1. Pancreas & diabetes Željka Kušter Mentor: A. Žmegač Horvat

2. Anatomy Retroperitoneal abdominal organ Exocrine and endocrine cells lobules ducts pancreatic duct

4. Exocrine function Acinar cells - exocrine cells of the pancreas that produce and transport digestive enzymes Amylase, lipase, phospholipase, proteases (trypsinogen, chymotrypsinogen)

5. Endocrine function Islets of Langerhans - endocrine cells of the pancreas that produce and secrete hormones into the bloodstream Glucagon - Alpha cells (A cells) - raises the level of glucose (sugar) in the blood Insulin - Beta cells (B cells) - stimulates cells to use glucose Somatostatin - Delta cells (D cells) - regulate the secretion of glucagons and insulin

6. Pancreatitis Inflammation of the pancreas

7. Acute pancreatitis Pancreas suddenly becomes inflamed Causes: Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion venom Hyperlipidaemia, hypothermia ↑Ca 2+ ERCP Drugs

8. Symptoms epigastric and central abdominal pain vomiting and nausea swollen and tender abdomen fever dehydration and low blood pressure Diagnosis medical history and physical exam blood test: ↑ amylase, lipase abdominal ultrasound, EUS, CT scan

9. Treatment nothing to eat or drink intravenous fluids analgesia ERCP and gallstone removal Complications shock, ARDS, renal failure, DIC, sepsis, ↓Ca 2+ pancreatic necrosis, pseudocyst, abscesses, bleeding, thrombosis

10. Chronic pancreatitis inflammation of the pancreas - gets worse over time and leads to permanent damage Causes: many years of alcohol use hereditary disorders of the pancreas cystic fibrosis haemochromatosis autoimmune conditions

11. Symptoms nausea and vomiting weight loss diarrhea steatorrhea Diagnosis medical history and physical exam abdominal ultrasound, CT scan, MRCP, ERCP

12. Treatment drugs - analgesia, lipase, fat-soluble vitamins diet surgery – pancreatectomy pancreaticojejunostomy Complications pseudocyst, diabetes, biliary obstruction, local arterial aneurysm, splenic vein thrombosis

14. Diabetes increased level of glucose in the blood (normal blood glucose level 3.5-6.0 mmol/l) Type 1 ( insulin-dependent DM, IDDM) destruction of insulin-secreting pancreatic β cells juvenile diabetes patient always needs insulin

15. Type 2 (non-insulin dependent DM, NIDDM) insulin resistance Β cell dysfunction, ↓insulin secretion Causes of insulin resistance: metabolic syndrome (central obesity, hyperglycaemia, hypertension, ↓HDL cholesterol, ↑triglycerides) renal failure pregnancy cystic fibrosis polycystic ovarian syndrome

16. Mechanisms of insulin resistance: post-receptor defects in insulin action gene mutation circulating autoantibodies

18. Diagnosis blood glucose level urine sample HbA1c test

19. Treatment: diet oral hypoglycaemics

20. insulin injections (long-acting, short-acting, rapid-acting) insulin pen insulin pump therapy

21. Complications

22. diabetec ketoacidosis hypoglycaemia diabetic retinopathy

23. atherosclerosis (heart disease and stroke) neuropathy (diabetic foot care)

24. Diabetes risk factors Age over 45 years Diabetes during a previous pregnancy Excess body weight Family history of diabetes Dyslipidaemia Hypertension Low activity level Metabolic syndrome Polycystic ovarian syndrome Acanthosis nigricans