Diseases of the Pancreas

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Diseases of the Pancreas
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• Most inaccessible organ in the body
• hard to diagnose tumors early

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• Large functional reserves makes it hard to
  diagnose lost function early

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Major Determinants of Disease

• The pancreas is an integral part of the digestive
  process, especially fat digestion
• Disease affecting the digestive function of the
  pancreas usually does not affect the
  insulin-producing capacity of the pancreas
• Normally, pancreatic digestive enzymes are not
  activated until they reach the duodenum.
  Premature activation of enzymes causes the
  pancreas to self-digest, which is a major factor
  in the development of acute pancreatitis
• The common bile duct from the liver passes
  through the head of the pancreas may be
  obstructed by disease in the pancreas
• The pancreas is isolated from other structures
  pancreatic malignancies can grow for many years
  without causing symptoms

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Acute Pancreatitis
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• Initially, areas of edema, congestion,
  inflammation
• As autodigestion progresses, inflammation
  worsens, bleeding, necrosis

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Acute Hemorrhagic Pancreatitis

• Extensive bleeding
• Entire pancreas can be destroyed

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• Amylase
• sensitive but not specific
• Lipase
• less sensitive but very specific
• Blood Ca2 low
• Possibly elevated bilirubin

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Chronic Pancreatitis

• About 2/3 of cases due to chronic alcoholism, the
  remainder usually has no known cause
• Gallstones are not involved
• About ½ have evidence of prior acute pancreatitis
• Dense scar tissue, dilated ducts, gritty
  calcification
• Could render patient diabetic

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Pancreatic Carcinoma

• Adenocarcinomas that arise in the ducts
• Common
• Usually older adults
• Insidious
• Know little about cause except that smokers 2X as
  likely to develop as nonsmokers
• Most arise in the head can obstruct the common
  bile duct
• Those in the body tail can be quite large by
  the time they are detected

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• ½ die within 6 weeks of diagnosis
• About 10 live a year
• 1 survive 5 years

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Major Determinants of Disease

• The pancreas produces insulin, which is required
  for glucose metabolism is essential for life
• Diabetes occurs when there is a lack of
  pancreatic insulin or there is tissue
  unresponsiveness to the action of insulin
• All of the complications of diabetes result from
  high blood levels of glucose
• Disease affecting the insulin-producing capacity
  of the pancreas does not affect the digestive
  pancreas

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Diabetes Mellitus

• Disorder of insulin action secretion that
  results in hyperglycemia
• Fasting blood glucose 126 mg/dl or a blood
  glucose 200 mg/dl at any time

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• Tendency to run in families is about 20
• Most often seen in people of northern European
  ancestry

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• Tendency to run in families about 60
• Resistance to insulin begins as much as 10 years
  before diagnosis
• Prediabetes
• high insulin levels slightly elevated glucose
  levels
• fasting blood glucose is gt110 mg/dl but lt 126
  mg/dl
• at risk for vascular disease

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• 80 of type 2 diabetes due to obesity
• Gestational diabetes
• usually disappears after delivery but about 1/3
  will develop diabetes within 10 years
• risks of developing are increased if
• obese
• family history
• Native American, African American, or Hispanic
• Steroids Cushing syndrome could cause diabetic
  glucose levels
• correct these diabetes goes away

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Short-term Complications
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Long-term Complications
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• Hyperglycemia causes glycosylation
• glucose attaches to proteins
• indicators are
• Hgb A1C
• average of blood glucose over the past 2-3 months
• fructosamine
• average of blood glucose over the past 2-3 weeks
• Mostly affects blood vessels nerves
• glycolated proteins in vessel wall makes it
  stiffer less elastic
• in large vessels, accelerates atherosclerosis
• in small vessels, slows blood flow diffusion

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• Vascular disease
• most seriously damaged
• accelerated atherosclerosis
• impairs blood flow causing ischemia infarction
• high incidence of
• MI
• stroke
• lower limb gangrene
• microvascular disease
• characterized by hyaline arteriolosclerosis
• leads to diabetic nephropathy diabetic
  retinopathy

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• Kidney disease
• diabetic nephrosclerosis
• most common cause of renal failure in US
• atherosclerosis of renal arteries
• infections of bladder kidney

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• Eye disease
• important cause of blindness associated with
• cataracts
• glaucoma
• diabetic retinopathy

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• Brain peripheral nerve disease
• peripheral neuropathy
• sensory functions affected more than motor
• nerve irritation, pain, abnormal sensations
• loss of sensation leads to unnoticed injuries
• Charcot joints
• postural hypotension
• brain
• accelerated atherosclerosis stroke
• necrotic cortex from hypoglycemia

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Treatment

• Weight reduction
• Diet exercise
• Oral hypoglycemic drugs
• increase insulin secretion
• reduce amount of glucose released by liver
• improve glucose utilization
• block conversion of CHO to glucose
• Insulin