What is the pancreas, where is it, how does it hurt?
- What is the pancreas?
- Where is the pancreas located?
- Pancreas dimensions
- Digestive enzyme functions
- How does the pancreas hurt?
- How is the pancreas treated?
- How to care for the pancreas?
- Role of diet in treatment
What is the pancreas?
The pancreas is an important organ of the digestive system with a mixed function: external (exocrine) and internal (endocrine). The function of external secretion is to release pancreatic juice, which contains the 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?
Every day, the pancreas produces 500-1000 ml of pancreatic juice, consisting of enzymes, salts and water. The enzymes produced by the pancreas are called "proenzymes" and are produced 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 activate the enzymes of pancreatic juice. The most powerful stimulant of pancreatic secretion is gastric acid hydrochloric acid, which, when it enters the small intestine, activates the secretion of secretin and pancreozymin by the intestinal mucosa, which, in turn, affect the production of pancreatic enzymes.
These enzymes include:
- Amylase, which breaks down carbohydrates;
- Trypsin and chymotrypsin, which are 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 provide 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 flow into the main excretory duct, which flows into the duodenum.
The internal secretory function of the gland is to release the hormones insulin and glucagon into the bloodstream. They are produced by groups of cells interspersed between the lobules and lacking 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 is transferred from the blood to 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. it increases blood glucose levels. Also, alpha cells are involved in the production of a substance called 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 numbers of other cells, for example, delta cells (1%), which secrete the hormone ghrelin, which is responsible for appetite and stimulates food intake. PP cells (5%) produce a pancreatic polypeptide formed by 36 amino acids and suppressing the secretion of the pancreas.
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 production.
The pancreas is closely related to other organs of the digestive tract. Any damage to it or disruptions 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 adjacent to it and the duodenum, at the level of the upper (first or second) lumbar vertebrae. In projection onto 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 encompasses it in a horseshoe shape. 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, blood outflow occurs through the portal vein.
In the body of the pancreas, anterior, posterior and inferior surfaces are distinguished. The top, front and bottom edges are also distinguished in it. The anterior surface is adjacent to the posterior wall of the stomach, slightly below. The posterior surface is adjacent to the spine and abdominal aorta. The vessels of the spleen pass through it. The lower surface is below the root of the transverse colon. The tail of the gland has a conical shape, directed up and to the left and reaches the gate 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 interconnect and merge into a common excretory duct, which runs in the thickness of the gland along its entire length, from the tail to the head. At the right edge of the head, the duct opens into the duodenum, connecting with the common bile duct. Thus, the pancreatic secretion enters the duodenum.
Between the lobules there 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 microns.
In terms of size, the pancreas ranks second after the liver among the organs that produce enzymes. Its formation begins already in the fifth week of pregnancy. In a newborn child, the gland is up to 5 cm long, 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 and more, the thickness varies from 1.5 to 3 cm. The body of the gland is the longest part, its width is 1.75-2.5 cm on average. 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 appropriate conclusions can be drawn about its condition.
All organ sizes, as well as the possible reasons for their changes, are recorded in detail in the ultrasound protocol. In an unchanged state, iron has a homogeneous structure. Small deviations from the normal sizes of the head, body and tail are permissible only with good indicators of a biochemical blood test.
Pancreas size is normal
The length of the gland of an adult is from 15 to 22 cm, its weight is about 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 make up the pancreatic juice: trypsin, lipase and amylase:
- Trypsin breaks down peptides and proteins. It is initially produced by the pancreas in the form of 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 is a water-soluble enzyme that digests and dissolves triglycerides (neutral fats). It is produced in the form of an inactive prolipase, and then, under the influence of other enzymes and bile acids, it turns into an active form. Lipase breaks down neutral fats into higher fatty acids and glycerin. Also, this enzyme is involved in energy metabolism, ensuring the delivery of polyunsaturated fatty acids to the tissues and the assimilation 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 is primarily reduced. The first sign of this is greasy, gray-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) the salivary glands. Changes in the content of this enzyme in the blood are characteristic of many diseases (diabetes mellitus, hepatitis, etc.), but this primarily indicates acute or chronic pancreatitis.
Unlike other substances involved in the digestion process, pancreatic enzymes are secreted only during meals - their active release begins 2-3 minutes after the 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 down lipids into smaller droplets, that is, prepares them for breakdown. Pancreatic enzymes are produced in an inactive form and are activated only in the lumen of the duodenum by enterokinase.
Pancreatic enzyme deficiency symptoms
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, it is possible to distinguish improper, inappropriate nutrition, concomitant diseases (gallstone disease), infections, injuries, and taking certain medications.
Lack of trypsin, lipase and amylase causes serious disturbances in the digestive process.
Common symptoms of pancreatic problems:
- pain in the upper left part of the abdomen under the ribs, which often occurs after eating, but may not be associated with food intake;
- decreased 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, 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; the stool is liquid, oily.
With a lack of amylase, there is an intolerance to foods rich in carbohydrates, frequent, loose, watery bulky stools due to excess starch, malabsorption (impaired absorption of nutrients in the small intestine, accompanied by diarrhea, vitamin deficiency, weight loss), a high content of opportunistic microflora in intestines.
Insufficiency of trypsin is expressed in moderate or severe creatorrhea (increased content in the feces of nitrogen and undigested muscle fibers, i.e. protein), the stool is mushy, fetid, anemia may develop.
Since the process of breaking down complex food molecules is disrupted, and it is not absorbed in full by the body, even with increased nutrition, there may be a decrease in body weight, vitamin deficiency, dry skin, brittle nails and hair. When poorly processed food from the small intestine enters the large intestine, flatulence (increased gas production and waste gases), frequent bowel movements occur.
With a decreased secretion of enzymes by the pancreas, replacement therapy is prescribed, however, plant-derived enzymes cannot fully compensate for the lack of its external secretion.
If the outflow of enzymes into the intestine is disturbed, this can lead to irritation of the tissues of the gland and its edema, and as a consequence - to destruction and necrosis.
When the islets of Langerhans are affected, insulin production is suppressed and clinical symptoms of type 1 diabetes mellitus are observed, the severity of which will depend on the number of preserved and fully functioning beta cells. The deficiency in glucagon secretion is not felt so 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 the left side under the ribs;
- Heart palpitations;
- Increased sweating;
- Yellowness of the skin and whites of the eyes;
- Temperature increase;
- Vomiting, diarrhea;
- In some cases - a state of shock.
In acute pancreatitis, the pain is severe, acute, begins suddenly, may have a shingles in nature, that is, cover the entire left side and go behind the back. The pain is not relieved by antispasmodics; it is relieved by sitting or bending forward. In some cases, an enlargement of the pancreas is physically felt: there is a feeling of fullness from the inside, pressure on the rib area, which interferes with normal breathing.
The stronger the pain, the more the gag reflex increases. Sometimes attacks of vomiting begin earlier than pain syndrome: it usually occurs in the morning or with food, as a result of stomach cramps. Vomiting has a bitter or sour taste, followed by temporary relief. It can be either periodic or systematic. In the event of an acute attack of pancreatitis, it is necessary to see a doctor and be treated in a hospital, since this disease itself will not go away. In case of persistent vomiting, the stomach is cleared with a probe and special enzymes are injected to calm the excessive aggressiveness of the stomach and pancreas.
Symptoms of pancreatitis are sometimes similar to those of osteochondrosis of the lumbar spine, an attack of pyelonephritis or shingles. It is possible to differentiate pancreatitis as follows: with osteochondrosis, painful palpation of the vertebrae; 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 violation of the diet (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 streams of the gland by gallstones. With chronic pancreatitis, the risk of developing an oncological process in the pancreas increases: cancer occurs in 4 cases out of 100 in patients with pancreatitis.
With 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 certain disorders, but with the depletion of internal resources, the process of development of necrosis of pancreatic tissues can be very rapid and irreversible.
How is the pancreas treated?
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, it means that 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 a lesion of the pancreas, the pain in the lateral position 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 studied: ALT and alkaline phosphatase, as well as bilirubin, their increase may be a sign of an attack of pancreatitis provoked by gallstones. Also, a study of urine for amylase using PABA (PABA) -test, a study of feces for the presence of chymotrypsin, trypsin and high fat content is carried out. To detect disorders of carbohydrate metabolism, the amount of glucose in the blood is determined.
From instrumental methods can be applied:
- X-ray - 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, and determine the presence of gallstones.
With an attack of acute pancreatitis, complete starvation is necessary for 1-2 days, since pancreatic juice in this case will be produced in a minimum amount, and the load from the gland will be removed. Usually, the appetite decreases or disappears altogether 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 case of severe abdominal pain, severe vomiting or moderate pain for several days, you should definitely contact a medical facility, since such symptoms can also be signs of cholecystitis, appendicitis, peptic ulcer or intestinal obstruction.
In the case of acute pancreatitis, hospitalization and treatment are necessary in a hospital setting. A dropper is placed to prevent dehydration and normalize pressure. Pain relievers 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 can be applied to the pancreas to reduce pain.
Find out more: Medicines used in the treatment of the pancreas
The most commonly used antispasmodics are: Baralgin, No-Shpa, Papaverine, Drotaverin, with moderate pain, you can use Acetaminophen or Ibuprofen. Sometimes analgesics are used: Aspirin, Paracetamol. Anticholinergic and antihistamines can also be used: Atropine, Platyphyllin, Diphenhydramine.
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 (Almagel, Fosfalugel) and agents that reduce its production (Contraloc, Omez, Omeprazole, Gastrozol, Proseptin, Otsid). In hospitals, H2-blockers Ranitidine, Famotidine or their analogs Acidex, Zoran, Gasterogen, Pepsidin are prescribed.
In order to reduce the production of enzymes, Contrikal or Aprotinin are used. After the removal of an acute attack and in chronic pancreatitis, enzyme therapy is prescribed to maintain the functions of the pancreas and improve digestion. The most common drugs are Pancreatin, Mezim, Festal, Creon, Panzinorm. However, they are based on pork protein and should not be taken if you have an allergic reaction to pork. In children, this allergic reaction can cause intestinal obstruction. In this case, herbal preparations based on rice fungus or papain are prescribed: Unienzim, Somilaza, Pepfiz.
Enzymes are taken immediately after a meal, the dose is prescribed by the doctor individually. The course of treatment is long, often supportive therapy becomes necessary throughout life.
Among other drugs, pilocarpine, morphine, vitamin A, magnesium sulfate stimulate the secretion of the pancreas, and lower histamine and atropine. If exocrine function is impaired, insulin preparations are prescribed to regulate blood sugar levels. Self-medication for lesions of the pancreas is unacceptable. This may 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, cyst of the gland, infection or necrosis of its tissues (necrosis).
The pancreas is a very delicate and sensitive organ, so any surgical intervention is highly undesirable. The 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 pancreatonecrosis.
How to care for the pancreas?
Within the framework of the "Health" program, the chief physician of the EXPERT polyclinic, MD, professor Sabir Nasredinovich Mekhtiev tells how to maintain the health of the pancreas:
Find out more: The most effective recipes for restoring the pancreas!
The Role of Diet in Treating the Pancreas
Diet is a very important element in the treatment and prevention of exacerbations of pancreatitis. If this is neglected, any medicine can be powerless. Since the qualitative and quantitative ratio of the enzymes produced by the gland varies depending on the composition of the foods consumed at one meal, it is recommended to switch to separate nutrition in order to reduce the load on the gland, that is, to consume proteins and carbohydrates in different meals. You should also not overeat: the daily calorie intake should not exceed the norm corresponding to age, gender and physical energy expenditure.
- Fatty foods, fried foods;
- Sausages, canned food, smoked meats, salted foods;
- Jellied meat, aspic;
- Sour juices;
- Strong tea and coffee;
- Confectionery (cakes, pastries), ice cream;
- Hot spices, herbs and seasonings, mustard, horseradish.
Find out more: What is possible, what is good and what is bad for the pancreas?
- Chicken, turkey, rabbit, fish - cod, bream, pike perch, pike;
- Steamed dishes;
- Kefir, yogurt;
- Non-acidic cottage cheese, unleavened cheese;
- Boiled or baked vegetables;
- Vegetable, cereal, noodle soups;
- Rice, oatmeal, buckwheat, pasta;
- Butter and vegetable oil without heat treatment;
- Kissel, compote, jelly.
The author of the article: Gorshenina Elena Ivanovna | Gastroenterologist
Education: Diploma in the specialty "General Medicine" received at the Russian State Medical University named after N. I. Pirogova (2005). Postgraduate studies in the specialty "Gastroenterology" - educational and scientific medical center.