Contents
What is the pancreas?
Pancreas It is an important organ of the digestive system with a mixed function: external (exocrine) and internal (endocrine). The function of external secretion is to secrete pancreatic juice, which contains digestive enzymes necessary for the complete digestion of food. The endocrine function consists in the production of appropriate hormones and the regulation of metabolic processes: carbohydrate, fat and protein.
What does the pancreas do?
exocrine function
Every day the pancreas produces 500-1000 ml of pancreatic juice, consisting of enzymes, salts and water. Enzymes produced by the pancreas are called “proenzymes” and are produced by the pancreas in an inactive form. When a lump of food enters the duodenum, hormones are released, with the help of which a chain of chemical reactions is launched that activates the enzymes of pancreatic juice. The most powerful stimulant of pancreatic secretion is hydrochloric acid of gastric juice, which, when it enters the small intestine, activates the secretion of secretin and pancreozymin by the intestinal mucosa, which in turn affects the production of pancreatic enzymes.
These enzymes include:
Amylase, which breaks down carbohydrates;
Trypsin and chymotrypsin, involved in the process of protein digestion, which begins in the stomach;
Lipase responsible for the breakdown of fats that have already been exposed to bile from the gallbladder.
Additionally, pancreatic juice contains trace elements in the form of acidic salts, which ensure its alkaline reaction. This is necessary to neutralize the acidic component of food from the stomach and create suitable conditions for the absorption of carbohydrates.
The secretion of pancreatic juice is regulated by nervous mechanisms and is associated with food intake, i.e., food of various composition stimulates the production of juice of different volume and content of enzymes. It accumulates in the interlobular ducts, which merge into the main excretory duct, which flows into the duodenum.
Endocrine function
The internal secretory function of the gland is to secrete the hormones insulin and glucagon into the blood. They are produced by groups of cells interspersed between the lobules and do not have excretory ducts – the so-called islets of Langerhans, located in significant numbers in the tail of the gland. The islets of Langerhans are composed primarily of alpha cells and beta cells. Their number in healthy people reaches 1-2 million.
Insulin is produced by beta cells and is responsible for the regulation of carbohydrate and lipid (fat) metabolism. Under its influence, glucose enters from the blood into the tissues and cells of the body, thereby lowering the blood sugar level. Beta cells make up 60-80% of the islets of Langerhans.
Glucagon is produced by alpha cells and is an insulin antagonist, i.e., increases blood glucose levels. Also, alpha cells are involved in the production of the substance lipocaine, which prevents fatty degeneration of the liver. Their share in the islets of Langerhans is about 20%.
The islets of Langerhans also contain small amounts of other cells, such as delta cells (1%), which secrete the hormone ghrelin, which is responsible for appetite and stimulates food intake. PP cells (5%) produce a 36 amino acid pancreatic polypeptide that inhibits pancreatic secretion.
The destruction of beta cells leads to inhibition of insulin production, which can trigger the development of diabetes. Symptoms of this are constant thirst, itching, increased urine output.
The pancreas is in close relationship with other organs of the digestive tract. Any damage to it or failures in its activity negatively affects the entire digestive process.
Where is the human pancreas located?
The pancreas is located in the abdominal cavity behind the stomach, closely adjoining it and the duodenum, at the level of the upper (first or second) lumbar vertebrae. In the projection on the abdominal wall, it is 5-10 cm above the navel. The pancreas has an alveolar-tubular structure and consists of three sections: head, body and tail.
The head of the pancreas is located in the bend of the duodenum so that the intestine surrounds it in the shape of a horseshoe. It is separated from the body of the gland by a groove along which the portal vein passes. The blood supply to the pancreas is carried out through the pancreatic-duodenal arteries, the outflow of blood occurs through the portal vein.
In the body of the pancreas, the anterior, posterior and inferior surfaces are distinguished. It also distinguishes the upper, front and lower edges. The anterior surface adjoins the posterior wall of the stomach, slightly below. The posterior surface is adjacent to the spine and abdominal aorta. Vessels of the spleen pass through it. The lower surface is below the root of the transverse colon. The tail of the gland is cone-shaped, directed upwards and to the left, and reaches the hilum of the spleen.
The pancreas consists of 2 types of tissue with different functions (endocrine and exocrine). Its main tissue is made up of small lobules – acini, which are separated from each other by layers of connective tissue. Each lobule has its own excretory duct. Small excretory ducts are interconnected and merge into a common excretory duct, which runs in the thickness of the gland along its entire length, from tail to head. At the right edge of the head, the duct opens into the duodenum, connecting with the common bile duct. Thus, the pancreatic secret enters the duodenum.
Between the lobules are groups of cells (Islets of Langerhans) that do not have excretory ducts, but are equipped with a network of blood vessels and secrete insulin and glucagon directly into the blood. The diameter of each island is 100-300 µm.
Size of the pancreas
In terms of size, the pancreas is the second largest enzyme-producing organ after the liver. Its formation begins as early as the fifth week of pregnancy. In a newborn child, the gland has a length of up to 5 cm, in a one-year-old – 7 cm, by the age of 10 its dimensions are 15 cm in length. It reaches its final size in adolescence, by the age of 16.
The head of the pancreas is its widest part, its width is up to 5 cm or more, the thickness varies from 1,5 to 3 cm. The body of the gland is the longest part, its average width is 1,75-2,5 cm. Length tail – up to 3,5 cm, width about 1,5 cm.
Due to the deep location, the diagnosis of pancreatic pathologies is very difficult. Therefore, an important point in the diagnosis is an ultrasound study, which allows you to determine the shape and size of the gland, on the basis of which you can draw appropriate conclusions about its condition.
All dimensions of the organ, as well as the possible causes of their changes, are recorded in detail in the ultrasound protocol. In an unchanged state, iron has a homogeneous structure. Small deviations from the normal size of the head, body and tail are only acceptable if the biochemical blood test is good.
The size of the pancreas is normal
The length of the gland of an adult is from 15 to 22 cm, its weight is approximately 70-80 grams. The thickness of the head should not exceed 3 cm, other data indicate pathology.
Functions of the digestive enzymes of the pancreas
The exocrine function consists in the production of the following enzymes that are part of the pancreatic juice: trypsin, lipase and amylase:
Trypsin breaks down peptides and proteins. It is initially produced by the pancreas as an inactive trypsinogen, which is activated by enterokinase (enteropeptidase), an enzyme secreted by the intestinal mucosa. The pancreas is the only organ in the body that produces trypsin, so the determination of its level is more significant in the study of the pancreas than the analysis of other enzymes. Determination of trypsin activity is an important point in the diagnosis of acute pancreatitis and the identification of its pathogenesis.
lipase – a water-soluble enzyme that digests and dissolves triglycerides (neutral fats). It is produced as an inactive prolipase, and then, under the influence of other enzymes and bile acids, it passes into the active form. Lipase breaks down neutral fats into higher fatty acids and glycerol. Also, this enzyme is involved in energy metabolism, providing delivery of polyunsaturated fatty acids to tissues and the absorption of some fat-soluble vitamins. In addition to the pancreas, lipase is produced by the liver, intestines, lungs, and each type of lipase is a catalyst for the breakdown of a certain group of fats. With hypofunction of the pancreas, lipase activity decreases first of all. The first sign of this is greasy, grey-yellow stools.
amylase (alpha-amylase) is necessary for the processing of carbohydrates entering the body. It is secreted by the pancreas and (to a lesser extent) by the salivary glands. Changes in the content of this enzyme in the blood are characteristic of many diseases (diabetes mellitus, hepatitis, etc.), but first of all, this indicates acute or chronic pancreatitis.
Unlike other substances involved in the digestion process, pancreatic enzymes are released only during meals – their active release begins 2-3 minutes after food enters the stomach and lasts 12-14 hours. Enzymes can only perform their functions if there is enough bile produced by the gallbladder. Bile activates enzymes and also breaks lipids into smaller droplets, i.e., prepares them for splitting. Pancreatic enzymes are produced in an inactive form and are activated only in the duodenal lumen by the action of enterokinase.
Symptoms of pancreatic enzyme deficiency
Disorders of secretion, its decrease and deficiency of pancreatic enzymes in an adult are usually a consequence of chronic pancreatitis – inflammation of this organ, which is accompanied by a gradual degeneration of glandular tissue into connective tissue.
In the first place among the causes leading to pancreatitis is alcohol abuse, among other reasons, one can single out improper, irrational nutrition, concomitant diseases (cholelithiasis), infections, injuries, and taking certain medications.
The lack of trypsin, lipase and amylase causes serious disorders of the digestive process.
Common symptoms of pancreatic problems include:
pain in the upper left side of the abdomen under the ribs, which often occurs after eating, but may not be associated with eating;
decrease or complete disappearance of appetite;
nausea, vomiting;
rumbling in the stomach, flatulence;
changes in stool color and consistency.
The severity of these symptoms depends on the degree of damage to the gland. As a result of poor digestion, the body lacks nutrients, and metabolic disorders can lead to osteochondrosis, osteoarthritis, and vascular atherosclerosis.
Lipase deficiency is characterized by steatorrhea (excessive excretion of fat with feces), the stool may be yellow or orange, sometimes there is a release of liquid fat without feces; loose, oily stool.
With a lack of amylase, there is intolerance to foods rich in carbohydrates, frequent, loose, watery voluminous stools due to excess starch, malabsorption (malabsorption of nutrients in the small intestine, accompanied by diarrhea, vitamin deficiency, weight loss), a high content of opportunistic microflora in intestines.
Trypsin deficiency is expressed in moderate or severe creatorrhoea (increased content of nitrogen and undigested muscle fibers, i.e. protein in the feces), the stool is mushy, fetid, and anemia may develop.
Since the process of splitting complex food molecules is disrupted, and it is not fully absorbed by the body, even with enhanced nutrition, weight loss, vitamin deficiency, dry skin, brittle nails and hair can be noted. When poorly processed food enters the large intestine from the small intestine, flatulence (increased gas formation and gas discharge), frequent defecation occurs.
With reduced secretion of enzymes by the pancreas, replacement therapy is prescribed, however, enzymes of plant origin cannot fully compensate for the insufficiency of its external secretion.
If the outflow of enzymes into the intestine is disturbed, this can lead to irritation of the gland tissues and its edema, and subsequently to destruction and necrosis.
When the islets of Langerhans are affected, insulin production is suppressed and clinical symptoms of type 1 diabetes are observed, the severity of which will depend on the number of preserved and fully functioning beta cells. Deficiency in glucagon secretion is not felt as strongly, as there are other hormones that have a similar effect: for example, steroid hormones produced by the adrenal glands that increase blood glucose levels.
How does the pancreas hurt?
The most common pathologies of the pancreas are pancreatitis (acute or chronic), stones in the excretory ducts, pancreatic adenocarcinoma, diabetes, necrosis.
With inflammation (pancreatitis) and damage to the pancreas, the following symptoms are noted:
Pain in left side under ribs;
Cardiopalmus;
increased sweating;
Yellowness of the skin and eye proteins;
Weakness;
Temperature increase;
Vomiting, diarrhea;
In some cases, a state of shock.
In acute pancreatitis, the pain is severe, acute, begins suddenly, may have a shrouding character, that is, cover the entire left side and go behind the back. The pain is not relieved by antispasmodics, it decreases in a sitting position or when leaning forward. In some cases, an increase in the pancreas is physically felt: there is a feeling of fullness from the inside, pressure on the area of uXNUMXbuXNUMXbthe ribs, which interferes with normal breathing.
The stronger the pain, the more the gag reflex increases. Sometimes attacks of vomiting begin earlier than the pain syndrome: it usually occurs in the morning or during meals, as a result of gastric spasm. Vomiting has a bitter or sour taste, after it comes temporary relief. It can be either periodic or systematic. In the event of an acute attack of pancreatitis, it is necessary to consult a doctor and receive treatment in a hospital, since this disease will not go away on its own. With persistent vomiting, the stomach is cleaned with a probe and special enzymes are administered to calm the excessive aggressiveness of the stomach and pancreas.
Symptoms of pancreatitis are sometimes similar to signs of osteochondrosis of the lumbar spine, an attack of pyelonephritis or shingles. Pancreatitis can be differentiated as follows: with osteochondrosis, palpation of the vertebrae is painful; with shingles (herpes virus), a rash appears on the skin; in acute pyelonephritis, the pain intensifies when tapping on the back in the projection of the kidneys, and then blood appears in the urine. All these signs are absent in pancreatitis.
In the case of chronic pancreatitis, the pain is less severe, exacerbations usually occur after a diet violation (eating a large amount of fatty foods) and alcohol abuse. To date, it has not been precisely established how alcohol affects the pancreas: either it prevents the outflow of pancreatic juice, or changes its chemical composition, thereby provoking an inflammatory process. Another reason may be blockage of the excretory ducts of the gland by gallstones. In chronic pancreatitis, the risk of developing an oncological process in the pancreas increases: a cancerous tumor occurs in 4 cases out of 100 in patients with pancreatitis.
With a constant pain syndrome, a feeling of addiction may appear, and the person will no longer feel pain so sharply. This is dangerous because you can miss the development of necrosis or serious complications. The human body has a certain margin of strength and resistance and can independently regulate metabolic processes for a long time even in the presence of some disorders, but with the depletion of internal resources, the development of pancreatic tissue necrosis can be very fast and irreversible.
How to treat the pancreas?
Diagnostics
If pancreatitis is suspected, the doctor interrogates and examines the patient, paying attention to the color of his skin and mucous membranes. Sometimes the pain can have different localization depending on which part of the gland is damaged. If it hurts above the navel in the right hypochondrium, then the head of the gland is involved in the pathological process, if in the left – the tail. Vague girdle pain in the upper abdomen indicates the defeat of the entire gland. It is possible to differentiate problems with the pancreas and the transverse colon as follows: the doctor palpates the painful area, first in the supine position, and then on the left side. With the defeat of the pancreas, the pain in the position on the side will be less severe, with problems with the transverse colon, it will remain the same.
From laboratory tests, the determination of the levels of amylase, lipase, trypsin in the blood serum is prescribed. With a general blood test, an increase in the level of leukocytes is observed. Additionally, the activity of liver enzymes can be investigated: ALT and alkaline phosphatase, as well as bilirubin, their increase may be a sign of an attack of pancreatitis provoked by gallstones. Also, a urine test for amylase is performed using a PABA (PABA) test, a stool test for the presence of chymotrypsin, trypsin and high fat content. To detect disorders of carbohydrate metabolism, the amount of glucose in the blood is determined.
Of the instrumental methods can be used:
Radiography – with its help it is determined whether the pancreas is enlarged or not;
Computed tomography or MRI – to clarify the diagnosis, identify pancreatic necrosis or fluid accumulation in the abdominal cavity;
Ultrasound – to study the structure and nature of the contours of the gland, the state of the common excretory duct, to determine the presence of gallstones.
Treatment
With an attack of acute pancreatitis, you need to call an ambulance. The doctor will most likely prescribe complete fasting for 1-2 days, since pancreatic juice in this case will be produced in a minimal amount, and the load from the gland will be removed. Usually appetite decreases or even disappears a few days before the exacerbation. During this period, you need to drink alkaline water (mineral water without gas, baking soda solution) or rosehip broth.
In the case of acute pancreatitis, hospitalization and treatment in a hospital is necessary. To prevent dehydration and normalize pressure, a dropper is placed. Painkillers and drugs that suppress the secretion of enzymes are prescribed. In the first 3-4 days they are administered intravenously, and after some relief they are taken in the form of tablets. Ice may be applied to the area of the pancreas to reduce pain.
Painkillers
The most commonly used antispasmodics.
Antacids
To relieve pain and prevent irritation and ulceration of the gastric mucosa, drugs are used in the form of suspensions and gels that neutralize hydrochloric acid and reduce its production.
Enzyme preparations
In the early days, drugs are used that reduce the production of enzymes. After the removal of an acute attack and in chronic pancreatitis, enzyme therapy is prescribed to maintain pancreatic function and improve digestion.
Enzymes are taken immediately after meals, the dose is prescribed by the doctor individually. The course of treatment is long, often maintenance therapy becomes necessary throughout life.
Of the other drugs stimulate the secretion of the pancreas, pilocarpine, morphine, vitamin A, magnesium sulfate, lower – histamine and atropine. In violation of exocrine function, insulin preparations are prescribed to regulate blood sugar levels. Self-medication with damage to the pancreas is unacceptable. This can result in her necrosis, diabetes mellitus or blood poisoning.
Complications of chronic pancreatitis can be blockage of the blood vessels of the organ, bile ducts, gland cyst, infection or necrosis of its tissues (necrosis).
Operative intervention
The pancreas is a very delicate and sensitive organ, so any surgical intervention is highly undesirable. An operation may be required in case of blockage of the ducts of the gland, in the presence of a cyst, with stones in the gallbladder (sometimes the gallbladder itself is removed), if necessary, remove part of the pancreas due to the development of pancreatic necrosis.
How to take care of the pancreas?
As part of the Health program, the chief physician of the EXPERT polyclinic, MD, Professor Sabir Nasredinovich Mehdiyev tells how to maintain the health of the pancreas:
यो anatamy को सम्मपुर्ण अध्यन गर्दा पुर्णभयैा