ANATOMY OF THE PANCREAS AND BILIRUBIN METABOLISM

DR AYOADE O. A

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.

Sphincter of Oddi

ERCP

FUNCTIONS OF THE PANCREAS

EXOCRINE FUNCTION ENDOCRINE FUNCTION

1.5 2.5L/day of alkaline juice ( pH 8.0- 8.3) Over 20 digestive enzymes Amylase carbohydrate Protease protein Lipase fat 3 phase secretion Cephalic, Gastric, Intestinal

Over 1 million islet of langerhan cells. 4 major cell types - Glucagon - Insulin - Somatostatin - pancreatic polypeptide

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.

BILIRUBIN METABOLISM
Heme
Heme oxygenase

Biliverdin
Biliverdin reductase

Bilirubin + albumin
UDP glucuronyl transferase

BMG, BDG
glucuronidases

Urobilinogen
Bacteria enzymes

Stercobilinogen Feaces

 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 and toxic. Bilirubin is excreted in Bile. Main constituent of Bile is water , bile acids, bile pigments, cholesterol, phospholipids & all inorganic ions found in plasma.

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.

 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.