The pancreas, like many other of our organs, doesn't come to mind much when it is humming along doing its job. The problem is that when something starts to misfire in the pancreas, pandemonium commences to result in the rest of the body. For instance, various degrees of diabetes and severe malnutrition can occur. The last picture of a gaunt Patrick Swayzy, who finally died of pancreatic cancer at age 57, is solemn evidence of the metabolic chaos which is a pancreas in distress.
Let us first consider some basic anatomy of the pancreas. It is rather like a salivary gland in appearance or a triangular. It is 12 to 15cm long, and lies tucked behind the stomach and duodenum. It has a head, body and tail in descriptive anatomy. The pancreatic ancinar cells, which produce digestive enzymes, all flow into the pancreatic duct, which joins with the biliary(liver) duct to empty into the duodenum at the Sphincter of Oddi. There are about a million Islets of Langerhans cell which secrete insulin and glucagon directly into the bloodstream. Thus the pancreas is unique in being both an exocrine gland which secretes into the bowel. It is an endocrine gland which secretes directly into the bloodstream to control processes at distant places in the body. The digestive cells of the pancreas receive signals from a certain part of the brain which continually evaluates what type of meal is in the stomach. These signals are transmitted by branches of the vagus nerve which innervate the pancreas to appropriately act.
The acinar cells secrete at least twenty-five enzymes into the pancreatic duct to process food. These are packaged as inactive substances called zymogens which are activated when they reach the duodenum. The duodenal duct cells secrete bicarbonate to keep the zymogens alkaline and inactive until they reach the duodenum which is at the stomach outlet. This acid from the stomach for absorption in the small bowel. If these were active in the pancreas they would simply digest the pancreas away. The self-destruction of the pancreas is what is generally called pancreatitis. Once the process starts, it tends to spiral out of control with worse and worse symptoms and glandular destruction. One of the only exceptions to zymogen production is triglyceride lipase, this is active within the pancreas. When a person has severely elevated serum triglycerides, as is often the case in diabetes, the triglycerides are broken down by this lipase to produce toxic fatty acids which poison and inflame the pancreas. This is one way that diabetes results in pancreatitis, and pancreatitis results in diabetes. Another condition which causes enzymes to be retained in the pancreas is a stone in the pancreatic duct, or a tumor which blocks the duct.
The pancreas produces many enzymes, but the most important are pancreatic lipase, pancreatic amylase, tryptsin, and chymotryptsin. Tryptsin is called the master enzyme because it activates many zymogens in the duodenum. Often we can tell that there is damage or obstruction of the pancreas because we can begin to measure the enzymes in the blood.
What does pancreatitis feel like? In most patients it is a severe pain in the epigastric area or upper central abdominal area. In most patients it is a severe pain in the epigastric area which radiates to the back. It can be accompanied by nausea, vomiting and fever. When there are too few digestive enzymes the person will have a fatty diarrhea from unabsorbed fat. The blood sugar can get out of control because complex carbohydrates are not broken down. There is often damage to the insulin secreting cells. On the misery scale, pancreatitis ranks very high. One adverse effect is that many patients became addicted to narcotics and opiods because their pain is so server. One in five patients admitted to the hospital with acute severe pancreatitis will die secondary to complications.
When the Islets of Langerhans are being progressively destroyed by pancreatitis, the result is diabetes. The destruction of the pancreas can be auto-immune where the body is producing antibodies to its own pancreas. This seems to be the case in juvenile diabetes. The pancreas is no longer able to secrete insulin which lowers the blood sugar, nor glucagon which raises it. The blood glucose thermostat is lost, and the elevated glucose levels begin to damage all the arteries in the body. At that point either pharmaceutical insulin has to be given or medicines which stimulate the remaining Islet cells.
Treatment of pancreatitis consists of controlling the pain, looking for the source of inflammation, ensuring adequate hydration, replacing or stimulating insulin production, and in decreasing the stomach acidity with something like H2 blocker or a protein pump inhibitor. The malabsorption can be treated with digestive enzymes in sufficient quantity to normalize digestion as much as possible.
What are some of the things which produce pancreatitis? Chronic alcohol abuse has long been considered to be injurious to the pancreas abuse is probably the primary cause. Recent studies have shown a linear relationship between the amount of tobacco grams smoked and the incidence of pancreatitis. Tobacco and alcohol abuse are addictive in their effect upon the pancreas. Other causes have included gallbladder stones. There can be simultaneous blockage of the biliary duct and the pancreatic duct at the Sphicter of Oddi. Obesity has been found to be related to pancreatitis. The relationship of high triglycerides to pancreatitis has already been mentioned.
What can you do to be good to your pancreas? Well, first of all, don't chronically abuse alcohol. Smoking cessation is an excellent way to avoid pancreatic problems. Have your serum lipids, blood sugar, and other labs checked with physical exams so your doctor can look for subtle markers of pancreatic dysfunction. Get on treatment for elevated triglycerides. Try to maintain an ideal body weight as much as possible. Discuss any pains with your doctor that occur repeatedly in the stomach area or in the back related to eating. Discuss any change in bowel habits such as frequent loose, foul-smelling stools. If you are starting to get diabetes follow all treatment plans and diets carefully and consistently. If you have gallbladder stones, see about getting surgery to remove it.
You can work with your physician to maintain maximal pancreatic health. Always remember what a vital organ the pancreas is, and try your best not to stress or damage it. When in doubt always consult your doctor.
John Drew Laurusonis
Doctors Medical Center