Cc lab

• Pancreas


  • Elongated, tapered organ located across the back of the abdomen, behind the stomach
  • Right side (head) lies in the curve of the duodenum
  • Tapered left side (body) extends slightly upward and ends near the spleen (tail)
• Endocrine function


  Hormone releasing function, composed of islets of Langerhans (Alpha, Beta & Delta cells)
• Alpha cells


  • Capable of secreting glucagon (hyperglycemic)
• Beta cells


  • Capable of secreting insulin (only hypoglycemic hormone in the body), major cell group in the pancreas
• Delta cells


  • Capable of secreting somatostatin
• Exocrine function


  Enzyme secreting function, could secrete about 1.5 to 2 liters per day, digestive in nature
• Pancreatic fluid


  Clear/Colorless watery fluid appearance with pH of 7.3 (basic or alkaline)
• Digestive enzymes


  Capable of digesting the 3 major classes of food substances (proteins, carbohydrates, and fats)
• Secretin


  Synthesized in response to the acidic contents of the stomach reaching the duodenum
• Cholecystokinin (CCK)


  Formerly known as pancreozymin, produced by the cell of the intestinal mucosa in the presence of fats or amino acids in the duodenum, responsible for the release of enzymes from the acinar cells by the pancreas into the pancreatic fluid
• Gastrin


  The most potent stimulus to gastric secretion, secreted by specialized G cells in the gastric mucosa and the duodenum in response to vagal stimulation, hormone that stimulates the secretion of gastric acid by parietal cells of the stomach and aids in gastric motility
• Pepsin


  Group of relatively weak proteolytic enzymes, with pH from about 1.6-3.6, catalyze the catabolism or breaking down of all native proteins except mucus
• Diabetes Mellitus (DM)


  Disease that affects the capacity of the body to utilize the glucose in the body, impaired insulin receptor/activity function, hyperglycemia
• Types of Diabetes Mellitus

  • Type 1 (Insulin dependent, ketosis prone, juvenile onset, more severe, absolute insulin deficiency, slender built, active lipolysis, associated with autoimmune disorder, insulin injection: therapeutic agent)
  • Type 2 (Formerly non-insulin dependent, adult onset, fat built/obese, associated with genetic syndrome, more common, oral hypoglycemic agent: therapeutic agent)
  • Type 3 (Candidate type, associated with brain and central nervous system, insulin resistance in brain, seen in Alzheimer's disease)
• Cystic Fibrosis


  Disease of exocrine gland, a.k.a "fibrocystic disease of the pancreas and mucoviscidosis", could also affect the skin, causes the small and large ducts and the acini to dilate and convert into small cyst filled with mucus, resulting in the prevention of pancreatic secretions, eventually blocks the lumen of the bowel leading to obstruction, inherited condition, gene responsible is Cystic Fibrosis Transmembrane Conductance regulator gene (CFTR) located at chromosome 7
• Pancreatic Carcinoma


  The 4th most frequent form of fatal cancer, slightly more common in males than females, signs: development of jaundice, weight loss, anorexia, nausea
• Gastrinoma


  Pancreatic cell tumors which overproduce gastrin, excessive gastrin can cause Zollinger-Ellison Syndrome
• Islet Cell Tumors


  Affect the endocrine capability of the pancreas, if the tumor occurs in beta cells results in hyperinsulinism and low blood glucose levels followed by hypoglycemic shocks (Insulinoma), pancreatic cell glucagon-secreting tumors: hypersecretion of glucagon is associated with DM
• Pancreatitis


  Inflammation of the pancreas caused by autodigestion of the pancreas as a result of reflux of bile or duodenal contents into the pancreatic duct, pathologic changes: acute edema, cellular infiltration, intra and extrahepatic pancreatic fat necrosis
• Acute Pancreatitis


  • No permanent damage to the pancreas
• Chronic Pancreatitis


  • Irreversible damage/injury into the pancreas
• Acute Pancreatitis Etiologic Factors

  • Mumps
  • Obstruction of biliary duct
  • Gallstones
  • Pancreatic tumors
  • Tissue injury
  • Atherosclerotic disease
  • Shock
  • Pregnancy
  • Hypercalcemia
  • Hereditary pancreatitis
  • Immunologic factors associated with postrenal transplantation and hypersensitivity
• Chronic Pancreatitis Etiologic Factors

  • Similar to acute, but chronic excessive alcohol consumption appears to be the most common predisposing factor
• Steatorrhea


  Failure to digest or absorb fats, renders a "greasy" appearance to feces, causes: malabsorption syndrome, parasitic infection, increased fatty food consumption
• Secretin/Cholecystokinin Test


  Direct determination of the exocrine secretory capacity of the pancreas, involves intubation of the duodenum without contamination by gastric fluid, performed after 6 hours or overnight fasting
• Fecal Fat Analysis


  Fecal lipids derived from 4 sources: unabsorbed ingested lipids, lipid secreted into the intestine, cells shed into the intestine, metabolism of intestinal bacteria, normal 1-4 g of lipid in feces/24 hour, not excreted about 7g / 24 hour, composition: 60% fatty acids, 30% sterol, iron alcohol & keroteroids, 10% triglycerides, cholesterol & phospholipids
• Qualitative Screening for Fecal Fat


  • Sudan 3
  • Sudan 4
  • Oil Red O or Nile Blue Sulfate
• Sudan Staining for Fecal Fat

  Yellow orange to red (color of neutral fats & other lipids when stained), normal feces can have up to 40 or 50 small (1-5mm) neutral lipid droplets per hpf, steatorrhea characterized by an increase in the number and size of stainable droplets often with some fat globules in the 50 to 100 mm range
• Sweat Electrolyte Determination


  Useful for Cystic Fibrosis diagnosis, measurement of the sodium and chloride concentration in sweat, sweat inducing drug: pilocarpine, sweat chloride concentrations >60 mmol/l are diagnostic of CF in children, 99% of patients with cystic fibrosis have elevated sodium and chloride
• Serum Enzymes


  Amylase is the serum enzyme most commonly relied on for detecting pancreatic disease, particularly useful in the diagnosis of acute pancreatitis, amylase increases within a few hours after the onset of acute pancreatitis, peak of amylase is 24 hours normalizes in 3-5 days
• Gastric Analysis


  Widely used in clinical medicine but now has been replaced by fiberoptic endoscopy and improved radiologic procedures, used clinically mainly to detect hypersecretion characteristic of the Zollinger-Ellison Syndrome, normal gastric fluid appears: translucent, pale gray, and slightly viscous, and often has a faintly acrid odor, normal volume should not exceed 75 ml, presence of food particles is abnormal (indicates obstruction in GIT)
• Lactose Tolerance Test


  Was used to establish lactose intolerance, but the test is subject to many-false positive and false-negative results, replaced by "hydrogen breath test"
• 1. Xylose Absorption Test


  Pentose sugar that is ordinarily not present in the blood in any significant amount, normal and easily absorbed by the small intestine, the ability to absorb D-XYLOSE is of value in differentiating malabsorption of intestinal etiology from exocrine pancreatic insufficiency, low or absent in urine = D-xylose is not absorbed
• Hormones produced by the reproductive glands (gonads)


  • Testosterone
  • Estrogen
• Testosterone


  A steroid hormone from the androgen group found in mammals, reptiles, birds, and other vertebrates
• Testosterone


  • Primarily secreted in the Leydig cells of the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands
  • The principal male sex hormone and an anabolic steroid
  • Plays a key role in the development of male reproductive tissues and promoting secondary sexual characteristics
  • Essential for health and well-being as well as the prevention of osteoporosis
  • Adult human males produce about ten times more testosterone than adult human females, but females are more sensitive to the hormone
  • Levels demonstrate circadian pattern and peak at the time of awakening (7AM), fall to their lowest level at 8PM
• Anabolic effects of testosterone

  Growth of muscle mass and strength, increased bone density and strength, and stimulation of linear growth and bone maturation
• Androgenic effects of testosterone

  Maturation of the sex organs, particularly the penis and the formation of the scrotum in the fetus, and after birth (usually at puberty) a deepening of the voice, growth of the beard and axillary hair
• Testosterone effects by age of occurrence

  • Prenatal
  • Early infancy
  • Pre-peripubertal
  • Pubertal
  • Adult
• Prenatal androgen effects


  Genital virilization, Development of prostate and seminal vesicles, Gender identity