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Pancreas: Functions and possible problems

Last updated

Last updated Fri 26 May 2017

Table of contents

  1. Features
  2. Function
  3. Disorders
  4. Maintaining a healthy pancreas
The pancreas is a gland organ. It is located in the abdomen. It is part of the digestive system and produces insulin and other important enzymes and hormones that help break down foods.

The pancreas has an endocrine function because it releases juices directly into the bloodstream, and it has an exocrine function because it releases juices into ducts.

Enzymes, or digestive juices, are secreted by the pancreas into the small intestine. There, it continues breaking down food that has left the stomach.

The pancreas also produces the hormone insulin and secretes it into the bloodstream, where it regulates the body’s glucose or sugar level. Problems with insulin control can lead to diabetes .

Other possible health problems include pancreatitis and pancreatic cancer .

Fast facts on the pancreas

Here are some key points about the pancreas. More detail is in the main article.

  • The pancreas is a gland organ with a key role in digestion and glucose control.
  • Problems related to the pancreas include diabetes and cancer .
  • A healthful diet can contribute to maintaining a healthy pancreas.

Features

[pancreas]
The pancreas is located in the abdomen and plays an important role in digestion.

The pancreas is an organ 6 to 8 inches long. It extends horizontally across the abdomen.

The largest part lays on the right side of the abdomen where the stomach attaches to the first part of the small intestine, the duodenum.

At this point, the partially digested food passes from the stomach into the small intestine, and it mixes with the secretions from the pancreas.

The narrow part of the pancreas extends to the left side of the abdomen next to the spleen.

A duct runs the length of the pancreas, and it is joined by several small branches from the glandular tissue. The end of this duct is connected to a similar duct that comes from the liver, which delivers bile to the duodenum.

Around 95 percent of the pancreas is exocrine tissue. It produces pancreatic enzymes to aid digestion. A healthy pancreas makes about 2.2 pints (1 liter) of these enzymes every day.

The remaining 5 percent comprises hundreds of thousands of endocrine cells known as islets of Langerhans. These grape-like cell clusters produce important hormones that regulate pancreatic secretions and control blood sugar.

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Function

A healthy pancreas produces chemicals to digest the food we eat.

The exocrine tissues secrete a clear, watery, alkaline juice that contains several enzymes. These break down food into small molecules that can be absorbed by the intestines.

The enzymes include:

  • trypsin and chymotrypsin to digest proteins
  • amylase to break down carbohydrates
  • lipase, to break down fats into fatty acids and cholesterol

The endocrine portion, or islets of Langerhans, secrete insulin and other hormones.

Pancreatic beta cells release insulin when blood sugar levels rise.

Insulin:

  • moves glucose from the blood into muscles and other tissues, for use as energy
  • helps the liver absorb glucose, storing it as glycogen in case the body needs energy during stress or exercise

When blood sugar falls, pancreatic alpha cells release the hormone glucagon.

Glucagon causes glycogen to be broken down into glucose in the liver.

The glucose then enters the bloodstream, restoring blood sugar levels to normal.

Disorders

Problems with the pancreas can affect the whole body.

If the pancreas does not produce enough digestive enzymes, for example, food will not be properly absorbed. This can lead to weight loss and diarrhea .

The islets of Langerhans are responsible for regulating blood glucose. Too little insulin production will increase the risk of diabetes, and blood glucose levels will rise.

Pancreatitis

[pancreatitis]
A flareup in pancreatitis can cause abdominal pain.

Pancreatitis refers to an acute or chronic inflammation of the pancreas. It can lead to secondary diabetes.

Inflammation can occur if the main duct from the pancreas is blocked by a gallstone or tumor .

Pancreatic juices will accumulate in the pancreas, causing damage to the pancreas. The pancreas may start to digest itself.

Pancreatitis can happen as a result of mumps, gallstones, trauma and the use of alcohol, steroids, and drugs.

Acute pancreatitis is rare, but it needs immediate medical attention.

Symptoms include:

  • intense abdominal pain, tenderness, and swelling
  • nausea and vomiting
  • fever
  • muscle aches

Immediate treatment is normally with fluids and painkillers. Patients often do not want to eat at the beginning, but if the pancreatitis is mild, they will start to eat again relatively quickly.

If a secondary infection has occurred, surgery may be necessary.

Chronic pancreatitis can develop if acute pancreatitis happens repeatedly, resulting in permanent damage.

The most common cause is alcohol abuse, and it mostly affects middle-aged men.

Symptoms include:

  • persistent pain in the upper abdomen and back
  • weight loss
  • diarrhea
  • diabetes
  • mild jaundice

Hereditary pancreatitis can happen if there is an inherited problem in the pancreas or the intestine. A person under 30 years of age may experience repeated acute pancreatitis, leading to a chronic condition.

It is a progressive condition that can lead to permanent damage. The person may experience pain, diarrhea, malnutrition or diabetes. Treatment aims to control pain to replace lost enzymes.

Genetic testing is available for patients who may be at risk.

Pancreatic cancer

Cancer can develop in the pancreas. The exact cause is often unknown, but it is often linked to smoking or heavy drinking.

Other risk factors include:

  • diabetes
  • chronic pancreatitis
  • liver problems
  • stomach infections

Symptoms include:

  • pain in the upper abdomen as the tumor pushes against the nerves
  • jaundice, a yellowing of the skin and eyes and darkening of the urine as the cancer interferes with the bile duct and the liver
  • loss of appetite, nausea, and vomiting
  • significant weight loss and weakness
  • pale or gray stool, and excess fat in the stool

Symptoms may not appear until the cancer is in the advanced stages. By then, it may be too late for successful treatment. The prognosis for pancreatic cancer tends to be poor.

Treatment usually involves surgery, chemotherapy , radiation, or a combination these.

Palliative treatment will focus on reducing the pain.

Pancreatic cancer is the fourth most common cause of cancer in men in the United States (U.S.) and the fifth in women. Over 37,000 new cases are diagnosed each year.

Diabetes

Type 1 diabetes is an autoimmune disease. It occurs when the immune system attacks and destroys the beta cells in the pancreas so that they can no longer produce insulin.

The exact cause remains unknown, but it may be due to genetic and environmental factors, including viruses.

Type 2 diabetes begins when the body’s muscle, fat, and liver cells become unable to process glucose. The pancreas reacts by producing extra insulin, but in time, it cannot produce enough insulin. The body can no longer control blood glucose levels.

Other problems that can occur include :

  • Exocrine pancreatic insufficiency (EPI): The pancreas does not produce enough enzymes
  • Pancreatic cysts: These can be removed by surgery if there is a risk of cancer
  • Pancreatic fluid collections: Resulting from a range of conditions, this can lead to pain and fever
  • Zollinger-Ellison syndrome: A tumor known as a gastinoma develops in the pancreas or duodenum

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Maintaining a healthy pancreas

Following a balanced diet and avoiding smoking and excessive drinking will help keep the pancreas healthy.

[drink water for a healthy pancreas]
Keeping hydrated is important for maintaining a healthy pancreas.

The National Pancreatic Foundation recommend :

  • consuming no more than 20 grams of fat a day
  • avoiding alcohol
  • drinking plenty of water to keep hydrated

A fasting diet may trigger the pancreas to regenerate itself, which could help people with diabetes, according to results of an animal study published in February 2017.

A fast would involve consuming far fewer calories than usual for a number of days.

The National Pancreatic Foundation suggests a similar strategy for people who are experiencing a flareup of pancreatic pain. They suggest taking a clear liquid diet for 1 to 2 days, including grape juice, broth, gelatin, apple, and cranberry.

A fast cannot provide all the necessary nutrients for wellbeing. After fasting, people should ensure they eat nutritious food to make up for nutrients lost.

Fasting should first be discussed with a doctor.

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A doctor will order a lipase test if they suspect that a person has a problem with their pancreas. When the pancreas is inflamed, it often produces more lipase than usual. If the results of a lipase test show high levels, a person may have pancreatitis. Learn more about lipase levels and how to lower them here.

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GastroIntestinal / Gastroenterology

Diabetes


Endocrinology


Pancreatic Cancer

Additional information

    Article last updated by Yvette Brazier on Fri 26 May 2017.

    Visit our GastroIntestinal / Gastroenterology category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on GastroIntestinal / Gastroenterology.

    All references are available in the References tab.

References

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    • The Pancreas
    • Parts of the Pancreas
    • Function of the Pancreas

    The pancreas has two functional components

    The pancreas is really two glands that are intimately mixed together into one organ. The bulk of the pancreas is composed of “exocrine” cells that produce enzymes to help with the digestion of food. These exocrine cells release their enzymes into a series of progressively larger tubes (called ducts) that eventually join together to form the main pancreatic duct. The main pancreatic duct runs the length of the pancreas and drains the fluid produced by the exocrine cells into the duodenum, the first part of the small bowel.

    The second functional component of the pancreas is the “endocrine” pancreas. The endocrine pancreas is composed of small islands of cells, called the islets of Langerhans. These endocrine cells don’t release their secretions into the pancreatic ducts, instead they release hormones, such as insulin and glucagon, into the blood stream, and these hormones in turn help control blood sugar (glucose) levels.

    images of pancreas

    Acinar cellsimages of pancreas
    Acinar cells are the exocrine (exo=outward) cells of the pancreas that produce and transport enzymes that are passed into the duodenum where they assist in the digestion of food.
    Islets of Langerhans The islets of Langerhans are the endocrine (endo= within) cells of the pancreas that produce and secrete hormones such as insulin and glucagon into the bloodstream. The pancreatic hormones, insulin and glucagon, work together to maintain the proper level of sugar (glucose) in the blood. Blood sugar is used by the body for energy.

    An understanding of the two functional components of the pancreas is important for two reasons.

    First, as they grow large tumors of the pancreas will interfere with both of these important bodily functions. When tumors block the exocrine system, patients can develop pancreatitis and pain from the abnormal release of digestive enzymes into the substance of the pancreas instead of into the bowel, and they can develop digestive problems, such as diarrhea, from the incomplete digestion of food. When tumors destroy the endocrine function of the pancreas, patients can develop sugar diabetes (abnormally high blood sugar levels).

    The second reason that the two functional components of the pancreas are important to understand is that tumors can arise in either component. The vast majority of tumors of the pancreas arise in the exocrine part and these cancers look like pancreatic ducts under the microscope. These tumors are therefore called “ductal adenocarcinomas,” or simply “adenocarcinoma,” or even more simply “pancreatic cancer.” Less commonly, tumors arise from the endocrine component of the pancreas and these endocrine tumors are called “pancreatic neuroendocrine tumors,” or “islet cell tumors” for short.

    How does it all fit together?

    digestive system

    The pancreas is an integral part of the digestive system, and the flow of the digestive system is often altered during the surgical treatment of pancreatic cancer. Therefore it is helpful to review the normal flow of food and the flow of digestive enzymes of the pancreas before reading about surgical treatment.

    Food is carried from the mouth to the stomach by the esophagus. The esophagus is a tube that descends from the mouth down into the abdomen. In the abdomen, the esophagus empties into the stomach where digestive acids made by the stomach break down the food. From the stomach, the partially digested food flows directly into the first part of the small intestine, called the duodenum. It is here in the duodenum that bile from the liver and digestive enzymes from the pancreas enter the digestive system.

    The duodenum then leads to the other parts of the small bowel, the jejunum and ileum, where further digestion of food takes place. The ileum then empties into the large bowel (also known as the large intestine), and finally completely digestive material passes out of the body through the anus.


    What is bile?

    Bile is important to understand because the flow of bile is often blocked by pancreatic cancers, and because the flow of bile is altered during surgery for pancreatic cancer. Bile is a greenish-yellow fluid that aids in the digestion of fats in food. After being produced by cells in the liver, the bile travels down through the bile ducts which merge with the cystic duct from the gallbladder to form the common bile duct. The gallbladder stores extra bile until needed. The common bile duct then passes through the head of the pancreas and joins the pancreatic duct to form the ampulla of Vater which then empties into the duodenum. The flow of bile is indicated by the green arrows.

    flow of bile

    Understanding that the tube (duct) carrying bile from the liver passes through the pancreas on its way to the intestine, helps us understand why some people with pancreatic cancer develop jaundice (an abnormal yellowing of the skin and eyes). Pancreatic cancers in the head of the pancreas (the bile duct passes through the head of the pancreas) can block the bile duct and in so doing can block the flow of bile out of the liver. The bile backs up and causes jaundice.


    What is pancreatic fluid?

    Instead of carrying bile, the pancreatic duct carries the fluid containing the digestive enzymes produced by the acinar cells (exocrine cells) of the pancreas. The main pancreatic duct is normally only one-sixteenth of an inch in diameter and it has many small side branches. The main pancreatic duct merges with the bile duct in the head of the pancreas to form the ampulla of Vater (a widening of the duct just before it enters the duodenum). Just as was true for bile, the flow of pancreatic fluid is often blocked by tumors of the pancreas, and altered by pancreatic surgery. The flow of pancreatic fluid is indicated by the dark yellow arrow.

    flow of pancreatic fluid


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