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Chapter 13
Disorders of the Pancreas
The Nature of Disease:
Pathophysiology for the Health Professions, 2nd ed.
Thomas H. McConnell
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
NORMAL PANCREATIC PHYSIOLOGY
• The exocrine pancreas excretes digestive juice into the
intestine.
–
Protease secreted as inactive enzyme (zymogen)
–
Lipase and amylase secreted as active enzyme
• The endocrine pancreas excretes hormones into blood.
–
Alpha cells: glucagon. Functional opposite of insulin,
stimulates liver glycogen >> glucose. Raises blood glucose
–
Beta cells: insulin. Opens cell membrane to glucose. Lowers
blood glucose
–
Delta cells: somatostatin. Inhibits glycogen formation and
insulin secretion. Raises blood glucose
–
PP cells: pancreatic polypeptide, acts on stomach to stimulate
juices and slow intestinal motility
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Figure 13.1 The pancreas and its anatomic
relationships
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Figure 13.2 Anatomic detail of the
pancreas
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Figure 13.3 Glucose, glycogen, insulin,
and glucagon metabolism
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PANCREATITIS
• Acute pancreatitis causes reversible injury.
– Chronic alcohol abuse causes 2/3 of cases.
– Half of patients have gallstones.
• Chronic pancreatitis is associated with irreversible
pancreatic injury.
– Repeated bouts of acute pancreatitis
– Chronic alcohol abuse causes 2/3 of cases.
– Half of patients have gallstones.
– 5% of patients with stones develop pancreatitis.
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Figure 13.4 The pathogenesis of acute
pancreatitis
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Figure 13.5 Acute pancreatitis
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Figure 13.6 Acute hemorrhagic
pancreatitis
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Figure 13.7 The consequences of
pancreatitis
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Figure 13.8 Gross anatomy of chronic
pancreatitis
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Figure 13.9 Complications of chronic
pancreatitis
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DIABETES
• Diabetes mellitus is not a single disease entity.
– Euglycemia, prediabetes, diabetes
• Type I diabetes is an autoimmune disease.
– 10% of cases, less genetic influence, normal peripheral cell
insulin sensitivity, rapid teen onset, decreased beta cells,
low blood insulin, not obese, difficult glucose control,
ketoacidosis common
• Type II diabetes is a multifactorial disease.
– 90% of cases, more genetic influence, decreased
peripheral cell insulin sensitivity, slow adult onset, obese,
normal beta cells, normal to high blood insulin, glucose
control easier, ketoacidosis uncommon
– Other causes: pregnancy, steroid Rx
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DIABETES—(cont.)
• The complications of diabetes are mainly caused by
hyperglycemia.
– Glycoproteins >> accelerate atherosclerosis, cause
diabetic microangiopathy, retinal and kidney disease
• The diagnosis of diabetes should be made according to
established criteria.
• Treatment of diabetes depends on calorie and insulin
management.
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Figure 13.10 Comparison of age
distribution in Type I and Type II diabetes
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Table 13.1 Diabetes Types I/II Compared
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Figure 13.11 The pathogenesis of Type I
diabetes
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Figure 13.12 The pathogenesis of Type II
diabetes
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Figure 13.13 Metabolic derangements in
diabetes
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Figure 13.14 Long-term complications of
diabetes
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Figure 13.15 Diabetic nephrosclerosis
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Figure 13.16 Diabetic retinopathy
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PANCREATIC NEOPLASMS
• Cystic neoplasms are uncommon and usually
benign.
• Pancreatic carcinoma is common and lethal.
• Islet cell tumors are usually benign and
functional.
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Figure 13.17 Pancreatic carcinoma
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Figure 13.18 Complications of carcinoma
of the pancreas
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