What is the pancreas?
The pancreas is a narrow, flat organ about six inches long, with head, middle, and tail sections. It is located below the liver, between the stomach and the spine, and its head section connects to the duodenum. Inside the pancreas, small ducts (tubes) feed fluids produced by the pancreas into the larger pancreatic duct. This larger duct carries the fluids down the length of the pancreas, from the tail to the head, and into the duodenum. The common bile duct also runs through the head section of the pancreas, carrying bile from the liver and gallbladder into the small intestine. The bile duct and the pancreatic duct usually join just before entering the duodenum and so have a common opening into the small intestine.
The pancreas consists of two kinds of tissues:
Exocrine — which make powerful enzymes to digest fats, proteins, and carbohydrates. The enzymes normally are produced and carried in an inactive form to the duodenum where activation occurs as needed. Exocrine tissues also make and secrete bicarbonates that work to neutralize stomach acids thereby allowing for the activation of the pancreatic enzymes
Endocrine — which produce the hormones insulin and glucagon and release them into the blood stream. These hormones regulate glucose transport into the body’s cells and are crucial for maintaining normal glucose levels and energy production.
Common Diseases of the Pancreas
Pancreatitis is an inflammation of the pancreas. It is caused when the digestive enzymes from the exocrine pancreas become activated inside of the pancreas, instead of in the duodenum, and start “digesting” the pancreas itself. It usually presents with abdominal pain and can cause nausea and vomiting.
May be a single or a recurring event, and it usually occurs suddenly. The abdominal pain with acute pancreatitis is often severe. Secretions can back up in the pancreas and cause permanent damage in just a few hours. Acute pancreatitis often presents with raised levels of pancreatic enzymes in the blood. These enzymes can circulate to other body organs, causing shock and organ failure. Acute pancreatitis can lead to internal bleeding and infection and can be life-threatening. The most common cause of acute pancreatitis is blockage of the pancreatic duct (obstruction), usually due to gallstones and sometimes due to particles (sometimes tiny gallstones) in bile that have precipitated (biliary sludge). Because these pass through the bile duct, they may cause blockage of the common duct through which both biliary and pancreatic secretions pass into the duodenum. Other causes may include alcohol excess, physical trauma to the abdomen, exceedingly high blood triglyceride level, and high blood calcium level.
is characterized by chronic or persistent abdominal pain and may or may not present with raised pancreatic enzymes. It develops gradually, often results in slow destruction of the pancreas, and can lead to other problems, such as pancreatic insufficiency (see below), bacterial infections, and type 2 diabetes. The main causes of chronic pancreatitis are gallbladder disease (ductal obstruction) and genetic risks, which are increased by modifying factors such as alcoholism. Other causes include high blood calcium level and very, very high triglyceride level, some drugs, and autoimmune conditions. Hereditary chronic pancreatitis results from mutations that affect the secretion of digestive enzymes, such as cystic fibrosis, or mutations that cause early activation of digestive enzymes while they are still in the pancreas.
Cancer of the pancreas is the fourth leading cause of cancer death in the United States, killing more than 35,000 people a year. Risks include smoking, age, gender (more common in men), chronic pancreatitis, and exposure to some industrial chemicals. About 95% of pancreatic cancers develop in the exocrine tissues. Pancreatic cancer is very difficult to detect in the early stages because symptoms are either absent or nonspecific: abdominal pain, nausea, loss of appetite, and sometimes jaundice. Tumors near the head section that block flow to the intestine may be detected earlier. Only about 10% of the cancers are still contained within the pancreas at the time of diagnosis.
Pancreatic insufficiency is not a primary disorder but is secondary to the other causes of pancreatic disease. It is the inability of the pancreas to produce and/or transport enough digestive enzymes to break down food in the intestine. It typically occurs as a result of progressive pancreatic damage – damage that may be caused by a variety of conditions. It is most frequently associated with cystic fibrosis in children and with chronic pancreatitis in adults; it is less frequently but sometimes associated with pancreatic cancer.