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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