Pancreas: anatomy, function and diagnosis

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The pancreas is a gland located deep in the abdominal cavity, just behind the lower part of the stomach. It has two important functions: secreting enzymes that aid digestion and releasing hormones, particularly insulin, to regulate the amount of glucose (sugar) in the blood.

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Anatomy

The pancreas is an elongated gland located deep in the abdominal cavity, between the stomach and the spine. One end of the pancreas is wider than the other and is called the head: it is located inside the duodenum (the first part of the small intestine) and is divided into two parts: the head itself and the uncinate process.

The hook-shaped process encompasses two major blood vessels, the superior mesenteric artery and the superior mesenteric vein .

Like a side coma, the pancreas expands slightly upward, becoming narrower and narrower. It is divided into areas called the neck, body and finally the tail, which is located next to the spleen.

The pancreas is about the length of the arm, about six inches.

The pancreas is made up of two types of glands, each with very different but vital functions. The exocrine gland , which runs throughout the entire pancreas, secretes digestive enzymes.

The endocrine portion of the pancreas is made up of groups of cells called islets of Langerhans. There are three types of cells in the islets, each of which secretes different hormones that help regulate the amount of sugar in the bloodstream.

Pancreas.

Function

The pancreas plays a key role in two important bodily functions: digestion and blood sugar control. These functions are performed independently.

Digestion

Each of the digestive enzymes secreted by the pancreas breaks down food differently, entering the duodenum through the ducts:

  • Lipase Works with bile (produced by the liver) to break down fat, which is important for the absorption of fat-soluble vitamins.
  • Protease. It breaks down proteins and provides protection against potentially harmful bacteria, yeast, and other gut microbes.
  • Amylase. It breaks down starch into sugar, which is used for energy.

The pancreas produces about 8 ounces of digestive juices that are loaded with enzymes every day.

Blood sugar control

The specific cells of the islets of Langerhans secrete three different hormones that control blood sugar levels.

  • Insulin : The cells responsible for the release of this hormone are called beta cells; they constitute 75% of the cells of the pancreas.
  • Glucagon : The pancreas releases this hormone when there is too little sugar in the blood to signal the liver to release stored sugar. It is secreted by alpha cells, which make up 20% of the cells in the pancreas.
  • Gastrin : gastrin causes the stomach to produce stomach acid; Most of the gastrin is produced in the stomach, but the pancreas produces a small portion.
  • Amylin : also produced by beta cells, this hormone is involved in appetite control and gastric emptying .

Related conditions

The disease most commonly associated with the pancreas is type 1 diabetes , an autoimmune disease in which the immune system mistakenly attacks and destroys the beta cells of the gland. As a result, little or no insulin is produced and blood glucose levels can fluctuate. Type 1 diabetes is a lifelong disease that cannot be cured; This is accomplished primarily by daily injections of supplemental insulin.

In type 2 diabetes, the pancreas is not attacked by the immune system, but it produces less insulin than it needs or the body cannot use the insulin it produces. The last condition is called insulin resistance. Obesity is the leading cause of insulin resistance.

Other conditions that affect the pancreas include pancreatitis , pancreatic cancer, and cystic fibrosis . The pancreas is also associated with nondiabetic hypoglycemia and hyperglycemia .

Restoring pancreatic function could, in fact, be the cure for type 1 diabetes, and there are several possible ways to do it. All are considered experimental.

  • Restore beta cell function to produce insulin again
  • Islet cell transplantation is a fairly successful but risky procedure
  • Pancreas transplant. The number of donors is limited, so this procedure is usually for people who are seriously ill from complications of type 1 diabetes.

Tests

Type 1 diabetes is diagnosed by blood tests that measure the amount of glucose in the blood. Sometimes blood glucose is used in the diagnosis of pancreatic cancer.

Other diseases and conditions associated with the pancreas are diagnosed by a variety of laboratory and imaging tests .

  • CA19-9 blood test : the presence of the CA19-9 protein indicates cancer. (CA stands for "cancer antigen"). It is most commonly measured to assess how well pancreatic cancer responds to treatment, but it can be used in diagnosis.
  • Secretin pancreatic function test : measures how well the pancreas can respond to a hormone called secretin. It involves inserting a thin tube through the nose into the duodenum (the first part of the small intestine), followed by intravenous administration of secretin (into the body through a vein). The tube is used to draw fluid for one to two hours for evaluation.
  • Fecal elastase test: measures the amount of elastase in the stool. Elastase is a digestive enzyme found in fluids produced by the pancreas. This test is used to diagnose exocrine pancreatic insufficiency (EPI), a condition characterized by chronic diarrhea .
  • Contrast-enhanced computed tomography (CT) scan : An imaging test that can detect problems in and around the pancreas, such as swelling or scarring. It can also help rule out pancreatic problems as a cause of abdominal pain.
  • Abdominal ultrasound : An imaging test that uses sound waves to create images of organs in the abdomen.
  • Endoscopic retrograde cholangiopancreatography (ERCP) : An imaging test that combines an endoscopy and an X-ray to evaluate the pancreas and bile ducts . It involves inserting a thin tube through the throat into the intestines and injecting a contrast dye to make the pancreatic duct and nearby structures visible.
  • Endoscopic ultrasound : useful for the diagnosis of severe pancreatitis.
  • Magnetic Resonance Cholangiopancreatography : An MRI test directed at the pancreas and bile ducts.
  • Angiography : A special X-ray that uses contrast dye to find out if the tumor is blocking blood flow .
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