Pancreas & diabetes

1. Pancreas & diabetes Željka Kušter Mentor: A. Žmegač Horvat

2. Anatomy • Retroperitoneal abdominal organ • Exocrine and endocrine cells lobules ducts pancreatic duct

4. Exocrine function • Acinar cells - exocrine cells of the pancreas that produce and transport digestive enzymes • Amylase, lipase, phospholipase, proteases (trypsinogen, chymotrypsinogen)

5. Endocrine function • 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 • Insulin -Beta cells (B cells) - stimulates cells to use glucose • Somatostatin- Delta cells (D cells) - regulate the secretion of glucagons and insulin

6. Pancreatitis • Inflammation of the pancreas

7. Acute pancreatitis • Pancreas suddenly becomes inflamed • Causes:Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion venom Hyperlipidaemia, hypothermia ↑Ca2+ ERCP Drugs

8. 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, EUS, CT scan

9. Treatment • nothing to eat or drink • intravenous fluids • analgesia • ERCP and gallstone removal Complications • shock, ARDS, renal failure, DIC, sepsis, ↓Ca2+ • pancreatic necrosis, pseudocyst, abscesses, bleeding, thrombosis

10. Chronic pancreatitis • 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

11. Symptoms • nausea and vomiting • weight loss • diarrhea • steatorrhea Diagnosis • medical history and physical exam • abdominal ultrasound, CT scan, MRCP, ERCP

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

14. Diabetes • increased level of glucose in the blood (normal blood glucose level 3.5-6.0 mmol/l) Type 1 ( insulin-dependent DM, IDDM) • destruction of insulin-secreting pancreatic β cells • juvenile diabetes • patient always needs insulin

15. 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

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

18. Diagnosis • blood glucose level • urine sample • HbA1c test

19. Treatment: • diet • oral hypoglycaemics

20. insulin injections (long-acting, short-acting, rapid-acting) • insulin pen • insulin pump therapy

21. Complications

22. diabetec ketoacidosis • hypoglycaemia • diabetic retinopathy

23. atherosclerosis (heart disease and stroke) • neuropathy (diabetic foot care)

24. Diabetes risk factors • Age over 45 years • Diabetes during a previous pregnancy • Excess body weight • Family history of diabetes • Dyslipidaemia • Hypertension • Low activity level • Metabolic syndrome • Polycystic ovarian syndrome • Acanthosis nigricans