Enzymes

Pancreas: large gland, 2nd to the liver in size. Elongated organ in the abdomen lies beneath the stomach connected to the small intestine at the doudenum. A yellowish organ, about 7 inches long and 1.5 inches wide. Involve in digestive process, compose of two morphologically and functionally different tissue.

3 regions of pancreas: 1. head 2. body 3. tail

Pancreatic Functions: 1. Release of hormones endocrine tissue

secrete hormones such as insulin, glucagon, gastrin, somatostatin maintain sugar Islets of Langerhans 1. glucagon- increase glucose in blood ( cells) 2. insulin- decrease glucose in blood ( cells) 3. somatostatin- regulate the secretion of glucagon and insulin ( cells) 2. To produce pancreatic digestive enzyme exocrine tissue help digest the food we eat proteolytic enzyme trypsin, chymotrypsin, elastase, collagenase, leucine aminopeptidase Lipid digesting enzyme: lipase, lecithinase carbohyfrate splitting : pancreatic amylase separate nitrogen-containing base of their sugar phosphate strands : several nucleases (ribonuclease)

Pancreatic action a.Secretin responsible for production of bicarbonate-rich and alkaline pancreatic fluid protect the intestinal lining from damage

b.Cholecytokinin (CCK) responsible for the release of the enzymes from pancreatic acinar cells into pancreatic fluid

Pancreatic Disease:
1. Pancreatic cancer: 5TH most fatal cancer - Arise as adenocarcinomas of ductal epithelium - Rich supply of nerve - pain is prominent feature of the disease 1 a. Body and tail tumor of pancreas: detection does not occur, until advance stage 2 b. head tumor of pancreas; usually detected earlier because of its proximity to common bile duct signs of tumor: - jaundice, weight loss, anorexia and nausea

Islet tumor - affect the endocrine capability of pancreas a. cell tumor: hyperinsulinism -low blood glucose -hypoglycemic shock b. cell tumor : over produce gastrin - called gastrinomas - cause Zollinger Ellison syndrome - doudenal in origin - associated with watery diarrhea, recurring peptic ulcer, significant hypersecretion and hyperacidity c. cell glucagon secreting tumor -rare - hypersecretion of glucagon - associated with diabetes mellitus

2.

Cystic fibrosis : fibrocystic disease of the pancreas and mucoviscidosis -inherited autosomal recessive disorder -dysfunction of mucous and exocrine glands -chromosome 7 - gene known CFTR

3. Pancreatitis is an inflammation of the pancreas which causes severe abdominal painmay be either a brief or recurring problem. Two types of pancreatitis: 3a. Acute pancreas suddenly becomes inflamed and then gets better -mumps, gallstones, pregnancy, hypercalcemia, tissue injury - no permanent damage to the pancreas

3b. Chronic - permanently damaged

- insufficient amount of hormones and digestive juices. - one acute attack-damaged ducts, - irreversible injury - excessive alcohol consumption

Factors may contribute to the onset of the disease: heavy alcoholism genetics nutritional factor

Clinical Considerations hypertrophy of the head may cause portal or bile duct obstruction degeneration of the islets of Langerhans leads to diabetes mellitus pancreatitis is a serious inflammatory condition of the exocrine pancreas cancer of the head of the pancreas is many time a fatal pathology Laboratory findings: 1. increased amylase 2. increased lipase 3. increased triglycerides 4. hypercalcemia malabsorption syndrome - vit B12 1.Megaloblastic anemia (pernicious anemia) lactose 1. Lactase deficiency

Acute pancreatitis
Cause: alcoholism or gallstones Symptoms: severe abdominal pain swollen tender abdomen nausea vomiting sweating fever rapid pulse jaundice

Patients relief: fluids injected by veins antibiotics surgery painkillers

Chronic pancreatitis
The scarring

and

calcification of pancreas. It occurs for about 8-10 years after the first clinical presentation of the disease. The disease is more common among men than women. Typically the patient is diagnosed at 30-40 years of age.

Inflammation of the pancreas, or pancreatitis, is a serious condition that is most commonly caused by either alcohol toxicity or gallstones. Gallstones can lodge in the common bile duct and block the flow of pancreatic enzymes out of the pancreas into the intestine. Pancreatitis due to alcohol toxicity is most often seen in chronic alcoholic patients. Most often, pancreatitis goes away with nonsurgical therapy. The patient will not be allowed to eat for three to five days, to prevent secretion of enzymes by the pancreas. He will also receive pain medication to control the pain caused by pancreatic inflammation.

Pancreas function test: 1. Secretin stimulation test/ CCK Secretin is administered through intravenous and the contents of duodenal secretions are aspirated, analyzed over a period of 2 hours used to determine the activity of pancreas in people with diseases that affect the pancreas

e.g a. Pancreatic obstruction --increase enzyme conc. ;decreased pancreatic flow b. Cystic fibrosis, chronic pancreatitis, pancreatic cyst, calcification and edema of the pancreas -- low concentration of bicarbonate and enzymes 2. Fecal Elastase test measure the levels of elastase, enzyme produced by pancreas elastase digest(break down) protein

3. Fecal fat analysis

a. Qualitative screening test - fat soluble stain - sudan III, Sudan IV, Oil Red 0 or Nile blue sulfate b. Quantitative fecal fat analysis - 72 hour stool collection ; 5 days - gravimetric method - titrimetric methods c. Gravimetric method of Sobel for fecal fat determination (modified) d. Sudan staining for fecal fat -normal feces: 40-50 small (1-5 mm) neutral lipid droplet/hpf -streatorrhea: 50-100 mm range fat globules, presence of meat fiber 4. Sweat electrolyte determinations sodium and chloride concentration cystic fibrosis surface electrode

5. Serum enzyme lipase and amylase 6. Computed Tomography ( CT) Scan with contrast dye 7. Abdominal ultrasound -detect gallstones 8. Endoscopic Retrograde cholangiopancreatography - make used of dye 9. Endoscopic Ultrasound - make used of probe 10. Magnetic Resonance Cholangiopancreatography (MRI)

If pancreatitis is due to gallstones, most often the responsible gallstone passes into the intestine spontaneously, and the pancreatitis goes away. Less commonly, a minor surgical procedure is necessary to extract a gallstone that is blocking the pancreatic duct where it drains into the small intestine. An endoscope, with a camera on its end, is passed down the esophagus, through the stomach, and into the small intestine. The entrance of the pancreatic duct into the small intestine can be viewed through the endoscope. A special instrument on the end of the endoscope can then be passed into the pancreatic duct and the gallstone is extracted. Very rarely pancreatitis is severe enough to require surgery, which is usually performed when the pancreas becomes infected. Dead pancreatic tissue is removed, and the area around the pancreas is washed clean. Patients who require such treatment usually have prolonged hospital stays and are seriously ill.

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