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The pancreas

The pancreas

The medical term for pancreas is the pancreas. What is this gland responsible for in the organism and what are common diseases?

The pancreas is hidden behind the stomach and the spine.

It is a yellowish gland, about 15 cm long, 5 cm wide and 2-3 cm thick, weighing about 80-120 g. It is divided into pancreatic head, pancreatic body and pancreatic tail. The head of the pancreas, through which a part of the bile duct passes, is closely related to the duodenum. The tail of the pancreas extends to the spleen on the left side. The body of the pancreas lies immediately in front of the origin of important vessels from the aorta, which supply blood to the liver, stomach, upper intestine and also the pancreas.

Basically, the pancreas fulfills three extremely important tasks:

  1. The pancreas is important for digestion (exocrine function).
  2. The pancreas controls blood sugar regulation (endocrine function).
  3. The pancreas neutralizes gastric acid.

The pancreas produces important enzymes. It produces 1.5-3 l of enzyme-containing secretion daily. In the process, 60 g of protein are converted in the gland. This is a great metabolic achievement. This digestive secretion is produced by specialized cells throughout the gland. Initially, an ineffective precursor is formed, which is directed into a widely ramified duct system and finally collected in a main duct, the so-called "ductus pancreaticus", and released into the duodenum. Just before entering the duodenum, this pancreatic secretion is joined by bile, which comes from the liver. These secretions are passed into the duodenum. The site of the orifice is called papilla Vateri. In the duodenum, the enzymes of the pancreas are activated, i.e. converted into their effective form. Now the food coming from the stomach can be digested. The pancreas produces more than 20 different digestive enzymes that break down the food into its smallest building blocks. Only in this way can the food be absorbed from the intestine into the blood. However, these enzymes are not converted to perform their task until they reach the duodenum. This prevents these enzymes from digesting the pancreas itself. The three most important pancreatic enzymes are amylase (digests carbohydrates), trypsin (digests proteins) and lipase (digests fats).

What you should know
Breaking down food components into tiny pieces is necessary for the body to absorb them through the intestines. If the pancreatic enzymes are missing, the carbohydrates (starches, etc.), proteins and fats are not broken down properly, and the intestines are not able to absorb the food components into the blood. As a result, undigested food continues to remain in the intestines. This can lead to significant diarrhea, flatulence and also abdominal cramps. The focus is on insufficient fat digestion, which can result in greasy, slimy stools. In addition, the lack of absorption of food components into the body leads to a steady loss of weight and possibly also to a deficiency of certain fat-soluble vitamins (A, D, E and K).

In addition to digestive enzymes, the pancreas produces an important hormone, insulin. This is produced in specialized cells, which are found in small groups (called islets) throughout the gland, but mainly in the tail of the pancreas. These so-called islets of Langerhann account for only about 2.5 g of the gland, which weighs about 80-120 g. The pancreas is the largest pancreas in the world. Approximately 1.5 million islets are found in the pancreas.

Insulin is released directly from the pancreas into the blood and controls blood glucose levels. In a sense, it opens the doors for sugar to enter all the cells of the body. Sugar is an important source of energy for our body. All cells depend on sugar. After the sugar has been absorbed from the intestine into the blood, insulin enables the sugar to pass from the blood into the various cells of the body.

If there is too little or no insulin left, the sugar cannot pass from the blood into the corresponding body cells. As a result, the sugar level in the blood continues to rise. This can have unpleasant and even life-threatening consequences for humans. Patients with diseases of the exocrine (digestive) parts of the pancreas usually suffer from a more or less pronounced lack of insulin.

What diseases of the pancreas are there?

In addition to rare hereditary malfunctions or malformations of the pancreas, we are mainly familiar with the following three clinical pictures: acute pancreatitis, chronic pancreatitis and pancreatic carcinoma.

What is acute pancreatitis?

Acute pancreatitis is an acute, i.e. sudden onset, inflammation of the pancreas. Damage to the pancreatic cells occurs, which leads to temporary functional impairment of the pancreas. Depending on the severity of the damage, pancreatic cells may also die. In this process, various harmful substances are released into the entire body, causing the patient to become life-threateningly ill. In the course of the disease, other organs may also be attacked and their function may be impaired. We distinguish two forms of acute inflammation of the pancreas:

  • Acute edematous pancreatitis.
  • The acute necrotizing pancreatitis

At the onset of pancreatitis, it is usually impossible to tell which of the two forms of the disease is present or developing. Therefore, all patients with acute pancreatitis must receive intensive care at an early stage.

What is chronic inflammation of the pancreas?

Chronic pancreatitis is a chronic (over a long period of time) inflammation of the pancreas. Persistent and recurrent episodes of inflammation of the pancreas result in the slow destruction of the functional cells in the gland. These are replaced by scar-like tissue. As a result, the pancreas can no longer perform its normal function adequately:
the production of digestive enzymes, which are responsible for ensuring that food can be broken down into smaller units and thus absorbed from the intestines into the body, dries up. Diarrhea (often foul-smelling), weight loss and vitamin deficiency states result.
The islet cells of the pancreas, are also destroyed. As a result, less or no insulin is produced, glucose metabolism is disturbed, and diabetes mellitus develops.

A major symptom of chronic pancreatitis is severe upper abdominal pain, which is often belt-shaped and may radiate to the back. They probably originate from changes in the nerve tissue in the pancreas and obstruction of outflow from the pancreatic ducts. This results in ever-increasing pressure in the organ. Pain can also occur due to obstruction of the passage of food through the stomach and intestines or massive flatulence. This pain often cannot be relieved even by the strongest painkillers.

What is pancreatic cancer?

Cancer can basically develop in any organ of the human body when individual cells begin to multiply more than normal, are no longer subject to the growth control of the surrounding tissue, and then grow into other tissues or organs. Cancer often develops due to congenital or acquired genetic defects. The reasons why these defects occur are often not yet known. If the cancer is not treated, it grows in an organ and destroys its normal function. It continues to grow beyond the organ boundary into neighboring organs. It is particularly dangerous that it spreads throughout the organism via the blood and lymphatic channels (metastasis). The goal of treatment of carcinoma is complete surgical removal. It is called curative surgery if the tumor can be completely removed.
If the surgery is mainly performed with the aim of reducing symptoms (e.g. pain relief) or eliminating obstacles to passage, it is called palliative surgery. Even with curative surgery, cancer cells can remain in the body because individual cancer cells have not visibly already migrated into the surrounding tissue or other organs. These individual cancer cells are often undetectable at the time of surgery. If it can be suspected that cancer cells may still remain in the body, additional therapy, such as chemotherapy or radiotherapy (radiation therapy), is often recommended to kill any cancer cells that may still be present. This form of treatment is called adjuvant therapy.
In cases where the tumor could not be completely removed, adjuvant therapy such as chemotherapy or radiotherapy is recommended to slow tumor growth or reduce symptoms caused by the remaining tumor. Due to advances in chemotherapy and radiotherapy, serious side effects that were common in the past (such as vomiting, hair loss) are now less common.
In order for advances to be made in the treatment of the tumor condition, clinical trials (studies) must be conducted. In this process, patients are assigned to different treatment groups (proven therapy method versus new one to be tested) in order to then be able to identify which method is the most successful. The optimal care of the patient is always in the foreground.

Cystic changes of the pancreas

Cystic changes in the pancreas are often discovered by chance during examinations performed for other reasons or as a check-up, since in the vast majority of cases they do not cause any symptoms. On the whole, they occur more and more frequently depending on age; it is assumed that 3-10% of all people have such changes in old age.

Genuine cystic changes must be distinguished from so-called "pseudocysts", which are found after acute pancreatitis or in chronic pancreatitis and are harmless. Among true cystic changes, serous and 8 pancreatic diseases - an information for patients and relatives mucinous cystadenomas as well as Intraductal Papillary Mucinous Neoplasia (IPMN) are most frequently found. These changes are benign in themselves, but - depending on which cystic change is present - have a risk of developing into a malignant tumor in the long term.

Therefore, especially in the case of mucinous cystadenomas and IPMNs, a detailed examination must be performed and then the risk of degeneration must be assessed. Some of these cystic changes can continue to be monitored at regular intervals, while others require surgery to prevent the development of pancreatic cancer or, if already present, to remove it at the earliest possible stage. Thus, the prognosis of these changes is very good overall.