Pancreas – structure and function, role in the development of diabetes

Inflammation of the pancreas is accompanied by constant or periodic pain of various types. This is the main symptom of pancreatitis, which can develop in acute and chronic forms. At the first manifestation of girdle pain around the abdomen, you should consult a doctor for examination. In most cases, treatment with medications and long-term diet is indicated.

The role of the pancreas in the body

It is difficult to overestimate the role of this organ, because after its complete removal a person usually does not live longer than one year³.
But why does this happen? On the shelves of pharmacies you can find enzyme preparations that compensate for the digestive function of the gland, and the lack of hormones can be compensated for by introducing their synthetic analogues into the blood. Unfortunately, not everything is so simple, since the endocrine function of the organ is very difficult to compensate. The pancreas produces many hormones and enzymes. The regulation of their secretion is associated with a huge number of factors that currently cannot be taken into account in hormone replacement therapy. Today, medicine can only correct the deficiency of any component, but not the functioning of the entire organ. The structure of the pancreas and the principles of its operation, discussed below, will help to understand this point more fully.

5 facts about the pancreas

• The most common organ disease is pancreatitis.
• Pancreatic enzyme preparations are made from the pancreas of slaughtered cattle.
• The pancreas begins to produce digestive juice within 2-3 minutes after eating.
• The organ has a similar structure to the salivary glands, which is why it was previously called the abdominal salivary gland.
• The gland is capable of digesting itself.

The structure of the pancreas

The pancreas is a fairly large organ (14-22 cm in length), which in a living person is located, contrary to its name, not under the stomach, but rather behind it. The “pancreas” was named because of its displacement under the stomach after a person’s death. It is also interesting that it is located separately from most digestive organs in the so-called retroperitoneal space, “settled” in it next to the kidneys and large vessels.

The structure of the pancreas consists of a head, body and tail. Its head adjoins the duodenum, and its tail approaches the spleen. Externally, the organ has a lobular appearance. Each such lobule is a functional unit of the gland (acinus), which consists of secretory cells and has its own small duct. The small ducts of each lobule unite into larger ones, and then flow into the main excretory duct, which runs in the center of the organ along the entire length.

Figure 1. Structure and topography of the pancreas. The red dotted line indicates the boundaries of the head, body and tail; black dotted line - ductal system of the gland. The bile ducts are marked in green. Illustration by Danila Melnikov

In the area of ​​contact between the head of the pancreas and the duodenum, the above-mentioned excretory duct opens into the cavity of the latter. Thus, pancreatic juice formed in the lobules enters the intestine through the excretory duct.

How are the pancreas and biliary system related?

Figure 1 shows that another large duct, called the common bile duct, flows into the excretory duct of the pancreas. Since both ducts have one outlet into the intestine, with cholelithiasis it is possible to block not only the bile ducts, but also the pancreatic duct system. The rule also works in the opposite direction: with neoplasms of the pancreas, the common bile duct may be blocked. It is for this reason that jaundice can be a symptom of both diseases.

Endocrine part of the pancreas

In addition to the lobules with exocrine cells involved in the production of pancreatic juice, the gland has so-called pancreatic islets. They are also called the islets of Langerhans in honor of the scientist who discovered them. These are small clusters of cells that are “scattered” inside the organ, mainly in its tail part. These cells do not have ducts, since their secretions are absorbed by adjacent microvessels and enter directly into the blood. The main products of pancreatic islets are hormones: insulin and glucagon.

Thus, the pancreas essentially combines two completely different organs: digestive and endocrine. Glands of this type, which remove secretions through ducts and at the same time secrete hormones into the blood, are called mixed secretion glands.

Obesity and pancreatic diseases

In addition to the fact that acute pancreatitis develops more often in obese individuals, the latter also contributes to the development of type 2 diabetes mellitus. With this form of diabetes, there is no direct damage to the pancreas. However, tissue resistance to insulin develops, which ultimately leads to hyperglycemia and the corresponding symptoms described above. Therefore, it is important to eat in moderation, watch your caloric intake and be physically active.

Diet for pancreatitis

For any form of the disease, the patient is prescribed a strict diet “Table No. 5p”, according to which it is forbidden to eat spicy and fried foods. All dishes are steamed, boiled or baked. Alcohol and smoking are also prohibited.

It is also necessary to limit salt intake and eat small portions 6 times a day. Dishes should always be served warm. It is necessary to exclude all products with a high content of extractives or essential oils (fish, meat broths, cocoa, coffee, etc.), fresh berries, vegetables, herbs, fruits, sour juices, carbonated drinks, marinades.

Functions in the body

The pancreas has two fundamentally different functions: exocrine and endocrine. In this regard, there is a complete correlation with the structure of the organ, as we have seen above. Let's look at each of the functions separately.

Exocrine function

The prefix “exo-” translated from Greek means outside, outside. In anatomy, exocrine glands are called glands that have ducts and the secretion of which is released through them into various cavities. In this case, pancreatic juice flows through the pancreatic duct and enters the intestine. Pancreatic juice is a liquid consisting of water, sodium bicarbonates and enzymes. Each of the components has a meaning:

• Sodium bicarbonate is a substance necessary to neutralize the aggressive acidic contents that flow from the stomach into the intestines. The thing is that acid is a damaging factor for the intestinal mucosa. Therefore, when hydrochloric acid as part of a bolus of food enters the intestine, it immediately reacts with the aforementioned bicarbonate and becomes harmless.
• Enzymes refer to special protein structures that break down food components: proteins, fats and carbohydrates. For each of these nutrients, pancreatic juice contains its own enzymes that break them down into simpler compounds. For carbohydrates - amylase, for proteins - trypsin and chymotrypsin, for fats - lipase and phospholipase. This is necessary for the reason that the intestinal mucosa is not able to absorb nutrients in their original form.
• Water is a universal solvent and an ideal medium for the remaining components.

In the absence of bicarbonates, gastric contents would form ulcers in the intestines. A lack of enzymes would lead to the inability to obtain the necessary nutrients and, as a consequence, to various metabolic disorders. It is these processes that occur in the body when the gland duct is blocked by a tumor, a stone, or when most of the organ is destroyed (with chronic pancreatitis).

Why doesn't the pancreas digest itself?

This question is quite reasonable, because pancreatic tissue, like all other organs and like the food we eat, consists of proteins, fats and carbohydrates. However, pancreatic juice enzymes normally do not cause any damage to the gland. The thing is that enzymes are initially secreted in an inactive form. Only after the enzymes in pancreatic juice enter the intestines do they become activated. The enzyme enteropeptidase, produced by the intestinal mucosa, is responsible for this process.

Endocrine function

The prefix “endo-” has the opposite meaning - in, inside. The endocrine part of the pancreas (pancreatic islets) secretes several hormones directly into the blood, the main ones being insulin and glucagon.

The importance of insulin for the body

Insulin is one of the most significant hormones in the human body. The main function of this substance is the distribution of glucose from the blood to organs and tissues. The hormone is produced especially actively in the first few hours after eating.

Figure 2. Functions of insulin in the body. Image: Ismail Jarmouni / Wikipedia (CC BY-SA 4.0)

During the digestion of food, complex carbohydrates are broken down into simple molecules, and glucose is the main product of this process. Glucose is the main energy substrate for almost all cells in the body. Without it entering the cells, their work will stop, just as a steam locomotive will stop without coal. In this comparison, insulin acts as a fireman throwing coal into the firebox of a steam locomotive. In addition to carbohydrates, insulin takes part in fat and protein metabolism. Without this hormone, the synthesis of the body's own proteins and fats is disrupted.

We can talk about the functions of insulin for a long time. However, it is very clear what happens to a person when this hormone is not produced or does not work for other reasons, which happens in patients with diabetes. All organ systems suffer: cardiovascular, immune, nervous - almost all organs are affected by the lack of glucose supply. The exception is the brain, which can take up glucose from the blood even without insulin. But as diabetes progresses, the brain also suffers damage due to vascular damage.

Glucagon and its functions

Glucagon is a complete insulin antagonist. If insulin stimulates the entry of glucose into cells and the synthesis of proteins and fats, then glucagon reverses these processes. The need for this arises during the period of fasting in order to release nutrient reserves into the blood from the depot and thereby constantly maintain a certain concentration in the blood. This is especially true during physical activity to ensure that fatty acids and glucose enter the bloodstream to fuel muscles. Insulin and glucagon are not produced separately; these hormones always work in pairs, clearly regulating metabolic processes in the body.

Symptoms of pancreas problems

Symptoms of pancreatic diseases vary greatly depending on the severity of the pathological process. The most common acute condition is acute pancreatitis. As for chronic diseases, these are mainly chronic pancreatitis, cysts and tumors. Type 1 diabetes mellitus stands apart, in which autoimmune damage to the endocrine apparatus of the gland occurs.

Figure 3. Proper nutrition to prevent pancreatitis. Source: BelSU

Symptoms of acute pancreatitis

Acute pancreatitis is a dangerous condition that is accompanied by destruction of the pancreas due to its self-digestion. This occurs due to a violation of the outflow of pancreatic juice and an increase in pressure within the ductal system, which ultimately gradually leads to the activation of enzymes before secretion into the intestine. The initial symptoms of acute pancreatitis are as follows:

• Sharp, sudden pain in the upper abdomen. The pain syndrome is distinguished by: high intensity, constancy, often encircling in nature. Less commonly, the pain spreads to the entire abdomen and very rarely is absent altogether.
• Specific taste in the mouth.
• Nausea.
• Repeated vomiting.
• Bloating.
• Yellow-bluish spots on the abdomen (rare).

Of these symptoms, the most persistent and constant is pain. The girdling nature of the pain is relatively specific for pancreatitis. The presence of other manifestations is variable. For this reason, acute pancreatitis in the initial stages is difficult to distinguish from other acute diseases of the abdominal cavity. However, the appearance of these symptoms 12-48 hours after drinking a significant amount of alcohol or some time after eating a large meal makes the diagnosis highly likely.

Important!

The described symptoms, especially pain, are a reason to seek help from an ambulance. Acute abdominal pain, combined with or without other symptoms, requires examination by a surgeon and urgent instrumental diagnosis.

Symptoms of chronic pancreatic diseases

Chronic pancreatitis

Chronic pancreatitis is a slowly progressive disease in which functional pancreatic tissue is replaced by nonfunctional connective tissue. Possible symptoms:

• Dull, aching pain in the upper abdomen, may be of a girdling nature.
• Nausea.
• Vomit.
• Alternating constipation and diarrhea.
• Loss of body weight.
• Yellowness of the skin.
• Symptoms of diabetes.

With an exacerbation of the process, the symptoms become the same as in acute pancreatitis.

Figure 4. Healthy pancreas and changes in it characteristic of acute and chronic pancreatitis. Image: Pikovit/Depositphotos

Pancreatic cysts and tumors

Pancreatic cysts are cavities with fluid that can be located both in the gland itself and in the tissues surrounding it. These formations can be congenital or appear as a result of various pathological processes. Small cysts do not manifest themselves in any way. Symptoms appear when the cyst becomes infected, becomes large, or causes pressure on nearby organs. Among the manifestations:

• Dull aching pain in the upper abdomen, constant or paroxysmal, can be girdling.
• Nausea.
• Vomit.
• Weakness and weight loss.
• Periodic increase in body temperature.
• Palpable tumor formation in the abdomen.
• Yellowness of the skin.

Tumors, both benign and malignant, are clinically identical to cysts. The difference is that malignant tumors more often cause jaundice, which is usually the reason for visiting a doctor. The appearance of pronounced symptoms in the case of malignant tumors, unfortunately, indicates an advanced process.

There are also special hormone-producing tumors of the pancreas. The most common of them is insulinoma. As the name suggests, this neoplasm is capable of uncontrollably secreting insulin into the blood, which causes low blood glucose concentrations. The following symptoms develop:

• Tremor.
• Weakness.
• Sweating.
• Constant feeling of hunger.
• Confusion, memory impairment.
• Epileptic seizures.
• Coma.

If you eat something sweet, these symptoms are smoothed out or disappear.

Symptoms of diabetes

Type 1 diabetes mellitus develops as a result of autoimmune damage to the insular apparatus of the pancreas. Because of this process, insulin is not secreted into the blood after eating, which leads to excessive concentrations of glucose in the blood (hyperglycemia). This manifests itself symptomatically:

• Increased urination.
• Thirsty.
• General weakness and fatigue.
• Increasing incidence of infectious diseases.
• Slow healing of wounds.

Typically, patients seek help at this stage of the disease. However, as the disease progresses, the number of symptoms may increase significantly due to the systemic nature of the disorders.

Symptoms of pancreatitis in men and women

Pancreatitis presents with similar symptoms in men and women. The main one is a sharp pain that surrounds the abdomen and can radiate to the back and shoulder blades. At the same time, the sensations do not intensify during coughing, sneezing or taking a deep breath, which is typical for cholecystitis and appendicitis. Sometimes pain is accompanied by vomiting and nausea, which, however, do not lead to a weakening of symptoms. The disease is also characterized by other manifestations:

• pale or blue skin;
• a sharp decrease or increase in temperature;
• colic in the intestines;
• cardiopalmus.

Attention!

Acute pancreatitis can cause internal bleeding, which is often fatal. Therefore, at the first occurrence of painful sensations of a chronic nature, it is necessary to undergo diagnostics.

What is the pancreas afraid of?

The two main “enemies” for the pancreas are alcohol and gallstone disease. Both cause acute pancreatitis in 90% of cases³.

The effect of alcohol on the pancreas

Alcoholic pancreatitis is common, but how does alcohol contribute to inflammation in the pancreas? The thing is that it affects the gland through three effects:

• Spasm of the sphincter of Oddi, a muscle that closes the outlet for pancreatic juice in the duodenum.
• Increased secretion of pancreatic juice by exocrine cells of the gland. This effect is especially pronounced when combining alcohol intake with fatty foods.
• Increasing the permeability of the ductal system for protein substances, which are pancreatic juice enzymes.

Thus, all conditions are created for the premature activation of digestive enzymes, which leads to the development of pancreatitis.

Alcohol is the main enemy of the pancreas. Photo: alexlmx/Depositphotos

Gallstones and pancreatitis

The connection between the common bile duct and the exit pancreatic duct has already been mentioned above. Because of this anatomical feature, stones in the biliary system can interfere with the release of pancreatic juice, which becomes the cause of biliary pancreatitis. Thus, the “enemies” of the gallbladder are also those of the pancreas. Common causes of gallstone disease are:

• Long breaks between meals.
• A diet high in fat and cholesterol, fried foods.
• Taking combined oral contraceptives in women.
• Obesity.

Causes of pancreatitis

As a rule, signs of pancreatitis in both women and men in most cases occur due to excessive consumption of alcohol-containing products. In 20% of cases, it is not possible to establish the cause of the disease at all.

At CELT you can get advice from a gastroenterologist.

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• Repeated consultation – 3,000

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Medical statistics are harsh: the risk of inflammation in the pancreas increases in patients suffering from:

• metabolic disorders – primarily lipid metabolism;
• diabetes mellitus;
• hormonal imbalance;
• diseases of the biliary system (in particular, cholelithiasis);
• vascular diseases;
• peptic ulcer;
• infectious diseases (mumps, viral hepatitis);
• autoimmune diseases (including primary biliary cirrhosis, inflammatory bowel disease, autoimmune thyroiditis and others).

Pancreatitis in children and adults can be triggered by injuries and wounds in the abdominal area, surgical interventions on the stomach and biliary tract, as well as taking a number of medications (including hormonal drugs). Some genetic disorders are associated with pancreatitis - familial hyperlipidemia, familial hyperparathyroidism.

Maintaining proper pancreas function

Unfortunately, not all pancreatic diseases have developed preventive measures, and some of these diseases are genetic in nature (for example, type 1 diabetes). But you can successfully prevent the most common pathology - acute pancreatitis.

To do this, first of all, you need to give up excessive alcohol consumption and adjust your diet. You should not abuse products such as:

• Rich bread.
• Fatty meats.
• Pork lard, beef and lamb fat.
• Sour vegetables and fruits.
• Ice cream, confectionery with cream.
• Fatty and spicy sauces.
• Deep fried food.
• Highly carbonated drinks.
• Strong coffee and cocoa.
• Products with artificial colors and preservatives.

For patients with chronic pancreatitis, it is better to try to exclude these foods from the diet completely. It is also recommended to avoid long breaks (more than 4-5 hours) between meals.

Treatment of acute pancreatitis

If acute pancreatitis is detected, the patient should be hospitalized immediately. Treatment should take place in a hospital setting, as this condition is very dangerous.

To relieve pain, antispasmodics are taken; in difficult cases, the contents of the stomach are pumped out to relieve the load on the gland.

In case of exacerbation of pancreatitis, patients require hospitalization with daily monitoring of blood parameters, water balance, leukocyte count, and enzyme levels in the blood serum during the first week. In the first 1–3 days, fasting and taking alkaline solutions every 2 hours are recommended.

During an exacerbation of chronic pancreatitis, the patient is shown therapy similar to the acute process. The patient must follow a diet throughout his life and take drugs from the group of antispasmodics and drugs that normalize the secretory function of the organ.

The most important thing in the chronic form of the disease is to maintain a diet that involves excluding fatty and fried foods from the diet. At the slightest violation of the regimen, the patient may experience discomfort and nausea. For intense pain, the doctor prescribes antispasmodics. Antisecretory therapy can be used for a short course.

Sources

1. Guyton, A.K. Medical physiology / A.K. Guyton, J.E. Hall / Per. from English; Ed. IN AND. Kobrina. - M.: Logosphere, 2008. - 1296 p.: ill.
2. Prives M. G., Lysenkov N. K., Bushkovich V. I. / Human Anatomy. — 12th ed., revised. and additional - St. Petersburg: Publishing house SPbMAPO, 2006. - 720 p., ill.
3. Surgical diseases: Textbook / M. I. Kuzin, O. S. Shkrob, N. M. Kuzin, etc.; Ed. M.I. Kuzina. — 3rd ed., revised. and additional - M.: Medicine, 2002. - 784 p.: ill.
4. Erika F. Brutsaert, MD. Diabetes mellitus // MSD Handbook - 2019.
5. Imaeva A.K., Mustafin T.I., Polovinkina S.R. MORTALITY AND MORTALITY INDICATORS IN ACUTE PANCREATITIS AS AN INDICATOR OF THE STATE OF MEDICAL CARE AT THE REGIONAL LEVEL // Problems of social hygiene, health care and history of medicine. 2021. No. 6.

What to do?

First of all, it is worth noting that you cannot self-medicate, you must contact a specialist. You should not take painkillers or put heat on your stomach - this can only worsen the process. You need to see a therapist or gastroenterologist, undergo an ultrasound, ECG and MRI. The doctor may also prescribe additional tests or examinations if necessary.

If the disease is diagnosed at an early stage, drug treatment will help. If the disease is advanced, surgical intervention is prescribed. In any case, there is no time to waste, you need to contact specialists and not self-medicate!