The pancreas plays an important role not only in digestion, but also in the life of the body as a whole. This organ of the endocrine and digestive systems produces enzyme substances necessary for the breakdown of food entering the stomach, as well as some hormones for regulating fat and carbohydrate metabolism.
Body description
Consider the structure and function of the pancreas. It is located in the retroperitoneal space between the areas of the duodenum and the upper vertebrae of the lower back, above the kidneys, and looks like an elongated “comma”. The weight of an adult organ ranges from 80-90 g.
The structure of the pancreas is a combination of glandular lobes through which blood vessels pass and the excretory ducts. Lobules produce pancreatic juice, the enzymes of which (lactase, amylase, trypsin, invertase, lipase) affect the processes of food breakdown. A channel passes through the entire gland, through which the juice penetrates into the duodenum, where it mixes with bile and ensures the process of intestinal digestion. Cell complexes between lobules with a developed capillary network are called islets of Langerhans. These formations from alpha, beta and delta cells synthesize hormones (insulin and glucagon).
Structure
The body has the following structure:
- the head (size 2.5-3.5 cm) fits snugly into the bend of the duodenum;
- a triangular body (2.5 cm) is located to the left of the spine towards the spleen;
- neck;
- pear-shaped tail (3 cm), through which the main duct of the gland.
Where the pancreas hurts in humans, we will describe below.
Body functions
The pancreas, as already mentioned, produces pancreatic juice. In the duodenum, food is broken down to the state necessary for absorption. This occurs under the influence of hydrolytic digestive enzymes of the pancreas, which are responsible for the interaction of food substances with water.
Pancreatic juice consists of hydrolases, which perform separate functions. They are divided into four categories:
- Lipase is an enzyme that breaks down fats into complex elements: glycerin and higher fatty acids. It also provides the digestibility of vitamins A, E, D, K.
- Proteases (chymotrypsin, carboxypeptidase, trypsin), activating enzymes that break down proteins to amino acids.
- Carbohydrases (amylase, maltase, lactase, invertase), necessary for the breakdown of carbohydrates to glucose.
- Nucleases are enzymes that break down nucleic acids and form their own genetic structures.
The principle of functioning of the pancreas is very complicated. Enzymes begin to be produced in the required amount 2-3 minutes after the food enters the stomach. Moreover, it all depends on the concentration of fats, proteins and carbohydrates present in it. In the presence of bile, the production of pancreatic juice with enzymes can last up to 12 hours.
Endocrine function
The endocrine function of the gland is carried out thanks to insulocytes - special cells of the islets of Langerhans. They synthesize a number of hormones: thyroliberin, c-peptide, somatostatin, insulin, gastrin, glucagon.
Exocrine pancreatic insufficiency
It is one of the most common consequences of organ inflammation, especially if such a pathology is characterized by a chronic course.
A distinctive feature of exocrine pancreatic insufficiency is a decrease in the absorption of food components (malabsorption) due to the development of maldigestion - a violation of the breakdown of food into components acceptable for the digestion process. This pathology is also called enzyme deficiency. Despite the prevalence of such pathologies among all groups of people, insufficient production of enzymes is considered a serious condition that can lead to exhaustion and even death of the patient if untreated.
Varieties
Exocrine pancreatic insufficiency is congenital (a genetic defect that disrupts or blocks the secretion of enzymes) and an acquired type. In addition, the pathology can be primary and secondary, be absolute or relative.
Primary exocrine insufficiency is caused by damage to the gland and a decrease in its exocrine function. In the secondary type of disease, enzymes are produced in sufficient quantities, but their activation does not occur in the small intestine.
Reasons for the development of pathology
The main causes of the development of exocrine pancreatic insufficiency of the primary type include all forms of chronic pancreatitis, cystic fibrosis, pancreatic cancer, pancreatic degeneration in obesity, surgical interventions on the gland, Schwachmann syndrome, congenital enzyme deficiency, organ agenesis or hypoplasia, as well as Johanson's syndrome.
Pathogenetic causes of the formation of exocrine gland insufficiency include:
- fibrosis and organ atrophy (as a result of alcoholic, obstructive, non-calculous or calculous pancreatitis, atherosclerosis, malnutrition, age-related changes, hemosiderosis, diabetes mellitus);
- pancreatic cirrhosis (considered the outcome of some forms of pancreatitis: fibrous-calculous, alcoholic, syphilitic);
- pancreatic necrosis (death of gland cells);
- the formation of calculi in pancreatic ducts.
Secondary exocrine insufficiency develops with lesions of the mucous membrane of the small intestine, after operations on the stomach and intestines, with gastrinoma, decreased secretion of enterokinase, pathologies of the hepatobiliary system, protein-energy insufficiency.
Absolute enzyme deficiency of the gland is due to suppression of the secretion of bicarbonates and enzymes against the background of a decrease in organ volume. Relative insufficiency is caused by a reduced intake of pancreatic juice in the intestine due to obstruction of the glands of the ducts of the gland with a tumor, stone, and scars.
Pancreatic scars result from the death of organ parenchyma cells. In these areas, dense scar tissue is formed. A similar process in medicine is called fibrosis, and it also leads to the development of exocrine insufficiency.
Symptoms
Let’s figure out where the pancreas hurts in humans. Of greatest importance in the clinical picture of this pathology is maldigestion syndrome, which is characterized by inhibition of digestion in the intestine. Undigested fats in the colon stimulate the production of colonocytes - diarrhea and polyphecal develop, feces acquire a fetid odor, gray color, its surface is shiny and oily. Undigested food particles may also be present in the stool.
Protein maldigestion contributes to the appearance of protein-energy deficiency, which is manifested by dehydration, progressive weight loss, deficiency of trace elements and vitamins, anemia. The weight loss is greatly influenced by a diet low in carbohydrates and fats, as well as fear of eating, which is formed in many patients with chronic pancreatitis.
Symptoms of exocrine pancreatic insufficiency are rather unpleasant. Violation of gastric motility (dyspeptic disorders, a feeling of fullness) can be due to both exacerbation of pancreatitis and the influence of exocrine insufficiency of the gland due to changes in gastrointestinal regulation, the occurrence of duodeno-gastric reflux.
Pancreatitis as a cause of pathology
Chronic pancreatitis is the main factor leading to enzyme deficiency. This is a lesion of the pancreas of inflammatory and destructive origin, leading to impaired function. What are the consequences of pancreatitis, few people know. With an exacerbation of the disease, pain occurs in the abdomen and left hypochondrium, there are dyspeptic symptoms, yellowness of the sclera and skin.
The main causes of adult pancreatitis (code for ICD-10 K86) are cholelithiasis and alcohol abuse, which is quite toxic to the parenchyma of this organ. In cholelithiasis, the inflammatory process is the result of the passage of infection from the bile duct to the gland through the lymphatic vessels, the development of biliary hypertension, or the casting of bile into the gland.
Conservative treatment of this disease includes a set of measures. Therapy is based on the following principles:
- a diet is required;
- pancreatic insufficiency is subject to correction;
- pain must be eliminated;
- complications should be prevented.
In the treatment of pancreatitis, it is necessary to exclude the use of alcohol, the use of drugs that can have a damaging effect on the pancreas (antibiotics, antidepressants, sulfonamides, diuretics: hypothiazide and furosemide, indirect anticoagulants, indomethacin, brufen, paracetamol, many glucocorticoids).
The consequences of pancreatitis can be different: exocrine gland insufficiency, obstructive jaundice, portal hypertension, infections (parapancreatitis, abscess, retroperitoneal cellulitis, inflammation of the biliary tract), internal bleeding. With the development of this disease, diabetes, weight loss, and pancreatic cancer can also occur.
Diagnostics
The main role in detecting enzyme deficiency in pancreatitis in adults (code according to ICD-10 K86) is played by special tests (probeless and probe), which are often combined with radiological, ultrasound and endoscopic methods. Probe diagnostics are considered more expensive and may cause patients discomfort, but their results are more accurate. Probingless procedures are cheaper, they are easily tolerated, but make it possible to determine this pathological process in the body only with the complete absence or significant decrease in pancreatic enzymes.
The direct secretin-cholecystokinin probe test is considered the gold standard for diagnosing exocrine pancreatic insufficiency. This technique is based on the stimulation of gland secretion by the introduction of cholecystokinin and secretin, with further sampling of duodenal contents with a time interval of 10 minutes. In the samples, the speed and activity of pancreatic secretion, the level of zinc, bicarbonates, and lactoferrin are studied.
Lund’s indirect probe testing is similar to the previous method, but gland secretion is stimulated by introducing food into the probe.
The probeless methods are based on the introduction of certain substances into the body that can interact with pancreatic enzymes in the blood and urine. A study of the metabolic products of this interaction provides an opportunity to evaluate the exocrine functions of the gland. Probeless tests include: pancreato-lauryl, bentiramide, triolein, iodolipol and others.
The level of pancreatic activity can also be determined by several indirect methods: by the level of absorption of plasma amino acids by the pancreas, by means of a qualitative analysis of the coprogram, determination of the volume of fat, trypsin and fecal chymotrypsin, elastase-1 in feces.
Instrumental methods for diagnosing the disease are: x-ray of the peritoneum, CT, MRI, ultrasound of the pancreas, ERCP.
Pathology treatment
Treatment of exocrine pancreatic insufficiency is usually complex. It includes the correction of nutritional status, replacement and etiotropic therapy, as well as symptomatic treatment. Etiotropic therapy is aimed at preventing the progression of glandular cell death. Correction of lifestyle is to eliminate the consumption of alcohol and tobacco. There is also an increase in the amount of protein in the diet, a reduction in the amount of fat, and the intake of vitamins.
The main method of treatment for hr. pancreatitis is a substitution of enzymes (for life). Steatorrhea with loss of more than 15 g of fat per day, progressive protein-energy insufficiency is an indication for replacement therapy with enzymes.
Microgranular enzyme agents in acid-resistant membranes and in gelatin capsules that dissolve in the stomach are most effective, providing the conditions for uniform mixing of the drug granules with food. Dosages of such drugs are selected individually and depend on the severity of the disease, the activity of pancreatic secretion.