin, elastase, collagenase, leucineaminopeptidase Lipid digesting enzyme: lipase, lecithinase carbohyfrate splitting : pancreatic amylase separate nitrogen-containing base of their sugar phosphate strands : several

nucleases (ribonuclease)


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Pancreatic action

a.Secretin responsible for production of bicarbonate-rich and alkalinepancreatic fluid

protect the intestinal lining from damage

b.Cholecytokinin (CCK) responsible for the release of the enzymes frompancreatic acinar cells into pancreatic fluid


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Pancreatic Disease:1. Pancreatic cancer: 5TH most fatal cancer

- Arise as adenocarcinomas of ductal epithelium- Rich supply of nerve- pain is prominent feature of the disease

1 a. Body and tail tumor of pancreas:detection does not occur, until advance stage

2 b. head tumor of pancreas;usually detected earlier because of its proximity to common bile duct

signs of tumor:- jaundice, weight loss, anorexia and nausea


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Islet tumor

- affect the endocrine capability of pancreasa. cell tumor: hyperinsulinism

-low blood glucose-hypoglycemic shock

b. cell tumor : over produce gastrin

- called gastrinomas- cause Zollinger Ellison syndrome- doudenal in origin- associated with watery diarrhea, recurring peptic ulcer,

significant hypersecretion and hyperacidityc. cell glucagon secreting tumor

-rare- hypersecretion of glucagon- associated with diabetes mellitus


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2. Cystic fibrosis : fibrocystic disease of the pancreas andmucoviscidosis

-inherited autosomal recessive disorder-dysfunction of mucous and exocrine glands-chromosome 7- gene known CFTR

3. Pancreatitis is an inflammation of the pancreas which causes severeabdominal painmay be either a brief or recurring problem.

Two types of pancreatitis:3a. Acute pancreas suddenly becomes inflamed and then gets better

-mumps, gallstones, pregnancy, hypercalcemia, tissue injury- no permanent damage to the pancreas


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3b. Chronic - permanently damaged- insufficient amount of hormones anddigestive juices.

- one acute attack-damaged ducts,- irreversible injury- excessive alcohol consumption

Factors may contribute to the onset of the disease: heavy alcoholism

genetics nutritional factor


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Clinical Considerations

hypertrophy of the head may cause portal or bile duct obstruction degeneration of the islets of Langerhans leads to diabetes mellitus pancreatitis is a serious inflammatory condition of the exocrine

pancreas cancer of the head of the pancreas is many time a fatal pathology

Laboratory findings:1. increased amylase2. increased lipase3. increased triglycerides4. hypercalcemia

malabsorption syndrome- vit B12

1.Megaloblastic anemia (pernicious anemia) lactose

1. Lactase deficiency


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Acute pancreatitis

Cause: alcoholism orgallstones

Symptoms:

severe abdominal pain

swollen tender abdomen

nausea

vomiting

sweatingfever

rapid pulse

jaundice

Patients relief:fluids injected by veins

antibiotics

surgery

painkillers


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Chronic pancreatitis

The scarring and

calcification ofpancreas. It occurs forabout 8-10 years afterthe first clinicalpresentation of thedisease.

The disease ismore common amongmen than women.

Typically thepatient is diagnosed at

30-40 years of age.


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Inflammation of the pancreas, or pancreatitis, is a serious condition that is mostcommonly caused by either alcohol toxicity or gallstones. Gallstones can lodge in thecommon bile duct and block the flow of pancreatic enzymes out of the pancreas intothe intestine. Pancreatitis due to alcohol toxicity is most often seen in chronicalcoholic patients. Most often, pancreatitis goes away with nonsurgical therapy. Thepatient will not be allowed to eat for three to five days, to prevent secretion ofenzymes by the pancreas. He will also receive pain medication to control the paincaused by pancreatic inflammation.


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Pancreas function test:

1. Secretin stimulation test/ CCK Secretin is administered through intravenous and the contents of

duodenal secretions are aspirated, analyzed over a period of 2 hours used to determine the activity of pancreas in people with

diseases that affect the pancreas

e.g a. Pancreatic obstruction--increase enzyme conc. ;decreased pancreatic flow

b. Cystic fibrosis, chronic pancreatitis, pancreatic cyst,

calcification and edema of the pancreas-- low concentration of bicarbonate and enzymes

2. Fecal Elastase test measure the levels of elastase, enzyme produced by pancreas elastase digest(break down) protein


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3. Fecal fat analysis

a. Qualitative screening test- fat soluble stain

- sudan III, Sudan IV, Oil Red 0 or Nile blue sulfate

b. Quantitative fecal fat analysis

- 72 hour stool collection ; 5 days

- gravimetric method- titrimetric methods

c. Gravimetric method ofSobel for fecal fat determination (modified)

d. Sudan staining for fecal fat

-normal feces: 40-50 small (1-5 mm) neutral lipid droplet/hpf

-streatorrhea: 50-100 mm range fat globules, presence of meat fiber

4. Sweat electrolyte determinations

sodium and chloride concentration

cystic fibrosis

surface electrode


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6. Computed Tomography ( CT) Scan with contrast dye

7. Abdominal ultrasound-detect gallstones

8. Endoscopic Retrograde cholangiopancreatography- make used of dye

9. Endoscopic Ultrasound- make used of probe

10. Magnetic Resonance Cholangiopancreatography (MRI)

5. Serum enzyme lipase and amylase


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If pancreatitis is due to gallstones, most often the responsible gallstone passes into theintestine spontaneously, and the pancreatitis goes away. Less commonly, a minor surgicalprocedure is necessary to extract a gallstone that is blocking the pancreatic duct where it

drains into the small intestine. An endoscope, with a camera on its end, is passed down theesophagus, through the stomach, and into the small intestine. The entrance of thepancreatic duct into the small intestine can be viewed through the endoscope. A specialinstrument on the end of the endoscope can then be passed into the pancreatic duct andthe gallstone is extracted. Very rarely pancreatitis is severe enough to require surgery, whichis usually performed when the pancreas becomes infected. Dead pancreatic tissue is

removed, and the area around the pancreas is washed clean. Patients who require suchtreatment usually have prolonged hospital stays and are seriously ill.


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