Pancreas / From the book. Sablin O.A., Grinevich V.B., Uspensky Yu.P., Ratnikov V.A. Functional diagnostics in gastroenterology. St. Petersburg, 2002.

1. Features of the pancreas in children and adults
2. Role and functions of the pancreas
3. How does the pancreas work?
4. Pancreatic enzymes
5. The role of hormones
6. How to prevent malfunctions of the pancreas?

The pancreas is one of the most important internal organs. This is a small, palm-sized organ that is located between the stomach and the spine. The pancreas (PG) contains three sections that are responsible for producing enzymes that help digest food. The pancreas also produces hormones designed to maintain normal glucose levels.

Features of the pancreas in children and adults

The pancreas is a rather sensitive organ. At the slightest disruption in its work, a person’s well-being immediately worsens. In adults, the size of this organ reaches 22 cm, weight up to 80 g. The formation of the organ occurs 4-5 weeks after conception. The pancreas is formed from endoderm and mesenchyme and is located near the liver. During development, the organ acquires parts: tail, body, head. The pancreas begins to perform its main functions already at the end of the 1st trimester of pregnancy. For some time the organ is mobile, which is explained by the lack of reliable fixation. Closer to 6 years of age, he occupies a permanent position.

Sources

1. Minutes of the meeting of the Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan No. 23 dated December 12, 2013. Acute pancreatitis.
2. St. Petersburg State Medical University named after Academician I. P. Pavlov. Department of Faculty Therapy, author: Honored Doctor of the Russian Federation, Associate Professor E. V. Kraevsky. Chronic pancreatitis.
3. Clinical protocol for diagnosis and treatment No. 18 of the Expert Council of the Republican State Enterprise at the Republican Center for Healthcare Development of the Ministry of Health and Social Development of the Republic of Kazakhstan dated November 30, 2015. Chronic pancreatitis in children.
4. First St. Petersburg State Medical University named after. acad. I.P. Pavlova. Treatment of acute pancreatitis. Authors: S. F. Bagnenko, N. V. Rukhlyada, A. D. Tolstoy, V. R. Goltsov.

Role and functions of the pancreas

The pancreas provides several functions at once: the production of hormones and digestive enzymes. It is an exocrine and intrasecretory gland.

The pancreas produces hormones that ensure the breakdown of fatty acids necessary for the functioning of the kidneys, heart, and muscles. The pancreas is also responsible for the production of hormones that regulate sugar levels (insulin, glucagon). It releases ghrelin, which is responsible for the urge to eat. Provides participation in metabolic processes: fat, carbohydrate, protein.

The pancreas is also responsible for the production of enzymes necessary for digestion. The key task of enzymes is the metabolism of carbohydrates, proteins, and fats.

If one function fails, the others remain normal, thanks to the division into different sections responsible for the production of enzymes/hormones. Thus, in diabetes mellitus there are no digestive disorders, and previous inflammation of the organ does not necessarily cause persistent hypoglycemia. However, it is important to understand that pathological changes in the organ can negatively affect the body’s energy supply and carbohydrate-fat metabolism.

Complications after taking medications

Medicines for pancreatitis, like any medicine, can lead to complications. Antibiotics - for digestive upset, non-steroidal anti-inflammatory drugs - for complications in the gastrointestinal tract and cardiovascular system. Enzyme preparations can cause allergies and lead to iron deficiency. Antisecretory drugs, although they are considered drugs with a minimum of side effects, can cause withdrawal syndrome: the appearance of heartburn and sometimes pain in the sternum after stopping their use. Even vitamins, if taken immoderately and without prior testing, can become not just a useless, but also a dangerous supplement.

How does the pancreas work?

The components of the pancreas are the islets of Langerhans. They consist of cells that produce hormones:

• delta cells - produce somatostatin, gastrin and ghrelin;
• beta cells - ensure the production of insulin;
• a-cells - produce glucagon;
• PP cells produce pancreatic polypeptide.

Proinsulin protein is synthesized in beta cells. When the C-peptide molecules are separated, it is converted into insulin. The part that is not synthesized enters the blood unchanged. Insulin is required by the body to transport glucose, which is the main source of energy. It is also responsible for the delivery of amino acids and potassium to cells. It itself is not able to penetrate the cell, but can affect its receptors. Insufficient insulin production occurs when beta cells are damaged. As a result, a person develops type 1 diabetes mellitus. If the process of glucose penetration into the cell is disrupted, type 2 diabetes is diagnosed. In this case, there is enough insulin in the blood, but the cells do not recognize it. In the first and second cases, glucose accumulates, which cannot be transported into cells, resulting in hyperglycemia. An excess of insulin secretion leads to the formation of insulinoma.

Glucagon (an insulin antagonist) is produced by the a-cells of the pancreas. When its level increases, the body receives a signal about the need for glucose. This is achieved by the transformation of glycogen to produce glucose or its formation through gluconeogenesis.

Gastrin is responsible for stimulating gastric secretion. Its concentration level changes throughout the day. It almost doubles after eating food. Production occurs when the level of hydrochloric acid in the stomach drops. Samostatin has an effect on the digestive system by suppressing the production of hormones (glucagon, gastrin, insulin) and enzymes. Able to suppress the secretion of other gastrointestinal organs.

Treatment Basics

The approach to treating pancreatitis varies depending on the form of the disease. In acute severe form of pancreatitis, when there is pain and constant vomiting, the patient is hospitalized. In case of a chronic disease and in the absence of relapses, hospitalization is not required; doctors fight the cause of the disease with the help of drugs.

Acute pancreatitis on a CT image. Photo: Hellerhoff / (Creative Commons Attribution-Share Alike 3.0 Unported license)

After admission to the hospital with acute pancreatitis, the patient is not fed, as a rule, for the first 48 hours. A tube is inserted into the stomach to remove its contents. If there are complications (bleeding, acute intestinal obstruction, suppuration, etc.), the patient is referred for surgery.

Next, the doctor prescribes various medications to reduce the load on the gland, reduce pain and prevent the development of infection.

With pancreatitis, control of the production of pancreatic digestive enzymes is vital. Lack of oral nutrition in the first week after the attack is over is the most effective way of such control. Therefore, parenteral nutrition is used, that is, intravenous infusion through a dropper, or enteral nutrition, in which nutritional mixtures are administered through a tube.

Pancreatitis can occur with a complication in the form of death of part of the pancreas or the entire organ (pancreatic necrosis). In this case, doctors adhere to a conservative method of treatment with the help of medications. In case of infected pancreatic necrosis, the use of antibiotics is mandatory. If conservative treatment does not help and the patient progresses to multiple organ failure, suppuration, pancreatic necrosis or pancreatic cancer, surgery is prescribed.

At the first stage, doctors prefer to minimize surgical intervention in the body. First, puncture and drainage of the pancreas and retroperitoneum are performed. To do this, using small incisions, special tubes (drains) are inserted inside, which remove excess liquid and wash the cavity with special solutions.

In case of a more severe condition of the patient and widespread damage to the gland, they resort to alternative treatment tactics, which include:

• laparotomy, that is, external drainage, in which incisions are made in the abdominal wall,
• resection of the gland or removal of it entirely.

Removing the gland is an extreme measure; it is resorted to in a situation where the organ can no longer be restored. It is possible to live without a gland, but you will have to artificially maintain its functions: take insulin, enzyme preparations and follow a very strict diet.

How to cope with an attack of pancreatitis?

The main task when severe pain occurs is to provide the gland with cold, hunger and peace. You should not eat anything and consult a doctor immediately. To relieve inflammation, you need to put a cold compress on your stomach.

Pancreatic enzymes

The pancreas produces digestive juice rich in enzymes. At the cellular level, proenzymes are produced, which remain passive until a certain point. After food enters the stomach, they are activated. Additionally, hormones that activate pancreatic enzymes enter the duodenum. The production of enzymes depends on pancreozymin, secretin, secreted by the mucous membrane of the small intestine upon penetration of gastric juice. Hydrochloric acid has an irritating effect.

To participate in the digestion process, the pancreas produces:

1. Amylase - performs the breakdown of carbohydrates.
2. Trypsin, chymotrypsin - after the stages of protein digestion in the stomach, it breaks down.
3. Lipase - ensures the breakdown of fats.

Amylase synthesis is partially carried out by the salivary glands, while trypsin is produced exclusively by pancreatic cells. The production of lipase is carried out not only by the pancreas, but also by other organs: intestines, liver, lungs. The enzyme is water-soluble and is involved in the breakdown of neutral fats. Provides a vital role in energy supply processes, transports polyunsaturated fatty acids and promotes the absorption of vitamins responsible for the dissolution of fats. The enzyme production mechanism starts after food enters the body.

Symptoms of pancreatitis

The main symptom of pancreatitis is severe pain. Along with it, nausea, vomiting, a slight increase in temperature, flatulence, stool disorders and some other symptoms may be observed.

Abdominal pain

The main symptom of acute pancreatitis is severe pain, which usually begins in the left side and then becomes encircling. The pain is not relieved either by antispasmodics (“no-spa” and analogues) or by painkillers (analgesics). Lying on your back may intensify. An attack of pain with pancreatitis is usually observed after eating or drinking alcohol. When eating against the background of pain, the pain intensifies.

Vomit

The onset of acute pancreatitis may be accompanied by bouts of vomiting. Vomit with pancreatitis usually contains bile. During this period, you must completely stop eating.

More about the symptom

Temperature

During an attack of pancreatitis, the temperature may rise to 37.5°C.

More about the symptom

Flatulence

The attack disrupts intestinal motility. This leads to bloating.

More about the symptom

Stool disorder

The lack of necessary enzymes does not allow food to be properly digested, which causes stool upset.

The role of hormones

Insulin and glucagon control blood sugar levels. Insulin ensures the entry of glucose into the cell, stimulates its absorption, and reduces the amount of sugar in the blood.

The main task of glucagon is to prevent hypoglycemia. It increases sugar levels. A-cells in the islets of Langerhans are responsible for production, which also produce lipocaine, which protects the liver from degeneration.

Pancreatic polypeptide produced by PP cells suppresses the secretion of gastric juice. It consists of more than three dozen amino acids that perform secretory functions. Thus, disturbances in the functioning of the pancreas can cause malfunctions and problems in other organs and systems of the body.

Diagnosis of the disease at the private medical clinic “Medunion”

Diagnosing this disease is not difficult, since the first signs speak for themselves. However, in order to prescribe adequate treatment, it is necessary to determine the form of the disease. To do this, the doctor performs laparoscopy - a method that allows you to examine the abdominal cavity from the inside using a special instrument.

If acute pancreatitis is suspected, laboratory tests are performed:

• General blood analysis
• Blood chemistry
• Analysis of urine
• Stool analysis
• Ultrasound, MRI or radiography of the abdominal organs
• Computed tomography according to indications

In the chronic form, the same studies are carried out, but it is better to take tests during the period of exacerbation of the disease.

How to prevent malfunctions of the pancreas?

If you have pain or discomfort in the abdominal area, you should immediately contact a gastroenterologist.

Pancreatitis (inflammation of the pancreas) is accompanied by frustration, vomiting, pain in the left hypochondrium, weakness and rapid pulse. With chronic inflammation, the pain is less intense, mainly after eating food. If alarming symptoms appear, examination and consultation with a specialist is necessary.

It is important to check your blood sugar levels regularly. This way you can prevent the development of diabetes and the occurrence of hyperglycemic coma - a condition in which sugar exceeds the permissible norm by several times. The danger of this condition is a high risk of death. No less dangerous is hypoglycemia, in which the glucose level decreases relative to the permissible values. This condition is even more dangerous than hyperglycemia, since it is much more difficult to increase sugar levels than to reduce them. Consequently, the risk of developing irreversible consequences in internal organs is much higher than with hyperglycemia.

Prevention of damage to the pancreas consists of proper nutrition with a low content of fast carbohydrates: refined sugar and products based on it (confectionery, fast food and other products). The diet should be balanced and contain proteins, fats and so-called “long” carbohydrates: cereals, fruits (in moderation), vegetables. Besides. The diet should be rich in essential microelements that contribute to the smooth functioning of the pancreas and other organs.

Causes of pancreatitis

In most cases, pancreatitis develops as a result of cholelithiasis (stones can obstruct the outflow of pancreatic secretions), or as a result of alcohol abuse.

Women at risk are during pregnancy and in the early postpartum period. Monotonous food, overeating and consumption of low-quality foods (including fast food) can also cause an attack of acute pancreatitis.

Other factors contributing to the development of pancreatitis include:

• diseases of the stomach and duodenum;
• tumors;
• injuries;
• parasites (worms);
• taking certain medications, such as furosemide, estrogens, antibiotics, sulfonamides;
• metabolic disease;
• hormonal changes;
• vascular diseases.

Most often the disease is registered between the ages of 40 and 60 years.