Pancreatic Disease Chapters 17 & 20

EXOCRINE PANCREAS:

constitutes 85-90% of the organ exocrine disease overshadowed by endocrine diseasediabetes mellitus

A. Acute pancreatitis: Defined as inflammation with acinar cell injury. 80% of cases caused by gallstones and alcoholism. Damage to organ occurs due to action of pancreatic enzymes released by inflammation. Mortality rate is 20-40% and usually due to shock and sepsis. Of diagnostic value is increased serum levels of lipase and amylase. Not specific for pancreatitis, however.

B. Chronic pancreatitis: May or may not follow acute pancreatitis. Half the people have no specific predisposing risk factors. Patients have repeated bouts of low grade pain. Organ is transformed into a densly fibrotic organ with atrophy of exocrine glands.

C. Carcinoma of the pancreas: Refers to carcinoma arising in the exocrine pancreas. Only known risk factor is smoking. Almost all are adenocarcinomas and involve the head of the organ. Poor prognosis---5% 5 year survival rate. Symptoms appear late in the disease and are often pain and jaundice from obstruction of the biliary tree.

ENDOCRINE PANCREAS: Here, talking about disease of the islets of Langerhans. 70% of the cells are beta-cells which produce insulin.

Diabetes mellitus:

A chronic insulin related disorder that affects carbohydrate, fat and protein metabolism. Traditionally, the disease was divided into Type I and Type II diabetes. In 1997 this distinction was officially abolished but it is still helpful to think of it as 2 types of diseases.

Review of insulin physiology:

Type I vs. Type II-------Pathogenesis: Table 20-6

Type I (often referred to as IA):Figure 20-33 * strong evidence for T-cell mediated immunologic destruction of beta-cells.

* *

genetic and environmental factors (virus?) play a role essentially little or no production of insulin by beta-cells

Type II: * no autoimmune issue * genetic factors more important than in Type I

decreased insulin production coupled with increased peripheral resistance to insulin

strong association with obesity

Clinical manifestations-----Types I and II: Figure 20-25 1. Cardiovascular affects

2. Metabolic affects:

3. Summary: