What is the Pancreas?
The pancreas is an yellowish gland, ca. 15 cm long,
5 cm wide and 2-3 cm in diameter. It can be roughly divided into three
parts: the head, the body and the tail (Fig. 2). The pancreas head is
closely connected to the first part of the small intestine, known as
the duodenum . The pancreas tail extends to the left part of the spleen
. The body of the pancreas is located before a junction of a number
of important blood vessels leaving the aorta . They supply blood to
the liver, the stomach, the upper part of the intestine and the pancreas
|The location of the pancreas|
does the Pancreas do?
The pancreas has two functions:
1. It is crucial to the function of the digestive system (exocrine function).
2. It controls blood sugar levels.
Pancreas and Digestion
The pancreas produces more than 20 different digestive enzymes. They break down food into small elements. Although the enzymes are produced in the pancreas, they only become functional in the duodenum. Therefore they will not digest the pancreas itself.
The three most important enzymes produced in the pancreas are:
- Amylase: digests carbohydrates
Breaking down food into components is necessary
so the body can absorb these through the intestines. In the absence
of the pancreatic enzymes sugars, proteins and fats will not be broken
down properly and the intestines will not be able to absorb nutrients
into the bloodstream, causing diarrhoea, bloating and abdominal cramps.
Persistent weight loss, vitamin deficiencies and malfunctioning of other
organs will also occur, as nutrients cannot be absorbed and the body
therefore lacks the required energy.
Pancreas and the Regulation of Blood Sugar
Blood sugar cannot enter the cells if there is not enough insulin (or none at all) in the bloodstream. If this condition is present, blood sugar levels rise constantly, leading to unpleasant or even life-threatening consequences. Diabetics suffer from varying degrees of insulin deficiency.
Another important hormone produced by the pancreas is known as glucagon. This hormone is also manufactured in the insulin cells. Glucagon counteracts insulin in the body. When cell life is threatened by a lack of blood sugar, glucagon releases residual blood sugar from elsewhere in the body, particularly the liver. In the absence of the pancreas (i.e. after surgery), the glucagon hormone can no longer be produced. This factor must be considered when caring for pancreas patients.
The production of pancreatic enzymes and insulin are by and large separate processes. If damage is done to the pancreas, both functions may be disrupted independently.
|During embryonic development, the pancreas arises from two separate parts, which move together as the embryo is growing.|
|During this process, both parts of the gland including the separate ducts fuse to a form single organ. The originally more ventrally located part of the pancreas moves to the back.|
Disturbances during the embryonic development of the pancreas can lead to two clinically important malformations i.e. annular pancreas and pancreas divisum.
1. Annular pancreas
The first symptoms usually arise in early childhood or in young adults. Characteristically, pain in the abdomen or frequent vomiting are present. Rarely, the patients can develop jaundice. In some cases, acute or chronic inflammation of the pancreas develop due to stenosis of the pancreatic duct.
2. Pancreas divisum
Subsequently, the pancreatic duct from the dorsal larger part of the pancreas drains through the so called Ductus Santorini via a small opening called the small (minor) Papilla. The ventral pancreatic duct drains the pancreatic juice via the so called Ductus Wirsungianus through the major opening called Papilla major. In this area, there is also the opening of the bileduct (Ductus choledochus)
The first line of treatment in this condition is to widen the opening of this pancreatic duct. It can be achieved endoscopically by making a small cut into the minor Papilla, sometimes together with the introduction of a small tube. While some patients benefit from this treatment, symptoms relapse in most patients.
Nowadays, the treatment of choice is an operation where parts of the openings are excised surgically without removing any part of the pancreas. Most patients undergoing this operation experience long term symptom relief.
|Location of the pancreas|
|Regulation of Blood Sugar|