17 Diseases of the Pancreas

7/25/2019 17 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 insulinproducing capacity ofthe pancreas

!ormally, pancreatic digestive en"ymes are not activateduntil they reach the duodenum# Premature activation ofen"ymes causes the pancreas to selfdigest, $hich is amajor 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 inthe pancreas The pancreas is isolated from other structures&

pancreatic malignancies can gro$ for many years$ithout causing symptoms


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'cute Pancreatitis


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(nitially, areas of edema, congestion, % inflammation

's autodigestion progresses, inflammation $orsens,bleeding, necrosis


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'cute )emorrhagic Pancreatitis

*+tensive bleeding

*ntire pancreas can be destroyed


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'mylase sensitive but not specific

Lipase less sensitive but very specific

lood -a./ lo$

Possibly elevated bilirubin


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-hronic Pancreatitis

'bout .01 of cases due tochronic alcoholism, theremainder usually has nokno$n cause

2allstones are notinvolved

'bout 3 have evidenceof prior acute pancreatitis

Dense scar tissue, dilatedducts, gritty calcification

-ould render patientdiabetic


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Pancreatic -arcinoma

'denocarcinomas that arise in the ducts

-ommon

4sually older adults

(nsidious 5no$ little about cause e+cept that smokers .6

as likely to develop as nonsmokers

Most arise in the head % can obstruct thecommon bile duct

Those in the body % tail can be 7uite large bythe time they are detected


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3 die $ithin 8 $eeksof diagnosis

'bout 9:; live a year

9; survive < years


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Major Determinants of Disease

The pancreas produces insulin, $hich isre7uired for glucose metabolism % is essentialfor life

Diabetes occurs $hen there is a lack ofpancreatic insulin or there is tissueunresponsiveness to the action of insulin

'll of the complications of diabetes result fromhigh blood levels of glucose

Disease affecting the insulinproducing capacityof the pancreas does not affect the digestivepancreas


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Diabetes Mellitus

Disorder of insulin action % secretion that

results in hyperglycemia

=asting blood glucose > 9.8 mg0dl or a

blood glucose > .:: mg0dl at any time


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Tendency to run infamilies is about.:;

Most often seen inpeople of northern*uropean ancestry


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Tendency to run infamilies about 8:;

?esistance to insulinbegins as much as 9:years before diagnosis

Prediabetes high insulin levels %

slightly elevated glucoselevels

fasting blood glucose is@99: mg0dl but A 9.8

mg0dl at risk for vascular

disease


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B:; of type . diabetes due to obesity

2estational diabetes usually disappears after delivery but about 901

$ill develop diabetes $ithin 9: years

risks of developing are increased if obese

family history

!ative 'merican, 'frican 'merican, or )ispanic

Cteroids % -ushing syndrome could causediabetic glucose levels correct these % diabetes goes a$ay


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Chortterm

-omplications


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Longterm-omplications


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)yperglycemia causes glycosylation

glucose attaches to proteins indicators are

)gb '9- average of blood glucose over the past .1 months

fructosamine average of blood glucose over the past .1 $eeks

Mostly affects blood vessels % nerves glycolated proteins in vessel $all makes it

stiffer % less elastic in large vessels, accelerates atherosclerosis

in small vessels, slo$s blood flo$ % diffusion


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ascular disease

most seriously damaged accelerated atherosclerosis

impairs blood flo$ causing ischemia % infarction

high incidence of

M( stroke

lo$er limb gangrene

microvascular disease

characteri"ed by hyaline arteriolosclerosis leads to diabetic nephropathy % diabeticretinopathy


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5idney disease diabetic nephrosclerosis

most common cause of renal failure in 4C

atherosclerosis of renal arteries infections of bladder % kidney


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*ye disease important cause

of blindnessassociated $ith

cataracts glaucoma

diabeticretinopathy


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rain % peripheral nerve disease

peripheral neuropathy sensory functions affected more than motor

nerve irritation, pain, abnormal sensations

loss of sensation leads to unnoticed injuries

-harcot joints

postural hypotension

brain

accelerated atherosclerosis % stroke

necrotic corte+ from hypoglycemia


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Treatment

Eeight reduction

Diet % e+ercise

Fral hypoglycemic drugs increase insulin secretion

reduce amount of glucose released by liver

improve glucose utili"ation

block conversion of -)F to glucose

(nsulin

17 Diseases of the Pancreas

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