The pancreas - anatomy, function and common diseases

Leading Medicine Guide Editors
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Leading Medicine Guide Editors

The human pancreas is an organ that is located in the retroperitoneal space of the body. It lies behind the peritoneum and stomach at the level of the 1st and 2nd lumbar vertebrae. The head of the pancreas lies on the duodenum, to which it is connected via an excretory duct. It weighs between 70 g and 120 g and is 15 to 20 cm long.

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Bauchspeicheldrüse Anatomie

Function of the pancreas

The pancreas is an endocrine gland and produces the hormones insulin and glucagon via the islet cells of Langerhan to regulate blood sugar levels. It is only through insulin that the sugar in the body can be utilized by the cells.

Without this hormone, glucose cannot be absorbed, which quickly leads to life-threatening conditions. If there is too little sugar in the body, glucagon ensures that the body's iron reserves are released, especially from the liver. Langerhan's islet cellsfor the production of hormones only account for around 2.5 g of the total weight.

The exocrine part of the pancreas also produces digestive enzymes such as

  • Amylase (for the digestion of carbohydrates),
  • trypsin (for the digestion of proteins),
  • and lipase for the digestion of fat

and releases these into the duodenum. However, the enzymes are only converted once they reach the intestine so that they can fulfill their purpose. Otherwise the pancreas would digest itself. A total of 20 different enzymes are produced.

Both functions of the pancreas, i.e. the production of hormones and digestive enzymes, exist largely independently of each other. In the event of a disease, one of the two functions can therefore be restricted without the other necessarily being affected.

Common diseases of the pancreas

Acute pancreatitis (inflammation of the pancreas)

A rapidly occurring, severe inflammation of the pancreas leads to the destruction of the organ's cells. It is characterized by sudden, severe pain in the upper and middle abdomen. There is often nausea with vomiting. The pain can radiate into the back like a belt. Meteorism, fever and signs of shock are further symptoms.

The acute form of pancreatitis must be differentiated from an episode of chronic pancreatitis. A common cause is excessive alcohol consumption and gallstones that block the main duct of the organ - less common causes are medication, metabolic disorders and other causes.

Chronic pancreatitis (inflammation of the pancreas)

Recurrent inflammation, which in some cases is not recognized as such due to the non-specific symptoms, can lead to slow, i.e. chronic destruction of the organ. Scar tissue then develops in place of healthy tissue.

As the disease progresses, this severely impairs digestive function and insulin production is also restricted. This leads to diabetes and digestive disorders due to enzyme deficiency. In around 80 percent of cases , excessive alcohol consumption is the cause, less frequently congenital genetic mutations, chronic gallstone disease and other causes.

Pancreatic tumor

When pancreatic cells grow uncontrollably, a pancreatic tumor forms. A distinction is first made as to whether it is benign or malignant. Cysts (water-filled cavities), for example, can be benign. Malignant tumors, on the other hand, grow very quickly into surrounding tissue structures and organs. In the worst case scenario, pancreatic cancer metastasizes and forms metastases in other organs. There are also types of tumors that exhibit uncertain behavior and cannot be clearly designated as benign or malignant.

Despite intensive research, the causes of tumors are not yet clearly understood. However, it has been observed in studies that changes occur in the genetic material of pancreatic cells that turn a normal cell into a tumor cell.

In addition, risk factors have been specified in large observational studies. However, if these occur in an individual, they do not necessarily lead to a disease. The most important risk factors are smoking (including passive smoking) and being very overweight. Chronic pancreatitis and type 2 diabetes can also increase the risk.

In some cases, risk genes can be inherited (familial pancreatic cancer). Those affected are recommended to consult a specialized pancreas center. To date, diet and environmental toxins have not been clearly linked as risk factors.

Pancreatic cancer rarely causes symptoms in the earliest stages. Symptoms may include

  • Lack of appetite,
  • nausea and vomiting
  • a feeling of weakness
  • and/or diarrhea

may occur. There may also be disturbances in the production of digestive enzymes. The result is so-called fatty stools (steatorrhea). However, this symptom is also seen in numerous other diseases, which makes it difficult to diagnose. Significant weight loss in a short period of time (more than five percent in three months) is always a warning sign and must be clarified by a doctor.

Note on diabetes

In fact, pancreatic disease is the cause of diabetes in less than one percent of cases. The most common reason for insulin resistance is an unhealthy lifestyle (severe obesity and lack of exercise). The fatty tissue reduces insulin sensitivity, which is initially compensated for by the pancreas with increased insulin production - until it is exhausted.

Diagnostic tools for pancreatic disease

Due to the non-specific symptoms of pancreatic disease, it is important for the doctor to recognize the specific disease and distinguish it from others. A variety of examination methods are used, such as

  • Laboratory diagnostics (blood and urine),
  • ultrasound,
  • CT and MRI examinations in unclear cases,
  • endoscopic examination (ERCP)
  • or a puncture.

In some cases, an X-ray can also provide important information (e.g. for a paralyzed bowel, calcifications of the pancreas or gallstones). In any case, it is important to undergo a medical examination and not just make an assessment based on information you have obtained yourself.

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