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