Part 2 – All about the pancreas

The pancreas is a soft and delicate organ located in the middle of your upper abdomen against the spine. Even though the pancreas is a single organ, we describe it as having a head, neck, body and tail. The pancreas is a fascinating organ involved in digestion, hormone production and blood sugar regulation.

The pancreas has millions of little factories that produce digestive enzymes. These enzymes break down fats, some proteins, and some sugars. The pancreas collects these enzymes in a pipe (pancreatic duct) that runs through the length of the pancreas. That pipe pushes the enzymes into the first part of the intestine (duodenum) to meet with the food that comes through the stomach. These enzymes then mix with food, breaking down the fats and proteins into building blocks that can be used by your body’s cells. Not having enough of these enzymes (exocrine insufficiency) can lead to foul-smelling greasy liquid stools, vitamin deficiencies, and weight loss.

The pancreas also makes several gastrointestinal hormones. The most notable hormones are insulin, glucagon and somatostatin. Beta cells within the pancreas make the insulin and release it directly into the blood stream. The insulin in the blood stream meets the blood glucose molecules and transports the glucose molecules into the body’s organs that need energy. At a very simple level, diabetes occurs when the organs of the body aren’t able to pull the glucose molecules out of the blood into the organ. That’s why in diabetics, blood sugars are high (they can’t be taken out of the blood into the organs). The pancreas produces a constant low-level of insulin (basal insulin) to meet all the resting energy needs of the body, as well as large surges of insulin during meals or snacks (bolus insulin).

Alpha cells in the pancreas produce another hormone named glucagon. Glucagon can be thought of as the opposite of insulin.  While insulin transfers glucose out of the blood stream into organs, glucagon makes more glucose available in the blood to prevent low blood sugars. Glucagon and insulin work together seamlessly to maintain blood sugars and ensure the ability of your body to use glucose when required.

Other hormones made by the pancreas include somatostatin, amylin, gastrin, and VIP. All these hormones are involved in the signaling of the gastrointestinal system and aid in food digestion and movement.

Unlike shown in the illustration above, the pancreas lays behind the stomach and in front of the spine, aorta and vena cava. On the right, the pancreas head is nestled within the turn of the duodenum (first portion of the intestine), and the tail extends towards the spleen on the left. The pancreas duct runs through the middle of the pancreas and drains into the duodenum through a door called the Ampulla of Vater. Through this same hole enters the bile duct from the liver. The common bile duct contains bile liquid full of bile salts that also help with digestion and absorption of several dietary factors. A portion of the pancreas head, called the uncinate process, wraps around one of the biggest branches of the aorta (superior mesenteric artery) and one of the main abdominal veins (superior mesenteric vein). These structures are essentials since support most of the intestines and colon. As you can see, the pancreas is truly in a very cramped and central location!

Being so centrally located, you might assume that the pancreas is a tough organ with thick skin. It is the exact opposite. The pancreas is a soft squishy organ that is hard to distinguish from the surrounding fat. It is extremely sensitive. Even minor injuries or insults can cause it to leak its corrosive digestive enzymes. A leak of these enzymes can cause unintended digestion of the surround fat causing severe abdominal pain affecting a lot of the surrounding organs. This process is called pancreatitis. Pancreatitis can be caused by alcohol abuse, gallstones, procedures performed around the pancreas (biopsies, ERCP), and some rarer causes such as high triglycerides, autoimmune conditions, and certain medications. For acute attacks of pancreatitis, the treatment is usually just hydration support and time to allow the pancreas to mend itself. Check out my upcoming video illustration of the pancreas. Now that you understand the basics of the pancreas anatomy and function, it will make it easier to grasp the types of pancreatic cancers and operations. Stay tuned for those posts.

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