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2.  Pancreas is a large gland  Involved in the digestive process but located outside the GI tract  Composed of both exocrine and endocrine functions  15-25 cm in length  60-100 gram in weight M. Zaharna Clin. Chem. 2009 2

3.  Two functionally different tissues: o Endocrine (hormone releasing) The smaller component consists of islet of langerhans – 4 cell types Secrete 4 hormones Insulin, glucagon, gastrin & somatostatin o Exocrine (enzyme secreting) The larger component secrets 1.5 – 2 L/day, rich in digestive enzymes has alkaline pH due to its content of NaHCO3 Produced by pancreatic acinar cells M. Zaharna Clin. Chem. 2009 3

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5.  Completes the job of breaking down food using digestive enzymes of pancreas o Protein → trypsin, chymotrypsin o Carbohydrates → amylase o Fats → lipase, lecithinase  Secretes hormones that affect the level of sugar in the blood. o Insulin, glucagon  Produces chemicals that neutralize stomach acids that pass from the stomach into the small intestine o NaHCO 3  Most of the pancreatic action is under the hormonal control of secretin and Cholecystokinin M. Zaharna Clin. Chem. 2009 5

6.  The major disorders of the pancreas are: o Endocrine pancreas: Diabetes Mellitus (DM) Islet Cell Tumors o Exocrine pancreas: Acute pancreatitis & chronic pancreatitis Pancreatic cancer Cystic fibrosis M. Zaharna Clin. Chem. 2009 6

7.  Tumors of the pancreatic islets are rare in comparison with tumors of the exocrine pancreas.  Islet cell tumors of the pancreas affect endocrine capability o If tumor occurs in beta cells → hyperinsulinism → low blood sugar o Alpha cell tumors → ↑ glucagon → DM M. Zaharna Clin. Chem. 2009 7

8.  Inflammation of the pancreas  The exocrine pancreas produces a variety of enzymes, such as proteases, lipases, and saccharidases.  These enzymes start auto-digestion of the pancreas which causes the pain and complications of pancreatitis.  About 80% of cases are associated with cholelithiasis and alcoholism.  Associated with raised levels of pancreatic enzymes (amylase and lipase) in blood and urine. M. Zaharna Clin. Chem. 2009 8

9.  Marked elevation of the serum amylase during the first 24 hours, followed within 72- 96 hours by a rising serum lipase.  Hypocalcemia M. Zaharna Clin. Chem. 2009 9

10.  Carcinoma of the pancreas refers to carcinoma of the exocrine pancreas  Almost always arising from ductal epithelial cells (adenocarcinoma).  Presentation often occurs as a result of metastases rather than as a direct effect of the primary tumor. M. Zaharna Clin. Chem. 2009 10

11.  Tumor markers, include: o carcinoembryonic antigen (CEA), o CA 19-9, o and CA 125,  All are associated with pancreatic cancer but are nonspecific and can be elevated in conditions other than malignancies M. Zaharna Clin. Chem. 2009 11

12.  Cystic fibrosis is an inherited, autosomal recessive disease that affects nearly all exocrine glands in the body.  The disease is characterized by: o chronic obstructive pulmonary disease, o pancreatic insufficiency, o and abnormally high sweat electrolytes.  The disease causes the exocrine glands to become obstructed by viscous material.  The blockage leads to cellular damage within the tissue.  Pancreatic insufficiency leads to poor digestion and poor growth pattern with a deficiency of fat-soluble vitamins. M. Zaharna Clin. Chem. 2009 12

13.  CF is caused by a mutation in the gene for the protein cystic fibrosis transmembrane conductance regulator (CFTR).  This gene is required to regulate the components of sweat, digestive juices, and mucus.  The diagnosis of cystic fibrosis is made by clinical symptoms and positive sweat chloride test.  People with cystic fibrosis have unusually large amounts of chloride in their sweat when compared to reference ranges of healthy individuals.  The sweat is collected on sterile gauze over a period of a few minutes and later analyzed for the amount of chloride present.  Genetic analysis can be used to counsel families for gene carrier status. M. Zaharna Clin. Chem. 2009 13

14.  Detection of malabsorption o Fecal fat test Distinguish between pancreatic dysfunction and intestinal malabsorption o D-xylose absorption test A pentose sugar which does not require pancreatic enzymes for absorption M. Zaharna Clin. Chem. 2009 14

15.  Measuring exocrine function o Secretin, chymotrypsin, trypsin, cholecystokinin  Measuring endocrine function o gastrin, insulin, glucose M. Zaharna Clin. Chem. 2009 15

16.  A 38-year-old man entered the emergency department with the complaint of severe, mid abdominal pain of 6 hours' duration.  The patient had a 15-year history of alcoholism  He had last been hospitalized for acute alcoholism 3 months ago, at which time he had relatively minor abnormalities of liver function.  On this admission, his blood pressure was 80/40 mm Hg; M. Zaharna Clin. Chem. 2009 16

17. Serum amylase640 units (3.5-260 units) Calcium4.0 mEq/L (4.5-5.5 mEq/L) Blood urea nitrogen32 mg/dL (8-25 mg/dL) White blood cell count16,500 Hemoglobin12 g/dL M. Zaharna Clin. Chem. 2009 17 1.What is the probable disease? 2.What is the cause for the low serum calcium? 3.What is the cause for the increased blood urea nitrogen?