Dr.Mohammed Sharique Ahmed Quadri Dr.Mujeeb Ahmed Shaikh PANCREATIC SECRETION Dr.Mohammed Sharique Ahmed Quadri Dr.Mujeeb Ahmed Shaikh

What You Should Know From This Lecture Identify Pancreatic Exocrine Secretions Outline the Composition of pancreatic juice Describe the role of Pancreatic Enzymes & Their Importance Describe the Mechanism of Pancreatic Juice Secretion Explain the pancreatic insufficiency (Steatorrhea) Describe Regulation of Pancreatic Exocrine Secretion

PANCREATIC SECRETION When food comes to small intestine [duodenum], it is mixed with pancreatic secretion and bile [pancreas and liver are accessory digestive organs]. PANCREAS It is mixed gland( exocrine and endocrine) secretion. We will discuss exocrine secretions .

PANCREATIC SECRETION Pancreas is elongated gland that lies behind and below the stomach. Pancreatic exocrine cells forms grapelike cluster of cells forming Acini and ducts. - Pancreatic Acinar cells secrete – digestive enzyme. - Pancreatic duct cells – secrete watery secretion rich in NaHCO3

COMPOSTION OF PANCREATIC JUICE Pancreatic secretion per day is 1 – 2 liters. pH – approximately 8.0 It contains - Water - Cations – Na+, K+, Ca++, Mg++ - Anions – HCO3-, Cl-, SO4, HPO4 - Digestive enzymes

PANCREATIC SECRETION Exocrine Pancreas secretes pancreatic juice. It has two components: 1. Pancreatic enzymes – secreted by Acinar cells. 2. Watery [aqueous] alkaline fluid rich in NaHCO3 actively secreted by duct cells that line the pancreatic ducts.

PANCREATIC SECRETION 1. Pancreatic enzymes The pancreatic enzymes are stored in zymogen granules in acinar cells after they are produced. They are released by exocytosis as needed. Pancreatic enzymes are important because they can completely digest food, in absence of all other digestive secretions.

PANCREATIC SECRETION Pancreas Acinar cell secrete three types of pancreatic enzymes: Photolytic enzymes for protein digestion. Pancreatic amylase for carbohydrate digestion. Pancreatic Lipase for fat digestion. We will discuss one by one.

(i). Pancreatic Proteolytic enzymes PANCREATIC SECRETION (i). Pancreatic Proteolytic enzymes Major Proteolytic enzymes are - Trypsinogen - Chymotrypsinogen - Procarboxypeptidase They are secreted in INACTIVE form.

Pancreatic Proteolytic Enzymes How these Proteolytic enzymes are activated? When Trypsinogen is secreted into the duodenal lumen, it is activated to its active form TRYPSIN by Enterokinase [enteropeptidase], an enzyme which is embedded in the mucus membrane of duodenal mucosa. Trypsin once formed activates more Trypsinogen [autocatalytic].

Activation of trypsinogen Enterokinase Autocatalytic

Activation Pancreatic Proteolytic Enzymes

Pancreatic Proteolytic Enzymes Chymotrypsinogen and Procarboxypeptidase. They are converted to active form by Trypsin in duodenal lumen also. IMPORTANT – We need initially Enterokinase to form trypsin. Once trypsin is formed it carries out further processes.

Pancreatic Proteolytic Enzymes Proteolytic Enzymes [Trypsin, Chymotrypsinogen, Carboxypeptidase] attack different peptide linkages. End result is formation of small peptide chains and amino acids.

(ii). Pancreatic amylase for carbohydrate digestion Pancreatic amylase causes conversion of polysaccharides into disaccharide maltose. Pancreatic amylase is secreted in the Active form as it is not the risk for auto digestion of pancreas.

(iii). Pancreatic Lipase for fat digestion Pancreatic lipase is very important. Why? Because it is the only enzyme secreted throughout the digestive system that can digest fat. NOTE – In human, insignificant amount of lipase are secreted in the saliva and Gastric Juice called Lingual Lipase and Gastric Lipase.

(iii). Pancreatic Lipase for fat digestion Pancreatic lipase hydrolysis dietary triglycerides into Monoglyceride and Free fatty acids, which are absorbed in small intestine. Pancreatic lipase is secreted in Active form as it is not the risk for pancreatic auto-digestion.

Pancreatic insufficiency Clinical Application Pancreatic insufficiency When pancreatic enzymes are deficient, digestion of food is incomplete. As pancreatic lipase is the only significant source for fat digestion, its deficiency results in Maldigestion of fats, resulting in STEATORRHEA [increased undigested fat in feces. Up to 60 – 70% of fat taken maybe excreted in feces.

Pancreatic Insufficiency Digestion of protein and carbohydrate is impaired to a lesser degree because salivary, gastric and small intestine enzymes contribute to their digestion.

2. Pancreatic Aqueous Alkaline Fluid As highly acidic Gastric contents are emptied into the duodenal lumen, this acidic Chyme must be neutralized quickly in the duodenal lumen. Why? - Because to allow the functioning of pancreatic enzymes [they work in neutral or slightly alkaline medium]. NaHco3 in pancreatic fluid neutralizes the acidic Chyme. - Also to prevent damage to duodenal mucosa.

Regulation Or Control Of Pancreatic Exocrine Secretion hormonal and neural mechanism. 1. Mainly by hormonal mechanism – secretin and Cholecystokinin [CCK]. 2. Parasympathetic stimulation – little contribution during cephalic phase. When Chyme enters the duodenum, Two major hormones secretin and CCK [Entrogastrones] are released in response to Chyme.

Regulation Or Control Of Pancreatic Exocrine Secretion We will discuss role of secretin and CCK. SECRETIN Primary stimulus for secretion of secretin is acid in the duodenum. Secretin is carried by blood to the pancreas where it stimulates the duct cells to increase NaHCO3 rich watery secretion in the duodenum. NaHCO3 neutralizes the acid content of Chyme.

Regulation Or Control Of Pancreatic Exocrine Secretion CHOLECYSTOKININ [CCK] CCK is released from duodenal mucosa. Main stimulus for release of CCK is Fat, to a lesser extent protein. CCK is transported by blood to pancreas Acinar cell to increase digestive enzyme secretion. These pancreatic enzymes help to digest fat, protein and carbohydrate. All three types of enzymes [for protein, fat, and carbohydrate] are packed in Zymogen granules together, therefore, all are released together by exocytosis.

Thank you