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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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Things worth knowing about "Pancreatic Function"

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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