Pancreas

About the Pancreas

The pancreas is a dual function organ located retroperitoneally behind the stomach. Exocrine function 95 percent of organ produces approximately 1.5 liters of pancreatic juice daily containing digestive enzymes: trypsinogen and chymotrypsinogen protein digestion, activated in the duodenum by enterokinase, pancreatic amylase carbohydrate digestion, pancreatic lipase fat digestion, and ribonuclease and deoxyribonuclease nucleic acid digestion. Bicarbonate rich fluid neutralizes stomach acid. Secretin stimulates bicarbonate, CCK stimulates enzymes. Pancreatic juice flows through the pancreatic duct, joining the common bile duct at the ampulla of Vater hepatopancreatic ampulla, emptying into the duodenum at the major papilla. Endocrine function, carried out by only a small fraction of the tissue, occurs in the islets of Langerhans: beta cells, the most numerous, secrete insulin lowering blood glucose, alpha cells secrete glucagon raising blood glucose, delta cells secrete somatostatin inhibiting both, PP cells secrete pancreatic polypeptide, and epsilon cells secrete ghrelin. Diabetes type 1 involves autoimmune destruction of beta cells, managed with lifelong insulin replacement. Type 2 involves insulin resistance. Pancreatitis auto digestion by activated enzymes causes severe abdominal pain.