The pancreas is a relatively small, elongated organ that is located in the abdominal cavity and behind the stomach. One of the things that makes the pancreas unique is that it is part of both the digestive system and the endocrine system. Yet it can also be understood by its two categories of function: exocrine and endocrine. Exocrine function means that a substance is secreted by a duct, while endocrine means that a substance is secreted directly into the bloodstream. In this way, the pancreas behaves both as an organ in the digestive system and as a gland in the endocrine system.
Structure of the Pancreas
In adults, the pancreas is usually about 12-14 centimeters long and tapers as it stretches from behind the stomach to the upper left side of the abdomen near the spleen. Anatomically, it can be divided into four parts: head, neck, body, and tail. The head is the widest part of the pancreas and it is situated in close proximity to the duodenum, the first part of the small intestine. The neck is where the pancreas starts tapering down to the body, the large middle section that is near the superior mesenteric artery. The tail is the tip of the pancreas that is closest to the spleen.
Function of the Pancreas
The location of the pancreas, near the stomach, small intestine, and liver, makes it ideally suited for its significant role in the digestion of food. The main way the pancreas contributes to digestion is by producing and secreting the right biochemical compounds at the right time. This occurs because of a variety of specific functions:
During the digestion process, food that makes its way to the stomach is broken down through peristalsis and stomach acids. The resulting material, a mostly liquid mixture called chyme, then enters the small intestine at the duodenum. At the duodenum, several chemicals from the pancreas enter the digestive tract via pancreatic ducts. The pancreas makes about 8 ounces of this digestive juice every day:
- Lipase: Lipase results is an enzyme that works in conjunction with bile that is produced in the liver and stored in the gallbladder. Together, lipase and bile break down fats into smaller molecules that are able to be absorbed in the bloodstream. It is especially important in accessing fat soluble vitamins like A, D, E, and K.
- Protease: Protease is also an enzyme produced by the pancreas. Whereas lipase breaks down fats, protease breaks down proteins into valuable amino acids. Protease is also known to aid immune function and protect the body from germs.
- Amylase: The main purpose of amylase is to break down starches and other carbohydrates in sugar (glucose) that can be used by our cells for energy.
Another major aspect of digestion that the pancreas is involved with is the regulation of blood sugar. Rather than releasing chemicals directly into the digestive tract, however, the pancreas secretes them into the bloodstream through the islets of Langerhans. Also, instead of enzymes that aid in digestion, the pancreas releases messenger hormones that affect the digestive system as a whole:
- Insulin: Insulin is made by special cells of the pancreas called beta cells, and it is the primary means of controlling blood sugar. When glucose is detected in the digestive system, the pancreas is signaled to release insulin; when present in the bloodstream, insulin allows cells to use the glucose for energy.
- Glucagon: Most of the rest of the endocrine aspects of the pancreas are related to the production of glucagon in the alpha cells. The pancreas secretes glucagon, a peptide hormone, in order to prevent blood glucose from being too low. Glucagon signals the liver to release stored glucose.
- Other hormones: Additionally, the pancreas produces small amounts of gastrin and amylin. Gastrin stimulates the production of gastric acid in the stomach, and amylin is involved in controlling appetite and stomach emptying.
Common Problems in the Pancreas
Because the pancreas is such a multifaceted organ, it also means that there are a number of ways that abnormal function can lead to health problems. Below are some of the most common conditions related to the pancreas:
- Diabetes: Diabetes mellitus is a metabolic disorder that results from having high blood sugar levels over a prolonged period of time. In patients with type 1 diabetes, the immune system attacks the beta cells in the pancreas that are responsible for producing insulin. Type 2 diabetes, the most common kind, is characterized by high blood sugar levels that come from insulin resistance and impaired insulin production.
- Pancreatitis: Pancreatitis is the condition of having inflammation of the pancreas; it can be either acute or chronic pancreatitis. The most common causes of inflammation in the pancreas are heavy alcohol use and gallstones blocking the common bile duct. In both cases, the basic mechanism of the inflammation is too much digestive enzyme lingering in the pancreas and irritating the tissues. Symptoms include abdominal pain, fever, nausea, and vomiting.
- Pancreatic cancer: Like all cancer, pancreatic cancer is an overgrowth of cells. In nearly 95% of cases, it begins specifically in the cells that produce the digestive enzymes. In addition to the risk of cancer cells spreading to other parts of the body, the cancer causes there to be fewer pancreatic enzymes than are needed for digestion. Symptoms include weight loss, lack of appetite, indigestion, and fatty stools.
- Pancreatic cysts: Sometimes small, fluid-filled sacs called pancreatic cysts form on or within the pancreas. Pancreatic cysts can be either benign or precancerous. While it is possible to get them by themselves, they are also often associated with pancreatitis and pancreatic cancer.
Diagnosis and Treatment of Problems with the Pancreas
The location of the pancreas, tucked behind the stomach, makes it difficult to evaluate in a physical examination. As a result, a doctor may utilize various imaging and pancreatic function tests. MRI, CT scans, and ERCP (endoscopic retrograde cholangiopancreatography) are all potential options for evaluating the health of the pancreas. Depending on the nature of the problem, more tests may be necessary.
As noted above, the main problems that can happen with the pancreas are diabetes, pancreatitis, and pancreatic cancer. The treatment for diabetes has evolved over time, but the same basic idea still applies: replace missing or ineffective insulin with insulin injections. In terms of pancreatitis, it can usually be resolved with changes to diet (drinking less alcohol, for instance) or medication. In the case of pancreatic cancer, however, standard cancer treatments like chemotherapy, radiation, and surgery (pancreatectomy) are the usual approaches.
Contact Cary Gastroenterology Today
The pancreas is an important part of the digestion process that is sometimes overlooked; the enzymes and hormones secreted by the pancreas are critically important for maintaining a metabolic balance and keeping our blood sugar in check. If you have been experiencing the symptoms of any of the conditions noted above, please contact us at Cary Gastro today to request an appointment. We are passionate about providing excellent digestive health care.