1. © 2003 Science Press Internet Services FISIOLOGÍA DIGESTIVA (BCM II) Clase 16- Páncreas Dr. Michel Baró A.

2. © 2003 Science Press Internet Services Major discoveries in pancreatic exocrine physiology

3. © 2003 Science Press Internet Services Physiologic function of the pancreas

4. © 2003 Science Press Internet Services Pancreatic exocrine secretion sólido líquido

5. © 2003 Science Press Internet Services Pancreatic control system

6. © 2003 Science Press Internet Services Overview of the pancreatic gland Insulina Glucagón Somatostatina Polipéptido pancreático 10% 80%

7. © 2003 Science Press Internet Services Electron micrographs of pancreatic acinar cells (a) RER Golgi Vacuolas Condensantes Gránulos Zimógeno Lumen (estímulo)

8. © 2003 Science Press Internet Services Electron micrographs of pancreatic acinar cells (b)

9. © 2003 Science Press Internet Services Overview of the neural innervation of the pancreas ACTH VIP GRP Neurotransmisores: T5 – T9 Inerva: vasos sanguíneos Ganglios Fibras dolorosas (sensorio-motor) + señales del Plexo mientérico

10. © 2003 Science Press Internet Services Overview of the duodenum I S Aferentes vagales que responden a pH, aminoácidos, lípidos Expresan receptores de CCK y secretina.

11. © 2003 Science Press Internet Services Feedback: control mechanisms

12. © 2003 Science Press Internet Services Sensation and amplification

13. © 2003 Science Press Internet Services Neurohormonal control of pancreatic bicarbonate secretion

14. © 2003 Science Press Internet Services The vagus and bicarbonate secretion

15. © 2003 Science Press Internet Services Cholecystokinin and pancreatic secretion (Tirosina Sulfatada en pos.7 ) Receptores CCK-A (alimentary) CCK-B (brain) -COOH

16. © 2003 Science Press Internet Services Origin of cholecystokinin (a) Origen: Cel. Endocrinas intestinales (I) Neuronas SNC y SNE Neuronas del Páncreas lumen

17. © 2003 Science Press Internet Services Origin of cholecystokinin (b) Lumen intestinal apical basal

18. © 2003 Science Press Internet Services Actions of cholecystokinin Enzimas Bicarbonato

19. © 2003 Science Press Internet Services Neurohormonal control of digestive enzyme secretion

20. © 2003 Science Press Internet Services Cholecystokinin and pancreatic enzyme secretion

21. © 2003 Science Press Internet Services Cholecystokinin receptors and afferent vagal fibers

22. © 2003 Science Press Internet Services Modifying mechanism controlling pancreatic secretion amplificación

23. © 2003 Science Press Internet Services Duodenal release of cholecystokinin

24. © 2003 Science Press Internet Services Neurohormonal feedback system controlling enzyme secretion

25. © 2003 Science Press Internet Services Most fundamental work came from work of Pavlov and students

26. © 2003 Science Press Internet Services Inhibitory neuromodulators

27. © 2003 Science Press Internet Services Role of inhibitory peptides and impairing their action +30-40% sin inhibidores

28. © 2003 Science Press Internet Services Somatostatin inhibits pancreatic secretion

29. © 2003 Science Press Internet Services The somatostatin receptor agonist, octreotide

30. © 2003 Science Press Internet Services Pancreatitis aguda

31. © 2003 Science Press Internet Services Etiologic classification of acute pancreatitis

32. © 2003 Science Press Internet Services Obstructive causes of acute pancreatitis

33. © 2003 Science Press Internet Services Toxins causing acute pancreatitis

34. © 2003 Science Press Internet Services Drugs that can cause acute pancreatitis

35. © 2003 Science Press Internet Services Metabolic causes of acute pancreatitis

36. © 2003 Science Press Internet Services Inherited forms of acute pancreatitis

37. © 2003 Science Press Internet Services Infectious causes of pancreatitis

38. © 2003 Science Press Internet Services Vascular causes of pancreatitis

39. © 2003 Science Press Internet Services Traumatic causes of acute pancreatitis

40. © 2003 Science Press Internet Services Biliary drainage of idiopathic acute pancreatitis

41. © 2003 Science Press Internet Services Summary of main etiologies for acute pancreatitis

42. © 2003 Science Press Internet Services Pathogenetic sequence of acute pancreatitis

43. © 2003 Science Press Internet Services

45. Possible pathogenetic sequence of acute pancreatitis

46. © 2003 Science Press Internet Services Pathology of acute interstitial pancreatitis

47. © 2003 Science Press Internet Services Pathology of necrotizing pancreatitis

48. © 2003 Science Press Internet Services Fat necrosis

49. © 2003 Science Press Internet Services Pathology of necrotizing/hemorrhagic pancreatitis

50. © 2003 Science Press Internet Services Diagnosis of acute pancreatitis

51. © 2003 Science Press Internet Services Serum C reactive protein levels in acute pancreatitis

52. © 2003 Science Press Internet Services Trypsinogen activation peptide levels in acute pancreatitis

53. © 2003 Science Press Internet Services Peritoneal aspirates in acute pancreatitis

54. © 2003 Science Press Internet Services Dynamic computed tomography scan of the pancreas

55. © 2003 Science Press Internet Services Local and systemic complications of acute pancreatitis

56. © 2003 Science Press Internet Services Scan of pancreas indicating gas bubbles within pancreas

57. © 2003 Science Press Internet Services Major causes of death in acute pancreatitis delineated

58. © 2003 Science Press Internet Services Infected necrosis can occur within first week of illness

59. © 2003 Science Press Internet Services Severe necrosis

60. © 2003 Science Press Internet Services Pseudocysts (A)

61. © 2003 Science Press Internet Services Pancreatitis crónica

62. © 2003 Science Press Internet Services Marseilles-Rome classification

63. © 2003 Science Press Internet Services Classification by etiology

64. © 2003 Science Press Internet Services Classification by pancreatic duct morphology

65. © 2003 Science Press Internet Services Pathophysiology (A) OH: consumo excesivo por 6 a 12 años Efecto tóxico directo cel. acinares? Excesiva estimulación secretora? Interferencia flujo proteínas intracelular? Formación de trombos proteicos ductales (litostatina)?

66. © 2003 Science Press Internet Services Pathophysiology (B)

67. © 2003 Science Press Internet Services Histology (A) normal islotes acinos

68. © 2003 Science Press Internet Services Histology (B) Destrucción de acinos Fibrosis islotes Pancreatitis crónica

69. © 2003 Science Press Internet Services Steatorrhea and diabetes mellitus (A)

70. © 2003 Science Press Internet Services Steatorrhea and diabetes mellitus (B)

71. © 2003 Science Press Internet Services Tests of structure: plain abdominal radiograph Idiopática: 20-40%, Alcohólica 70%, (a los 15 años)

72. © 2003 Science Press Internet Services Tests of function: simple markers

73. © 2003 Science Press Internet Services Natural history

74. © 2003 Science Press Internet Services Basis for pain relief by reducing pancreatic secretion (A)

75. © 2003 Science Press Internet Services Basis for pain relief by reducing pancreatic secretion (B)

76. © 2003 Science Press Internet Services Octreotide: reducing pancreatic secretions, relieving pain

77. © 2003 Science Press Internet Services Enzyme use for pain

78. © 2003 Science Press Internet Services Steatorrhea and diabetes