Pancreatic, Liver and Intestinal Functions

Pancreatic and Liver
Functions
Dr.K.Ananda kumar,M.D.
Secretary functions of Pancreas
Pan=all
Creas=soft
Pancreas contains a head, body and a tail.
It has two portions
1.Endocrine
2.Exocrine
Composition of pancreatic juice
Daily secretion:1.5 liters.
PH=8.5
Inorganic substances:
Hco3-
Cl- (Inversely related to Hco3- concentration)
Na+
K+
Pancreatic juice(organic)
 Organic constituents
Mucus
Enzymes
Trypsin inhibitor
Enzymes:
Proteolytic ;Trypsinogen,chymotrypsinogen,Procarboxy
Peptidases,Proelastases,collagenase
Lipolytic :Lipase,colipase,Phospholipase,cholesterol esterase
Amylolytic :Pancreatic amylase
Nucleolytic:Ribonuclease, Deoxyribo nuclease
Pancreatic secretion
Secretion of pancreatic enzymes
• Most of the pancreatic enzymes are

secreted in inactive form – proenzyme.
• Enterokinase is secreted from the small
intestine
• It converts trypsinogen to trypsin
The enzymes in active form are:
 Trypsin
 Chymotrypsin
 Carboxypeptidase
 Elastase
 phospholipase A
Release of Trypsin Inhibitor
prevents autogdigestion of
pancreatic tissue
Secretion of Bi-carbonate and
H2O
 Secreted by epithelial cells of ducts and
ductules of Pancreatic gland
 -HCO3 concentration can be as high as

145 mEq/L
Regulation of Pancreatic secretion
Basic stimuli:
1. Acetylcholine from Vagus N
2. Cholecystokinin (CCK)from Duodenum
/Jejunum
3. Secretin from Duodenum /Jejunum
Acetylcholine and CCK cause release of

large quantities of Pancreatic enzymes
whereas Secretin causes release of
NaHCO3 from pancreatic ductal
epethlium
Disorders of Pancreatic function
1.Steatorrhoea:Due to pancreatic insufficiency
Lipids are not digested and excreted in large
quantities. Bulky offensive stools are seen in acute
pancreatitis, obstructive jaundice and vitamin K
defeciency.
2.Cystic Fibrosis: Autosomal recessive disorder.
Defective gene is present on the long arm of
chromosome 7.Causes deficiency in pancreatic
secretions. Steatorrhoea and lung fibrosis is also
seen.
3.Acute Pancreatitis:Due to lack of trypsin
inhibitor or regurgitation of bile into the
pancreatic duct causing activation of
enzymes and autodigestion.
Increase in serum amylase levels and a
decrease in serum calcium levels are seen
in this condition.
Pancreatic function tests:
1.24 hour fecal fat estimation

2.Estimation of serum amylase level.
Biliary Tree
Hepatobiliary Tree.
Functions of Liver
1.Liver stores protein,glycogen,vit A,D,B12 and folic
acid. Iron is also stored.
2.Plasma proteins are synthesized.
Glycogen,Phospholipids,bile acids and heparin are
synthesized.
3.Bile acids and bile pigments are secreted.
4.Metabolic functions:
a. Carbohydrate metabolism: Glycogenolysis,
Glycogenesis and Gluconeogenesis.
Liver functions
Protein metabolism:
Synthesis of proteins
Deamination and transamination reactions
Urea formation from nitrogen
Fat metabolism: synthesis of triglycerides
Phospholipids and ketone bodies.
Excretion of heavy metals ,cholesterol and
bile pigments, drugs and hormones.
Liver functions
Haemopoetic function:
Liver produces RBC in fetal life.
RBCs are also destroyed as part of reticulo
endothelial system.
Body Defense: Kupffer cells lining the liver sinusoids
act as macrophages.
Detoxification of toxic substances and conjugation.
Activation of vitamin D.
Bile
Bile is secreted by the liver at a rate of 30-60
ml/hr.Daily secretion:1000ml.
Composition:
Bile pigments, Bile salts
Cholesterol,lecithin
Hco3-,ca++,Na+,K+,Cl-
Water.
PH:8-9
Regulation of Bile secretion
Neural mechanism: vagal stimulation
Humoral mechanism:
Secretin:stimulates bile secretion,Hco3-
secretion
Gastrin:stimulates bile secretion
Bile salts:stimulate
CCk-pz: causes contraction of gallbladder.
Functions of Bile
1.Emulsification of fats
2.Digestion of fats
3.Absorption of lipids
4.Excretion of Heavy metals,Drugs and
cholesterol
5.Facilitates passage of stools
6.Inhibits bacterial growth
7.Prevents gall stone formation
Disorders of Bile secretion
Gall stones:
Three types,
a.Cholesterol stones
b.Pigment stones
c.Mixed stones
Typical patient is Fat, Fertile, Female of Forty
Aetiology: Bile stasis, saturation of bile.
Investigation: Oral cholecystography
Treatment: Dissolution of stones by ultra sonic waves
(Lithotripsy)
Surgical removal of stones
Functions of Small and Large
Intestines
Intestinal secretion
Villus:
• high turnover of
cells
• change function as
they ascend villus,
from secretory to
absorbtive
• All Epithelial cells
renewed in 5 day
Intestinal secretion
Intestine absorbs ~ 8.5-9 L/day,
but it also secretes about 1.5 L/day
Two types of secretion(succus entericus)

1. NaHCO3
 Predominately in duodenum
 Protection against gastric H+
 Enterocytes & Brunner’s Glands (Mucus)
2. NaCl
 Throughout length of small intestine
 Osmotic equilibration of gut contents
 Flushing of pathogens from gut
 Enterocytes of crypts
Enzymes in Intestinal Secretion-
In enterocytes
 Peptidases
 Sucrase, Maltase etc
 Lipases
Colonic secretion
 Mucosa of large intestine secretes Mucus

 Goblet cells secrete mucus which helps in
lubrication of the undigested food material.
 Large surface area is helpful in absorption of
water and electrolytes.
 Local and neural control (parasympathetic)

Roughage
 Undigested food mainly contains cellulose.
 It helps in increasing the bulk of undigested
food which increases rectal pressure .
 Cellulose retains water in the colon
 Fiber content (Roughage) of food is thus
helpful in bringing about a regular defecation
reflex which prevents carcinoma of the
rectum on the long run .
Defecation Reflex
Defecation reflex is the process by which
unwanted food residue or feces is
evacuated at regular intervals. The interval
varies from person to person. A majority
have once a day. Some people move their
bowels several times a day.Others once in a
few days.
Nerve supply to Rectum
Nerve supply to Rectum
 Sympathetic:T12, L1,2
 Carry pain sensation and contraction of the
internal sphincter.
 Parasympathetic:S2,3,4
 Detect pressure changes and cause contraction of
the rectum and relaxation of the internal sphincter.
 Somatic:Pudendal nerve,S2,3,4. Causes voluntary
control.
Mechanism
 When feces enter rectum pressure
increases. When the pressure increases to
20-25 cm water ,impulses travel to the
spinal center and cause contraction of
rectum and relaxation of internal anal
sphincter. External sphincter is under
voluntary control.Contents of rectum are
expelled when the surroundings are
congenial.
Disorders
 Constipation—infrequent defecation
 Diarrhoea– Frequent defecation
 Flatus –Passage of gas.
Case study
A- 54- year- old man is suffering from
obstructive jaundice. He developed
pancreatic insufficiency over three months.
After surgery his plasma bilirubin levels are
normal. Serum amylase is increased.
What other investigation confirms
steatorrhoea in this patient?
A. Serum calcium estimation
B. Serum bicarbonate estimation
C. Serum chloride estimation
D.24 hour fecal fat estimation
E. Serum bilirubin estimation
 Which vitamin absorption is affected in this
condition?
A.Vitamin C
B.Vitamin B
C.Niacin
D.Vitamin K
E.Pantathonic acid
Case study
A 21 year old man comes to the casuality with
tense abdomen after partying with his
friends.His acid out put is high(gastric
lavage).He has high B.P. and tachy cardia
on examination.Which of the following lab
findings confirms the diagnosis?
A.Serum calcium estimation
B.Serum bilirubin estimation
C.Serum bicarb estimation
D.Serum amylase estimation

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Pancreatic and Liver

• Most of the pancreatic enzymes are

 -HCO3 concentration can be as high as

Acetylcholine and CCK cause release of

1.24 hour fecal fat estimation

Two types of secretion(succus entericus)

 Mucosa of large intestine secretes Mucus

 Local and neural control (parasympathetic)

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