8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 1/18

ANATOMY OF THE PANCREAS

AND

BILIRUBIN METABOLISM

DR AYOADE O. A

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 2/18

  PANCREAS

• Pan (all); kreas (flesh).

• Exocrine and endocrine organ.

• Retroperitoneal.

• Termed “Most unforgiving organ”. 

• Tremendous reserve capacity.

• 75 - 100gm in weight.

• 15 - 20cm in length.

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 3/18

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 4/18

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 5/18

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 6/18

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 7/18

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 8/18

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 9/18

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 10/18

Sphincter of Oddi ERCP

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 11/18

  FUNCTIONS OF THE PANCREAS

EXOCRINE FUNCTION

1.5 – 2.5L/day of alkaline

 juice ( pH 8.0- 8.3)

Over 20 digestive

enzymes

Amylase – carbohydrate

Protease – proteinLipase – fat

3 phase secretion

Cephalic, Gastric, Intestinal

ENDOCRINE FUNCTION

Over 1 million islet of 

langerhan cells.

4 major cell types

 α - Glucagon

 β - Insulin

 δ - Somatostatin

 ρρ - pancreatic

polypeptide

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 12/18

  BILIRUBIN METABOLISM

Jaundice or icterus  • Yellowish discolouration of 

the skin, mucous

membranes, sclera. 

• Excess plasma bilirubin

• Normal range

– < 1 mg / dl

• Clinically obvious

– > 3 mg / dl

• Not a disease but a Sign.

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 13/18

BILIRUBIN METABOLISM

Heme

 Heme oxygenaseBiliverdin

 Biliverdin reductase

Bilirubin + albumin

UDP glucuronyl transferaseBMG, BDG

 β   glucuronidases

Urobilinogen

 Bacteria enzymesStercobilinogen

Feaces 

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 14/18

• About 4mg/kg of bilirubin produced per day.

• 80% from Hemoglobin.

• 20% from other hemeproteins– myoglobin, cytochromes, catalase, peroxidase.

• Unconjugated bilirubin (aka indirect) is fat soluble andtoxic.

• Bilirubin is excreted in Bile.

• Main constituent of Bile is water , bile acids, bilepigments, cholesterol, phospholipids & all inorganic ionsfound in plasma.

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 15/18

Bile acid metabolism

•  LIVER -The primary bile acids,  chenodeoxycholic & cholic acid are

formed from cholesterol .• INTESTINE - converted to Secondary bile acids  - deoxycholate ,

lithocholate & are absorbed in terminal ileum.

• Main function are:

– Reduction of surface tension (surfactants)

– Emulsification of Fat for easy digestion and absorption

in the small intestine. (Detergents)

– Absorption of Fats and fat soluble vitamins ( A D E K )

– Maintain cholesterol homeostasis.

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 16/18

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 17/18

 

• Pancreas

 –  Sorrounded by the Great vessel and vital organs.

 –  Avascular plane behind its neck 

 –  Coeliac plexus block.

• Bilirubin

 –  80 % from breakdown of RBC

 –  In its unconjugated form is toxic• Bile acids

 –  Obstruction to its flow - malabsorption of fats &vitamins A, D, E, K.

8/2/2019 Anatomy of the Pancreas and Bilirubin Metabolism

http://slidepdf.com/reader/full/anatomy-of-the-pancreas-and-bilirubin-metabolism 18/18