Lecture 18

Question 1

Pancreas Glands

Answer 1

Exocrine glands (98-99%) - digestion
Endocrine gland (1-2%) – glucose metabolism

Question 2

Exocrine function

Answer 2

Secretes alkaline pancreatic juice rich in digestive enzymes into the duodenum through the pancreatic duct to aid the digestion of proteins (trypsin and chymotrypsin), carbohydrates (amylase), and fats (lipase)

Question 3

Endocrine function

Answer 3

Endocrine tissue of the pancreas which consists of multiple small clusters of cells scattered throughout the gland as pancreatic islets, or islets of Langerhans – regulation of blood glucose

Question 4

Alpha cells

Answer 4

Secrete glucagon; raise blood glucose

Question 5

Beta cells

Answer 5

Secrete insulin; lower blood glucose

Question 6

Delta cells

Answer 6

Secrete somatostatin; inhibit secretion of glucagon and insulin

Question 7

Acute Pancreatitis

Answer 7

Pathogenesis - Blockage (gallstones or alcoholism) but there is an active production of pancreatic juice which results in a buildup and increases pressure in the ducts. Juices will leak into pancreatic tissue which cause destruction of tissue and blood vessels in pancreas. Can manifest as mild/transient disease or lead to severe abdominal pain, multiple organ failure, shock and high mortality.

Question 8

Acute Pancreatitis Diagnosis and Treatment

Answer 8

Diagnosis – elevated amylase/lipase, ultrasound/CT
Tx –fluids, pain management, antibiotics

Question 9

Chronic Pancreatitis

Answer 9

Repeated inflammatory episodes (gets worse and worse) which are replaced by scar tissue – are common in chronic alcoholism

Question 10

Chronic Pancreatitis manifestations

Answer 10

Difficulty digesting and absorbing nutrients (nutrient deficiency), Not enough surviving pancreatic tissue to produce adequate enzymes, Destruction of pancreatic islets may lead to diabetes, can form blockage of bile duct and associated symptoms of cholestasis

Question 11

Diagnosis and treatment of Chronic Pancreatitis

Answer 11

Diagnosis: Elevated amylase/lipase in blood (often not seen in chronic pancreatitis), Xray – calcification, CT scan – calcification, inflammation, necrosis or cancer (risk for adenocarcinoma)
Treatment: Pain management, IV hydration, pancreatic enzyme supplements - Removal

Question 12

Cystic Fibrosis

Answer 12

Pancreatic fibrosis and cysts present in pancreas; Serious hereditary disease, autosomal recessive trait caused by mutation of CFTR on long arm of chromosome 7 (regulates chloride regulation in cells) - manifests in infancy and childhood ; average lifespan is 40 years (could be more or less depending on the severity of the disease)

Question 13

Cystic Fibrosis pathogenesis

Answer 13

Defective transport of chloride (decreased secretion), sodium (increased reabsorption), and increased H2O across the cell membrane. Results in deficient electrolyte concentrations and H2O in the mucus secreted by the pancreas, bile ducts, respiratory tract, and other secretory cells. Mucus becomes very thick and causes obstruction

Question 14

Obstruction of pancreatic ducts

Answer 14

Causes atrophy and fibrosis (85% exhibit chronic pancreatitis) – leads to maldigestion/malnutrition – also destruction of exocrine tissues

Question 15

Obstruction of bronchi

Answer 15

Causes lung injury, susceptibility to infection

Question 16

Obstruction of biliary ducts

Answer 16

Causes liver scarring

Question 17

Abnormal function of sweat glands

Answer 17

Unable to conserve sodium and chloride with excessively high salt concentration in sweat; basis of diagnostic test for CF

Question 18

Treatments for Cystic fibrosis

Answer 18

Gene therapy (Future), drugs, bronchodilators, prophylactic treatment with antibiotics, lung transplant

Question 19

Insulin

Answer 19

Made by pancreas - influences carbohydrate, protein, and fat metabolism on liver cells, muscle, and adipose tissues (main stimulus is high glucose); promotes the entry, use, conversion, and storage of glucose

Question 20

Type 1 diabetes (8%)

Answer 20

Insulin deficiency and occurs primarily in children and young adults

Question 21

Type 2 diabetes (90%)

Answer 21

Inadequate response to insulin, Typically, adult-onset, More common than Type 1, Becoming more common in children

Question 22

Pancreatogenesis diabetes (3% -2%) causes

Answer 22

Pancreatitis (Chronic – Alcohol, CF, obstructive), Pancreatic cancer, Autoimmunity, Trauma/ resection

Question 23

Prediabetes and treatment

Answer 23

Number of insulin-producing beta cells is beginning to decline – not enough to cause disease, may develop in the future (50% of people over 65)
Pharmacologic treatment (metformin)
Glucose tolerance can be improved with alpha-glucosidase inhibitors (oral pill), Reduces sugar mobilization from liver and improves insulin resistance, Decreases glucose absorption in intestine

Question 24

Mild hyperglycemia symptoms

Answer 24

Asymptomatic or mild symptoms like fatigue, frequent urination/thirst

Question 25

Diabetes Mellitus

Answer 25

Very common and important metabolic disease (9% of Canadian population, 25% of over 65yo); Glucose is absorbed by intestines normally but is not used properly for energy due to insulin deficiency or insensitivity – glucose is unable to enter cells and accumulates in blood (hyperglycemia); glucose leaves body through urine causing chronic dehydration and electrolyte imbalance

Question 26

Ketoacidosis

Answer 26

Metabolism relies on adipose (fat) stores exclusively and can lead to metabolic acidosis (diabetic ketosis), a serious condition that can cause cardiac (abnormal rhythm -VT), respiratory (Kussmaul – starts rapid and shallow and becomes deep/labored as acidosis worsens) and neurological symptoms (lethargy, coma, seizures)

Question 27

Type 1 Diabetes Mellitus

Answer 27

An autoimmune disease (80% non-hereditary) which results from damage to pancreatic islets leading to reduction or absence of insulin secretion. CD8+ T-cells infiltrate and destroy the pancreatic islets, often following a viral infection

Question 28

Factors that can increase likelihood of developing diabetes

Answer 28

Obesity
Insulin resistance
Blood lipid abnormalities
Hypertension

Question 29

Type 2 Diabetes Mellitus

Answer 29

Complex metabolic disease – much more common than type 1 (hereditary and population factors included - obesity, etc.); Occurs in older, overweight, or obese adults – spectrum of severity. Reduced response of tissues to insulin (insulin resistance).

Question 30

Severe hyperglycemia

Answer 30

Blood glucose increases 10 to 20 times normal value

Question 31

Hyperosmolar Hyperglycemic Nonketotic Coma

Answer 31

Type 2 diabetes complication; Results in coma due to extreme hyperosmolarity of blood (Cells become dehydrated)

Question 32

Hyperglycemia

Answer 32

Insufficient insulin, blood glucose levels increase

Question 33

Hypoglycemia

Answer 33

Too much insulin, glucose levels decrease

Question 34

Conditions predisposing to hypoglycemia in a diabetic patient taking insulin

Answer 34

Skipping a meal (Carbohydrate intake is insufficient in relation to amount insulin and blood glucose falls), Vigorous exercise (With high physical activity there is high glucose utilization; excess insulin), Insulin shock (Excess insulin causes a precipitous drop in blood glucose, leading to insulin reaction), Oral hypoglycemic drugs in type 2 diabetics, Islet cell tumor

Question 35

Treatment of Diabetes

Answer 35

Diet – control glucose intake (glycemic control), insulin, constantly checking blood glucose and glycosylated hemoglobin measurements, weight management, and oral hypoglycemic drugs

Question 36

Complications of Diabetes

Answer 36

High blood glucose which can lead to increased susceptibility to infection, Diabetic coma (T1D) – hyper glycemia or ketoacidosis, Hyperosmolar coma (T2D) – hyperglycemia without acidosis, arteriosclerosis, blindness, renal failure, and peripheral neuritis

Question 37

Pregnancy-Associated Diabetes (Gestational Diabetes) + treatment

Answer 37

High levels of placental hormones raise blood glucose and cause the pregnant woman to be less responsive to insulin (higher risk for obese patients). Higher risk of developing TD2 after delivery. Treat with supplementary insulin if necessary

Question 38

Other causes of hyperglycemia

Answer 38

Chronic pancreatic disease (Damage or destruction of pancreatic islets), Endocrine diseases (Overproduction of pituitary or adrenal hormones that raise blood glucose), Drugs that impair glucose utilization as side effects (some diuretics, beta-blockers, corticosteroids (most common), antipsychotics), Hereditary diseases (rare, characterized by disturbed carbohydrate metabolism), Autoimmunity - pancreatic

Question 39

Carcinoma of the pancreas

Answer 39

Usually develops in the head of the pancreas, Blocks common bile duct Causes obstructive jaundice
90% of pancreatic cancers are adenocarcinoma, and poor prognosis (1 yr survival 25%, 5y survival 5%) since they are usually found in later stages