PANCREAS Heartland Society of Gastroenterology Nurses and Associates Mary Ganley RN CGRN BSHA
ANATOMY • Fish shaped lobulated gland. Covered with five connective tissues • Weighs less than four ounces • Three segments Head Body Tail 4. Both cellular and ductal system 5. Cellular System Endocrine Exocrine
Pancreas 6. Endocrine Alpha cells produce glucagon Beta cells produce insulin Delta cells produce somatostatin 7. Exocrine - acinar cells Make up most of the pancreas Production and secretion of pancreatic juices is 1000cc – 2500cc/day Juice is colorless, alkaline, pH is 8.3 Components are: water, bicarb, enzymes, K+, Cl, Ca++ Pancreatic juices neutralize acidic chyme
PANCREAS • Exocrine- Acinar Cells THREE TYPES of Pancreatic Enzymes Amylase - breaks down carbs into sugar Lipase - early stages of fat digestion Protease - breaks down amino acid bonds of protein chain 8. Endocrine products are released directly into the systemic circulation. 9.Pancreatic Juices use the pancreatic ductal system as mode of transport
Diseases for the Pancreas • Pancreatitis – Inflammation of the pancreas from obstruction of the pancreatic duct, trauma, toxicity from alcohol, infections, and drugs. • Signs and Symptoms - pain, nausea, vomiting, low grade fever, abdominal swelling, Low blood pressure, anorexia, weight loss, hypoxia, and increased serum amylase • Treatment • Treat the symptoms - adequate pain relief, NPO, NG Tube, bed rest, TPN, blood transfusion if needed, insulin if needed, and intensive care • Most patients improve after diagnosis within several days
Diseases of the Pancreas • Pseudo cyst- is an encapsulated sac that is lined by granulation tissue but no epithelium and is filled with pancreatic fluid and sometimes blood • Symptoms – epigastric pain, nausea, vomiting, weight loss, occasional jaundice and fever. • Treatment – Conservative treatment for pancreatitis. Usually form after pancreatitis • Drainage of cyst
Carcinoma • Pancreatic canceris the fourth most common cancer related death in the US. • Symptoms - RUQ pain radiates to the back, anorexia, and weight loss. • Treatment- depends on the staging of the cancer. Treatment of symptoms.
ZES • Zollinger-Ellison Syndrome (ZES)= gastrinoma or non beta islet cell tumor of the pancreas releases the hormone gastrin into the circulation which stimulates gastric acid hyper secretion and in turn leads to severe ulcers in the upper GI tract. • Symptoms - pain as with peptic ulcer disease, diarrhea , steatorrhea, elevated serum gastrin • Treatment - long term PPI
Cystic Fibrosis • Cystic Fibrosis - autosomal recessive disease of the exocrine glands that not only affects the pancreas but also the respiratory system, the sweat glands and the reproductive system • CF- A hereditary disorder of infants, children, and young adults in which there is widespread dysfunction of the exocrine glands. It is characterized by signs of pulmonary disease caused by excessive mucus production in the respiratory tract, pancreatic deficiency, and abnormally high levels of electrolytes in the sweat and occasionally by biliary cirrhosis .
Cystic Fibrosis • Diagnostic test is sweat electrolyte test – elevated sodium and chloride. • Treatment includes managing respiratory complications, aiding digestion through dietary regulation, pancreatic enzyme replacement and replacement of Vitamins A, D, E and K
PANCREAS DIVISUM • A developmental anomaly in which the pancreas is present as two separate structures each with its own duct. • Causes pancreatitis. Diagnosis by pancreatography ERCP • Treatment - Sphincterotomy
SCHWACHMAN-DIAMOND SYNDROME • The second most common cause of pancreatic insufficiency. • Main features presented are pancreatic insufficiency, cyclic neutropenia, metaphyseal and growth retardation. Dental abnormalities, renal dysfunction, hepatomegaly, abnormal lung function, delayed puberty, and ichthyosis, malabsorption infancy with steatorrhea. The most prevalent feature is stunted growth. • Diagnosed with a pancreozymin/secretin stimulation test – low or absent pancreatic zymogen enzymes. • High stool fat content. Stools are greasy ,pale, and foul smelling.
Children • The three leading causes of pancreatitis in children are trauma, drugs and viral infection.
QUESTIONS • The majority of pancreatic tissue is made up of what cells? Answer: Acinar Cells • The endocrine cells of the pancreas are located where? Answer: Islets of Langerhans • The beta cells secrete? Answer: Insulin
QUESTIONS • The most severe form of pancreatitis is? Answer: Necrotizing • Zollinger-Ellison syndrome often results in what manifestation? Answer: Peptic Ulcer Disease • The most prevalent clinical feature of Schwachman-Diamond syndrome is? Answer: Stunted Growth