ENDOCRINE SYSTEMPancreatic Anatomy Located in the retroperitoneal space of the upper abdomen, behind the stomachhttp://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/17194.jpgAnatomy & Physiology Closely attached to other retroperitoneal structures Ganglia and nerves of the celiac plexus Has an exocrine and endocrine portion Exocrine – secretes (main source) digestive enzymes Those that break down starch, lipids, proteins Endocrine – secretes hormones Insulin, glucagon, somatostatinPhysiology Alpha cells secrete glucagon (20%) Increases BG levels by stimulating liver and other cells to release stored glucose Beta cells secrete insulin (70%) Lowers BG levels by facilitating entrance of glucose into the cells for metabolism Delta cells secrete somatostatin (10%) Believed to regulate release of insulin and glucagonMajor DiseasesAcute Pancreatitis Tissue necrosis caused by digestive enzymes being released and activated prematurely Accompanied by edema and hemorrhage Etiology Medications Viral infections Pancreatic surgeryAcute Pancreatitis Clinical Manifestations Peritonitis Caused by leakage of digestive enzymes into abdominal cavity Pseudocyst and abscess formation Capsule of both structures becomes fibrotic with time Progression to chronic pancreatitis Peritoneal rigidity Accompanied by paralytic ileusAcute Pancreatitis Clinical Features Abdominal pain & distention Nausea & vomiting AnxietyAcute Pancreatitis Treatment Prevent damage and systemic consequences of shock Eliminate cause of pancreatitis Prognosis Can cause heart, lung, kidney failure and lead to death 20% mortality rate Consequence of shock Mortality rate increases with older patients with multiple co-morbiditiesChronic Pancreatitis Fibrosis replaces pancreatic parenchyma Irreversible, progressive Produce endocrine and exocrine pancreatic insufficiency Etiology/Pathogenesis Related to alcohol abuse Cystic fibrosis HeredityChronic Pancreatitis Clinical Features Pain Malabsorption Weight loss, weakness Signs of DM Destruction of islets of LangerhansPancreatic Cancer Risk factors thought to be: Tobacco use Previous intestinal surgery DM Chronic pancreatitis Poor prognosis Incurable…detected too late Clinically silent without warning signs Metastases occur early in diseasePancreatic Cancer Symptoms are non specific Weight loss Loss of appetite Nausea Vomiting JaundiceDiabetes Mellitus (DM) There are 23.6 million children and adults in the United States, or almost 8% of the population, who have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, unfortunately, 5.7 million people (or nearly one quarter) are unaware that they have the diseaseDiabetes Mellitus Group of systemic, metabolic diseases characterized by chronic hyperglycemia Resulting from defect in insulin secretion, insulin action or both Causing disturbances in carbohydrates, protein, and fat metabolism Chronic hyperglycemia is associated with long-term damage, dysfunction, and failure of various organs Eyes, kidney, nerves, heart and blood vesselsDiabetes Mellitus IDDM (Type I) Pancreatic beta cell destruction, usually leading to absolute insulin deficiency Etiology Autoimmune Viral Genetic Environmental IdiopathicDiabetes Mellitus IDDM (Type I) Symptoms tend to occur suddenly Individual usually <20 y/o (onset) Normal or thin Treatment Insulin Diet ExerciseDiabetes Mellitus NIDDM (Type II) More prevalent form Insulin produced, but the insulin produced is ineffective and resistant to action on a cellular level or the amount produced is not sufficient Risk factors Age Obesity (and/or increased % age of central body fat distribution) Lack of exercise GeneticsDiabetes Mellitus NIDDM (Type II) Symptoms tend to develop over a period of time Individual usually >40 y/o (onset) Obese (80%) Treatment Oral hypoglycemic agents Diet Exercise Weight control InsulinDiabetes Mellitus ClassificationStageFasting Blood GlucoseOral Glucose Tolerance TestNormal<100mg/dL<139mg/dLPre-Diabetes100-125mg/dL140-199mg/dLDiabetes>125mg/dL>200mg/dLDiabetes Mellitus Cardinal signs of DM Polyuria – excessive urination Polydipsia – excessive thirst Polyphagia – excessive hunger (type I only) Weight loss (type I only) Recurrent blurred vision Ketonuria (type I only) Weakness, fatigue, dizziness Often asymptomaticDiabetes Mellitus Hyperglycemia Thirst Polyuria and volume loss Dehydration Lethargy/confusion Seizures Coma Blood glucose level >300 mg/dLDiabetes Mellitus Hypoglycemia Shakiness Dizziness Sweating Hunger Headache Pale skin color Sudden moodiness or behavior changes; irritability Clumsy or jerky movements Seizure Difficulty paying attention, or confusion Tingling sensations around the mouth Blood glucose level <70mg/dLDiabetes Mellitus Diabetic ketoacidosis (DKA) Occurs when there is too little insulin in the body Without insulin, cells cannot use glucose for energy Instead the body breaks down fat and muscle for energy In effect, ketones (fatty acids) are produced and enter blood stream Cause metabolic acidosis because of ketone build up Primarily in IDDM Can be first sign of diabetes! Life threatening!Diabetes Mellitus Diabetic ketoacidosis (DKA) Etiology – any condition that increases the insulin deficit in a person with diabetes Not taking enough insulin under stressful conditions Severe infection or illness Dehydration Alcohol abuse Stroke Renal failure Combination of aboveDiabetes Mellitus Thirst or a very dry mouth Frequent urination High blood glucose (sugar) levels High levels of ketonesin the urine Constantly feeling tired Dry or flushed skin Nausea, vomiting, or abdominal pain A hard time breathing (short, deep breaths) Fruity odor on breath A hard time paying attention, or confusion Diabetic ketoacidosis (DKA) (Type I only) – Symptoms:Diabetes Mellitus – Lifetime Changes Atherosclerosis Begins earlier and more extensive Increased risk for CAD, MI, CVA, PVD Due to the hyperglycemia and increased
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