Clinica Pancreas

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  • 1. Profa. Dra. Cristina Maria Henrique Pinto Profa. Adjunto do Depto. Cincias Fisiolgicas-CCB-UFSC Como citar este documento: PINTO, Cristina Maria Henrique. Fisiologia do Sistema Digestrio e aplicaes clnicas. Disponvel em: . Acesso em: (coloque a data aqui) Fisiologia do Sistema Digestrioe aplicaes clnicas

2. Esta apresentao foi utilizada em minhas aulas para a graduao em Medicina (6 fase) at o ano de 2007. Para que este material no se perca, deixo aqui disposio daqueles que eventualmente tenham interesse. Bons estudos! 3. Bibliografia bsica recomendada sobreFisiologia Humana Livros-textos: Berne & Levy: Fisiologia Koeppen & Stanton, 2009,6 Ed. (Ed. Elsevier) Tratado de Fisiologia MdicaGuyton & Hall, 2006,11 Ed. (Ed. Elsevier) Fisiologia Aires, M. M. 2008, 3 Ed.(Ed. Guanabara Koogan) Fisiologia Costanzo, 2007,3 Ed.(Ed. Elsevier) Berne & Levy: Fundamentos de Fisiologia, Levyet al , 2006, 4 Ed. (Ed. Elsevier) Fundamentos de Fisiologia MdicaJohnson, 2003 (Ed. Guanabara Koogan) Fisiologia: texto e atlasSilbernagl e Despopoulos, 2003 (Ed. Artmed) 4. Profa. Dra. Cristina Maria Henrique Pinto CFS/CCB 6 fase - Medicina O Pncreascomo glndula excrina 5. Figure 3. The pancreas and adjacent anatomy.divises: cabea e processo uncinado, colo, corpo e cauda http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&organ=4&disease=22&lang_id=1 PNCREAS localizao: -rgo retroperitoneal. -anteriores a ele esto o estmago, alas do intestino delgado, colon e omento 6. Duct system of the pancreas. Berne et al., 2004 Ducto pancretico principal formado a partir dos ductos intercalares, intralobares extralobares e ductos coletores principais 7. Ducto pancretico: -desde a cauda at a cabea do pncreas -une-se ao ducto coldoco j prximo ao duodeno, formando a ampola hepatopancretica e a papila maior doduodeno ( ou ampola de Vater ). http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&organ=4&disease=22&lang_id=1 comum a existnciade umducto pancretico secundrio , acessrio ou dorsal (papila menor) 8. Normally (90% of the time) pancreatic secretions from the entire pancreas and biliary secretions gain access to the duodenum by way of the ventral pancreatic or Wirsungs duct because of the fusion of the dorsal pancreatic duct during embryological development. There is only a remnant of the dorsal pancreatic or Santorinis duct connecting to the duodenum. In 10% of individuals, fusion does not occur. This situation is called pancreas divisum. In pancreas divisum secretions from the dorsal and ventral ducts drain separately into the duodenum. Individuals with pancreas divisum may be at higher risk for pancreatitis (see Acute Pancreatitis for additional information). Note that the distal common bile duct reaches the duodenum through the head of the pancreas. http://www.gastroslides.org/main/browse_deck.asp?tpc=2&mxpg=390&pg=1844#image DUCTO PANCRETICO PRINCIPAL EDUCTO PANCRETICO ACESSRIO(ocorrncia em 90% da populao) 9. This figure demonstrates that the stomach, duodenum, liver, biliary system, gallbladder and pancreas are derived from closely related structures in early embryological development. The pancreas, liver, gallbladder and biliary system bud from the duodenum during early embryological development. The pancreas starts as two components, the ventral and dorsal pancreas. In the process of development, the organs enlarge and the ventral pancreas together with the common bile duct rotates. Then, in most cases, the pancreatic duct from the dorsal pancreas fuses with the pancreatic duct from the ventral pancreas to form the main pancreatic duct. After fusion the pancreatic secretions from the entire pancreas and biliary secretions gain access to the duodenum by way of the ventral pancreatic duct. http://www.gastroslides.org/main/browse_deck.asp?tpc=6&mxpg=390&pg=2233#image EMBRIOLOGIA 10. Normally (90% of the time) pancreatic secretions from the entire pancreas and biliary secretions gain access to the duodenum by way of the ventral pancreatic or Wirsungs duct because of the fusion of the dorsal pancreatic duct during embryological development. There is only a remnant of the dorsal pancreatic or Santorinis duct connecting to the duodenum. In 10% of individuals, fusion does not occur. This situation is called pancreas divisum. In pancreas divisum secretions from the dorsal and ventral ducts drain separately into the duodenum. Individuals with pancreas divisum may be at higher risk for pancreatitis (see Acute Pancreatitis for additional information). Note that the distal common bile duct reaches the duodenum through the head of the pancreas. http://www.gastroslides.org/main/browse_deck.asp?tpc=2&mxpg=390&pg=1844#image DUCTO PANCRETICO PRINCIPAL EDUCTO PANCRETICO ACESSRIO(ocorrncia em 90% da populao) PANCREAS DIVISUM (ocorrncia em 3 a 7% da pop.) 11. http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&organ=4&disease=22&lang_id=1 -a mais comum anomalia congnita do pncreas -ocorre em 3 a 7% da populao -resulta em fuso incompleta ou inexistente dos brotos dorsal e ventraldurante o desenvolvimento embrionrio. As regies da cauda, corpo, colo e pequena poro da cabea tm suas secrees drenadas para o duodeno atravs da papila menorvia ducto acessrio . Obstrues na papila menor podem causar pancreatite aguda (drenagem insuficiente). Oducto pancretico principalque esvazia-se na papila duodenal maior, drena apenas uma pequena poro da secreo excrina pancretica (poro ventral). CAUSA de pancreatite Pancreas divisum(oupncreas dividido ) 12. http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&organ=4&disease=22&lang_id=1 Esfncter de Oddi: clulas musculares lisas que envolvem a poro terminal dos ductos biliar comum e pancreticoprincipal. uma estrutura dinmica que relaxa ou contrai, alterando as dimenses da papila maior duodenal 13. http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&organ=4&disease=22&lang_id=1 Figure 7. Gallstone obstruction.-uma das mais causas comuns de pancreatite(USA e pases europeus) -baixa mortalidade -mecanismos causais ainda no totalmente entendidos -obstruo causaria refluxo biliar nas vias pancreticas o que desencadearia umacomplexa cascata de efeitos(p. ex. ativao da tripsinanos cinos e/ou induo de resposta inflamatria). CAUSA de pancreatite aguda Colelitase 14. The pancreas is divided into an exocrine portion (acinar and duct tissue) and an endocrine portion (islets of Langerhans). The exocrine portion, comprising 85% of the mass of the pancreas, secretes digestive enzymes, water and NaHCO3 into the duodenum. The endocrine portion, comprising 2% or less of the pancreas, secretes hormones into the blood stream. http://www.gastroslides.org/main/browse_deck.asp?tpc=6&mxpg=390&pg=2240#image O PNCREAS: UMA GLNDULAENDCRINAEEXCRINA 15. ? VOLUME SECRETADO PELO PNCREAS NO INTESTINO DELGADO: 1,5 L/DIA 16. secreo hidro-eletroltica enzimas digestivas (proteases, amilase e lipases) Principais tipos celulares encontrados no pncreas Ilhotas de Langerhans hormnios: insulina (cl. ), glucagon (cl. ),somatostatina (cl. ) e polipeptdeo pancretico (cl. ) 17. ilhota (clulas alfa: glucagon) ilhota (clulas beta: insulina) cinos e ilhota de Langerhans http://www.udel.edu/Biology/Wags/histopage/histopage.htm HISTOLOGIA DO PNCREAS PORO ENDCRINA(hormnios: glucagon, insulina, somatostatina e polipeptdeo pancretico) PORO EXCRINAenzimas e secreo hidroeletroltica http://www.gastroslides.org/main/browse_deck.asp?tpc=6&mxpg=390&pg=2241#image 18. The relationships and major features of the units of the exocrine pancreas. The pancreatic acinar cells of the acinus have prominently stained zymogen granules in the apical area of the cell. The connecting ductule does not contain zymogen granules. The blue cell in the cartoon depicts the centroacinar cell at the border between the acinus and ductule. The centroacinar cell functions similarly to the duct cell. The major secretory products of the acinus are digestive proenzymes and enzymes with lesser amounts of water and ions. The major secretory products of the duct are water and ions. http://www.gastroslides.org/main/browse_deck.asp?tpc=6&mxpg=390&pg=2243#image AS SECREES EXCRINAS PANCRETICAS:gua e eletrlitos 19. Neutralization of gastric acid delivered to the duodenum is necessary for optimal digestion and absorption of a meal. Several mechanisms that are not shown are involved in the neutralization process. First, the meal provides buffers from digestion of protein and triglycerides. That is, the peptides and fatty acid products act as pH buffers. Another neutralization process is absorption of hydrogen ion by the duodenal mucosa. Finally, the pancreas, biliary system and duodenal mucosa secrete bicarbonate into the duodenal lumen for neutralization.http://www.gastroslides.org/main/browse_deck.asp?tpc=6&mxpg=390&pg=2287#image Importncia da secreo hidroeletroltica pancretica, rica em HCO 3 - , Na +e gua na digesto NaHCO 3+ HClNaCl + H 2 O + CO 2(reabsoro) 20. Secreo hidroeletroltica pancretica: grande volume e rica em Na +e HCO 3 - 21. Stimulation (i.e. a meal) there is an increase in the flow rate of pancreatic secretions. Furthermore, with increasing flow rates there is a dramatic change in the concentrations of chloride and bicarbonate. The increase in bicarbonate concentration results in a secretion that is alkaline. The bicarbonate ion comes from ductal epithelial cells in the pancreas. In contrast to acinar cells, the ducts secrete a large volume of fluid with a high concentration of bicarbonate. Because the volume of secretion from the acinar cells is thought to be small compared to ductal secretion, with increasing stimulation of the pancreas the concentration of ions approaches that of the duct