Function of the pancreas

introduction

The pancreas (pancreas) is a gland and can be divided into two parts both in terms of its microscopic structure and in terms of its function.
The exogenous part is responsible for the production of digestive enzymes, while the endogenous part is essential for the production of various hormones.

Structure of the pancreas

The pancreas weighs about 50-120 grams, is 1-2 centimeters thick and 14-18 centimeters long. If you look at the pancreas from the outside, you can roughly divide it into three parts:

1. Pancreatic head
2. Pancreatic body
3. Pancreatic tail

The digestive juice is made up of small (exocrine) Glandular lobules produced which release the secretion into fine ducts that unite in the middle of the pancreas to form a large duct. This duct ends in the duodenum. About 1.5 million small islet cell groups that produce insulin and other hormones are distributed over the entire tissue of the abdominal storage gland (endocrine part).

Location of the pancreas

The pancreas is located in the back of the upper abdomen and forms the back border of the Omental bursa. This is a small space in the upper abdomen that is bounded by the stomach, small peritoneum, liver, pancreas and spleen.
The pancreas lies almost across the abdomen and therefore "crosses" in front of the spine on the other side. This is particularly important because this location can cause more frequent injuries to the pancreas, for example if you fall on the handlebars of a bicycle.

The pancreas produces two major types of enzymes and hormones. These two types are produced by different parts of the pancreas.
Once from the exocrine part, these products are carried further into the small intestine and once from the endocrine part, these products are released directly into the blood.
The duct of the pancreas, which enables the digestive enzymes to be transported to the exocrine part, ends in the duodenum, rather than in the upper part of the small intestine. There it usually ends together with the duct of the gallbladder.

Illustration of the pancreas

1. Body of
   Pancreas -
   Corpus pancreatis
2. Tail of the
   Pancreas -
   Cauda pancreatisauda
3. Pancreatic duct
   (Main execution course) -
   Pancreatic duct
4. Duodenum lower part -
   Duodenum, pars inferior
5. Head of the pancreas -
   Caput pancreatis
6. Additional
   Pancreatic duct -
   Pancreatic duct
   accessorius
7. Main bile duct -
   Common bile duct
8. Gallbladder - Vesica biliaris
9. Right kidney - Ren dexter
10. Liver - Hepar
11. Stomach - Guest
12. Diaphragm - Diaphragm
13. Spleen - Sink
14. Jejunum - Jejunum
15. Small intestine -
    Intestine tenue
16. Colon, ascending part -
    Ascending colon
17. Pericardium - Pericardium

You can find an overview of all Dr-Gumpert images at: medical illustrations

Exogenous part of the pancreas

The exogenous part of the pancreas (pancreas) is used to produce digestive enzymes.
1.5 to 2 liters of secretion - consisting of digestive enzymes, water and ions - are formed here every day.
This passes through small execution aisles into the main execution aisle (Pancreatic duct - pancreatic duct), which runs into part of the small intestine called the duodenum (Duodenum), opens.

The enzymes produced by the pancreas are used to break down the three main components of food:

• lipase is used to break down fat
• Alpha-amylase (also present in saliva) is used to break down carbohydrates
• serve to break down proteins
  • Trypsinogen
  • Chymotrypsinogen
  • Elastase

Many of these enzymes are still in their inactive form in the pancreas. They only become active after reaching the small intestine. This serves to protect the pancreas from self-digestion.

You might also be interested in: Task of enzymes in the human body

Endogenous portion of the pancreas

The endogenous share makes up the minority - as far as the share of pancreatic tissue is concerned. It consists of the so-called Langerhans Islandswhich primarily out A cells, B cells and D cells consist.
This is where the pancreas hormones are produced, which are then released directly into the blood.

• The A cells, which make up about 20% of the islets of Langerhans, produce glucagon
• The B cells, which make up about 75%, produce insulin
• The remaining 5% is made up of the D cells, which produce the hormone somatostatin
• The PP cells, which synthesize the pancreatic polypeptide, make up a very small proportion

Function of the pancreas

The pancreas has two important functions that must be distinguished from one another. On the one hand it is the largest and most important digestive gland and on the other hand it regulates the blood sugar level via the hormone insulin.

As a digestive gland, the pancreas produces around 1.5 liters of digestive juice (also called Pancreatic juice designated). This juice contains substances that the human body needs to

• carbohydrates
• Fats and
• Egg whites

that occur in food, to be broken down into smaller and smaller pieces, i.e. to be digested. These substances are also called digestive enzymes (Amylases, lipases, proteases). Since the pancreas releases its digestive juice through an outlet duct directly into the duodenum, this function of the pancreas is called "exocrine"(separating from the glands to the outside).

In addition to this exocrine gland function, the pancreas also has an endocrine glandular component. Endocrine means that something is released directly into the blood without a duct. In the pancreas, around 2% of the organ fulfills an endocrine function. These parts of the pancreas are also called "islets of Langerhans" because the endocrine cells are grouped together in the form of islands and produce pancreatic hormones, e.g. insulin. This part of the pancreas regulates the blood sugar level by releasing hormones, especially after consuming food rich in carbohydrates.

With the production of the hormones insulin and glucagon, the pancreas plays a central role in regulating blood sugar levels. The buzzword here is glucose, which is an important - if not the most important - substrate for the body's energy supply.

The hormone glucagon ensures an increased supply of glucose in the blood. In the liver and muscles, for example, it ensures that new glucose is produced (Gluconeogenesis) and glucose stores are broken down with the release of individual glucose molecules (Glycogenolysis). This is especially necessary when the body needs energy.

The antagonist to glucagon is insulin, which is also produced by the pancreas. Its function is that glucose is absorbed from the blood into the cells and metabolized or stored in stores. Insulin is increasingly produced after food is consumed because a particularly large amount of glucose is then washed ashore with the food.

The digestive juice and hormones are produced largely independently of one another. This means that both functions of the pancreas can be disrupted independently of one another if damage to the pancreas occurs for any reason.

You can also read about this:

• Functions of the pancreas
• Pancreatic enzymes

The role of the pancreas in digestion

The release of digestive juice by the pancreas is stimulated by food intake. The autonomic nervous system identifies food intake when the stomach wall expands through the filling and reacts by activating the pancreas. In addition, various hormones such as secretin (from the duodenum) lead to the release of digestive juice.

In the pancreas itself, the substances (enzymes) that make up the pancreatic juice are stored as so-called precursors. This means that they are not yet able to break down starch, proteins and fats. Only after they have been released from the pancreas through the excretory duct do these substances take effect at their destination, the small intestine.

The composition of the digestive juice depends on the type of food consumed. If, for example, very fatty food is consumed, more fat-splitting enzymes (so-called Lipases) released.

If these enzymes are missing, the food components are not broken down properly and cannot be absorbed by the intestine into the bloodstream. This causes undigested food to move further through the intestines, causing gas and diarrhea.
In addition, the lack of nutrient absorption can lead to further symptoms such as weight loss, lack of vitamins and functional disorders of organs.

Role of the pancreas in blood sugar regulation

The second function of the pancreas is blood sugar regulation, which intervenes when foods rich in carbohydrates are ingested. In response to increased blood sugar levels, the pancreatic B cells release insulin because it is the only hormone in our body that can lower blood sugar levels.

Insulin enables sugar, especially grape sugar (Glucose) can be absorbed from the blood into the various cells of the body. Dextrose is the most important source of energy for all cells in the body.
The liver and muscle cells in particular can absorb a great deal of sugar in a short time. There the sugar is either stored or converted directly into energy.

In contrast, when the blood sugar level in the blood drops sharply, the A cells in the pancreas release the hormone glucagon. Glucagon causes the liver to release the sugar stores and thus increases the blood sugar level. Thus, the body cells continue to be supplied with glucose and get enough energy to maintain their function.

You may also be interested in this topic: Hypoglycaemia - what happens if you have low blood sugar?

Support of the pancreas function

For diseases of the digestive tract and to support the pancreas function, well-tolerated meals and light foods are recommended. Low-fat and low-carbohydrate meals relieve the pancreas. Dietary fiber, on the other hand, is indigestible food components that have various health-promoting properties, but in excess can also lead to flatulence and indigestion.

It can also be helpful to keep the blood sugar level as constant as possible and not let it rise very quickly. This can be achieved, for example, by using whole grain products instead of foods with simple sugars such as sweets.

The most important measure to support the function of the pancreas is to abstain from alcohol. About 80% of all pancreatitis occurs as a result of consuming too much alcohol. For acute or chronic digestive problems, enzyme supplements can help support the pancreas by providing missing enzymes for digestion.

Some teas, plants and herbs that contain bitter substances are said to stimulate digestion. Basically, it is advisable to consume regular and balanced food and to exercise sufficiently.

How can you stimulate the function of the pancreas?

A manifest underfunction of the pancreas cannot be completely compensated for. However, there are a few things you can do to make your life easier:

• Well-chewed food (chewed at least 40 times) is already pre-digested in the mouth by the enzymes contained in the saliva and puts less strain on the pancreas
• Several small meals mean less work for the pancreas at once
• Easily digestible fiber stimulates lipase secretion (fat-digesting enzyme)
• A low-fat diet and the avoidance of alcohol and finished products with numerous additives relieve the pancreas
• Bitter substances in the mouth ensure that digestion is stimulated and also stimulate the pancreas. Rich in bitter substances are z. B. grapefruits, chicory, artichokes, dandelions and special bitter food supplements.
• The pancreatic enzymes can also be replaced by enzyme preparations. Both natural preparations and high-dose drugs exist for this.

How can you test the function of the pancreas?

An underactive part of the pancreas that is directly involved in digestion can often be identified by simple complaints. Digestion suffers because fewer digestive juices can be produced. The consequences are often a feeling of fullness, flatulence and slimy fatty stools, especially after large, fatty and protein-rich meals. If such an underfunction is suspected, a stool sample can be taken in the doctor's office or in the hospital.

This is examined for the enzyme elastase, which is produced by the pancreas and excreted after digestion. If the stool contains too little elastase, an underactive pancreas is likely. Alternatively, the stool can be examined for its fat content, here the rule of thumb applies: the more fat the stool contains, the less it could be digested by pancreatic juices.

Read more on the topic: Underactive pancreas

Pancreas blood counts

Depending on the suspected disease of the pancreas, different blood values ​​are determined.
In acute inflammation of the pancreas (acute pancreatitis) not only measured the C-reactive protein (CRP), which is usually increased in every inflammatory process, but also the enzymes lipase, elastase and amylase.

These digestive enzymes are produced by the exocrine part of the pancreas and therefore serve as good measurement parameters for inflammation of the organ.
With an alcohol consumption of 50-80 grams per day, the carbohydrate-deficient transferrin (CDT), so it is a good marker of alcoholism. However, this value can also be increased in primary cheap cirrhosis or hepatocellular carcinoma.

When the exocrine part of the pancreas can no longer produce enough enzymes (exocrine pancreatic insufficiency), the proportion of these enzymes in the stool also decreases. Therefore, if there is a suspicion, the elastase in the stool is determined.

If there is a suspicion of decreased work of the endocrine pancreas (endocrine pancreatic insufficiency), glucagon and insulin are determined in the blood. As a rule, the same diagnostics are used to diagnose diabetes mellitus. Not only is insulin determined, but blood sugar as well. A distinction must be made between type 1 diabetes mellitus, ultimately an absolute insulin deficiency, and type 2 diabetes mellitus, a relative insulin deficiency.

The pancreas and diabetes

In the case of diabetes (Diabetes mellitus) is a (relative) insulin deficiency for the "hypoglycemia" of the blood that is typical for the disease (Hyperglycemia) responsible. The function of the somatostatin produced by the D cells primarily inhibits the production and release of many other hormones, including glucagon and insulin. It also inhibits the secretion of digestive enzymes produced by the pancreas.

Type 1 diabetes mellitus is triggered by antibodies in the immune system against the body's own insulin-producing cells (so-called autoantibodies). This means that the body's own immune system destroys these islet cells for unknown reasons, so that the pancreas cannot produce any or far too little insulin. This type of diabetes is usually diagnosed in childhood or young adulthood. Characteristic symptoms are

• Weight loss
• constant feeling of thirst
• frequent urination
• Powerlessness and
• fatigue

The other functions of the pancreas are not affected in type 1 diabetes. This means that only the missing insulin is supplied in artificial form for the treatment of type 1 diabetes. So far there is no therapy to cure this form of diabetes.

The situation is different with type 2 diabetes mellitus. Although there is enough insulin available, this can no longer work properly at its target location, the body cells. One speaks of a so-called insulin resistance, because the corresponding receptors no longer react to their target hormone. At first, the pancreas reacts by increasing the production of insulin, but at some point it cannot produce enough insulin to control blood sugar levels. Then one speaks of a type 2 diabetes mellitus.
Diseases of the exocrine part of the pancreas, which fulfills the digestive function, can in very rare cases be the cause of diabetes mellitus.

You may also be interested in this topic: Diet in Diabetes