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Pancreatic Function – Digestion and Hormones
Pancreatic function includes the production of digestive enzymes and hormones such as insulin. It is essential for metabolism and proper digestion.
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Pancreatic function includes the production of digestive enzymes and hormones such as insulin. It is essential for metabolism and proper digestion.
What Is Pancreatic Function?
The pancreas is a vital organ located in the upper abdomen, behind the stomach. It performs two fundamental roles in the human body: an exocrine function (producing digestive juices) and an endocrine function (producing hormones that regulate blood sugar). Both functions are closely linked and are indispensable for a healthy metabolism.
Exocrine Function: Digestion
The vast majority of the pancreas – approximately 98% of its tissue – is exocrine. These glandular cells produce up to 1.5 litres of pancreatic juice per day, which is released into the duodenum (the first section of the small intestine) via the pancreatic duct.
- Lipases: Break down fats into fatty acids and glycerol.
- Amylases: Digest carbohydrates (starch) into sugars.
- Proteases (e.g., trypsin, chymotrypsin): Break down proteins into amino acids.
- Bicarbonate: Neutralises the acidic gastric juice and creates an optimal environment for enzyme activity.
Without these enzymes, food cannot be adequately broken down and absorbed – a condition known as exocrine pancreatic insufficiency.
Endocrine Function: Hormone Production
The endocrine role is carried out by specialised cell clusters known as the islets of Langerhans. These make up only about 1–2% of pancreatic tissue but are essential for blood sugar regulation.
- Beta cells: Produce insulin, which lowers blood sugar and promotes the uptake of glucose into body cells.
- Alpha cells: Produce glucagon, which raises blood sugar when needed (e.g., during fasting).
- Delta cells: Produce somatostatin, which regulates the secretion of both insulin and glucagon.
Destruction of the beta cells leads to type 1 diabetes mellitus, while reduced insulin effectiveness with preserved tissue is the basis of type 2 diabetes mellitus.
Diseases of the Pancreas
Disorders of pancreatic function can have various causes and serious consequences:
- Acute pancreatitis: Sudden inflammation, often triggered by gallstones or alcohol consumption.
- Chronic pancreatitis: Ongoing inflammatory process leading to progressive tissue damage.
- Exocrine pancreatic insufficiency (EPI): Insufficient production of digestive enzymes, resulting in fatty stools, weight loss, and malnutrition.
- Diabetes mellitus: Disruption of insulin production or action, affecting the entire metabolism.
- Pancreatic cancer: A malignant tumour of the pancreas that is often diagnosed late.
Diagnosis of Pancreatic Conditions
Several diagnostic methods are available to assess pancreatic function:
- Blood tests: Measurement of amylase, lipase, blood glucose, and HbA1c levels.
- Stool tests: Measurement of faecal elastase-1 as a marker of exocrine function.
- Imaging: Ultrasound, CT scan, or MRI to visualise the structure and any changes in the organ.
- ERCP (Endoscopic Retrograde Cholangiopancreatography): Examination of the bile and pancreatic ducts.
Treatment and Support of the Pancreas
Treatment depends on the underlying condition:
- For exocrine insufficiency: Enzyme replacement therapy (pancreatin preparations) taken with meals.
- For diabetes: Insulin therapy or blood sugar-lowering medications.
- For pancreatitis: Pain management, dietary modifications or fasting, and in-patient care if necessary.
- General measures: Avoiding alcohol, following a balanced low-fat diet, and regular medical check-ups.
References
- Kasper, D. L. et al.: Harrison's Principles of Internal Medicine. 21st edition, McGraw-Hill, 2022.
- Löhr, J. M. et al.: United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis. United European Gastroenterology Journal, 2017. Available at: https://pubmed.ncbi.nlm.nih.gov/29344355/
- World Health Organization (WHO): Global Report on Diabetes. WHO Press, Geneva, 2016. Available at: https://www.who.int/publications/i/item/9789241565257
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