What is the Pancreas?

The pancreas is an yellowish gland, ca. 15 cm long, 5 cm wide and 2-3 cm in diameter. It can be roughly divided into three parts: the head, the body and the tail (Fig. 2). The pancreas head is closely connected to the first part of the small intestine, known as the duodenum . The pancreas tail extends to the left part of the spleen . The body of the pancreas is located before a junction of a number of important blood vessels leaving the aorta . They supply blood to the liver, the stomach, the upper part of the intestine and the pancreas itself.

The Pancreas and Digestion
The pancreas manufactures important enzymes . 1.5 - 3 litres of a secretion saturated with enzymes are produced on a daily basis. 60 g of protein are metabolised in the process, which amounts to an enormous output. Specialised cells located throughout the entire gland produce the secretion. At first, a preliminary version is produced and pumped into a vast system of ducts from where it is released into the main duct (known as ductus pancreaticus). Bile secretion (produced in the liver) merges with the pancreatic secretion shortly before the mixture flows into the duodenum, at a point, which is known as Papilla Vateri. Pancreatic enzymes are activated at this point and receive their full digestive functionality. Food passed by the stomach can now be digested.

The pancreas produces more than 20 different digestive enzymes. They break down food into small elements. Although the enzymes are produced in the pancreas, they only become functional in the duodenum. Therefore they will not digest the pancreas itself.

The three most important enzymes produced in the pancreas are:

- Amylase: digests carbohydrates
- Trypsin: digests proteins
- Lipase: digests fats

Breaking down food into components is necessary so the body can absorb these through the intestines. In the absence of the pancreatic enzymes sugars, proteins and fats will not be broken down properly and the intestines will not be able to absorb nutrients into the bloodstream, causing diarrhoea, bloating and abdominal cramps. Persistent weight loss, vitamin deficiencies and malfunctioning of other organs will also occur, as nutrients cannot be absorbed and the body therefore lacks the required energy.

The Pancreas and the Regulation of Blood Sugar
Aside from digestive enzymes, the pancreas also produces an important hormone , known as insulin . Insulin is manufactured in special groups of cells, known as the Islets of Langerhans, found throughout the pancreas. They account for only 2.5 g of the total weight of the pancreas (80 - 100 g). There are about 1.5 million of these cells. The insulin is secreted from these cells in the pancreas directly into the bloodstream. It is crucial in the control of blood sugar levels. Glucose is the most important of all sugar molecules. All cells depend on glucose to retain their functionality. After reaching the bloodstream through the intestines, blood sugar enters the individual cells with the help of insulin.

Blood sugar cannot enter the cells if there is not enough insulin (or none at all) in the bloodstream. If this condition is present, blood sugar levels rise constantly, leading to unpleasant or even life-threatening consequences. Diabetics suffer from varying degrees of insulin deficiency.

Another important hormone produced by the pancreas is known as glucagon. This hormone is also manufactured in the insulin cells. Glucagon counteracts insulin in the body. When cell life is threatened by a lack of blood sugar, glucagon releases residual blood sugar from elsewhere in the body, particularly the liver. In the absence of the pancreas (i.e. after surgery), the glucagon hormone can no longer be produced. This factor must be considered when caring for pancreas patients.

The production of pancreatic enzymes and insulin are by and large separate processes. If damage is done to the pancreas, both functions may be disrupted independently.