Anatomy of the Pancreas and Bilirubin Metabolism
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Transcript of Anatomy of the Pancreas and Bilirubin Metabolism
8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism
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ANATOMY OF THE PANCREAS
AND
BILIRUBIN METABOLISM
DR AYOADE O. A
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PANCREAS
• Pan (all); kreas (flesh).
• Exocrine and endocrine organ.
• Retroperitoneal.
• Termed “Most unforgiving organ”.
• Tremendous reserve capacity.
• 75 - 100gm in weight.
• 15 - 20cm in length.
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Sphincter of Oddi ERCP
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FUNCTIONS OF THE PANCREAS
EXOCRINE FUNCTION
1.5 – 2.5L/day of alkaline
juice ( pH 8.0- 8.3)
Over 20 digestive
enzymes
Amylase – carbohydrate
Protease – proteinLipase – fat
3 phase secretion
Cephalic, Gastric, Intestinal
ENDOCRINE FUNCTION
Over 1 million islet of
langerhan cells.
4 major cell types
α - Glucagon
β - Insulin
δ - Somatostatin
ρρ - pancreatic
polypeptide
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BILIRUBIN METABOLISM
Jaundice or icterus • Yellowish discolouration of
the skin, mucous
membranes, sclera.
• Excess plasma bilirubin
• Normal range
– < 1 mg / dl
• Clinically obvious
– > 3 mg / dl
• Not a disease but a Sign.
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BILIRUBIN METABOLISM
Heme
Heme oxygenaseBiliverdin
Biliverdin reductase
Bilirubin + albumin
UDP glucuronyl transferaseBMG, BDG
β glucuronidases
Urobilinogen
Bacteria enzymesStercobilinogen
Feaces
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• About 4mg/kg of bilirubin produced per day.
• 80% from Hemoglobin.
• 20% from other hemeproteins– myoglobin, cytochromes, catalase, peroxidase.
• Unconjugated bilirubin (aka indirect) is fat soluble andtoxic.
• Bilirubin is excreted in Bile.
• Main constituent of Bile is water , bile acids, bilepigments, cholesterol, phospholipids & all inorganic ionsfound in plasma.
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Bile acid metabolism
• LIVER -The primary bile acids, chenodeoxycholic & cholic acid are
formed from cholesterol .• INTESTINE - converted to Secondary bile acids - deoxycholate ,
lithocholate & are absorbed in terminal ileum.
• Main function are:
– Reduction of surface tension (surfactants)
– Emulsification of Fat for easy digestion and absorption
in the small intestine. (Detergents)
– Absorption of Fats and fat soluble vitamins ( A D E K )
– Maintain cholesterol homeostasis.
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• Pancreas
– Sorrounded by the Great vessel and vital organs.
– Avascular plane behind its neck
– Coeliac plexus block.
• Bilirubin
– 80 % from breakdown of RBC
– In its unconjugated form is toxic• Bile acids
– Obstruction to its flow - malabsorption of fats &vitamins A, D, E, K.