The pancreas plays an important role not only in the processes of 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 to regulate fat and carbohydrate metabolism.
Description of the organ
Let's consider the structure and functions of the pancreas. It is located in the retroperitoneal space between the sections of the duodenum and the upper vertebrae of the lower back, above the kidneys, and outwardly resembles an elongated "comma". The weight of an adult human organ ranges from 80-90 g.
The structure of the pancreas is a combination of glandular lobules, through which blood vessels pass, and excretory ducts. The lobules produce pancreatic juice, the enzymes of which (lactase, amylase, trypsin, invertase, lipase) affect the processes of food breakdown. Passes throughout the glanda channel through which the juice enters the duodenum, where it mixes with bile and ensures the process of intestinal digestion. Complexes of cells 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 organ has the following structure:
- head (size 2.5-3.5 cm) fits snugly into the flexure 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 passes.
Where the human pancreas hurts, we will tell below.
Functions of Organ
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 action of hydrolytic digestive enzymes of the pancreas, which are responsible for the interaction of food substances with water.
Pancreatic juice consists of hydrolases that perform separate functions. They are divided into four categories:
- Lipase is an enzyme that breaks down fats into complex elements: glycerol and higher fatty acids. It also ensures the absorption of vitamins A, E, D, K.
- Proteases (chymotrypsin, carboxypeptidase, trypsin) that activate enzymes that break down proteins into amino acids.
- Carbohydrases (amylase, m altase, lactase, invertase) needed to break down carbohydrates to glucose.
- Nucleases are enzymes that break down nucleic acids and form their own genetic structures.
The principle of the functioning of the pancreas is very complex. Enzymes begin to be produced in the required amount 2-3 minutes after food enters the stomach. 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 hallmark of exocrine pancreatic insufficiency is a decrease in the absorption of nutritional components (malabsorption) against the background of 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, enzyme deficiency is considered a serious condition that can lead toexhaustion and even death of the patient if left untreated.
Varieties
Exocrine pancreatic insufficiency can be congenital (a genetic defect that disrupts or blocks the secretion of enzymes) and acquired. In addition, pathology can be primary and secondary, 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 the disease, enzymes are produced in sufficient quantities, but their activation does not occur in the small intestine.
Causes 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, degeneration of the pancreas in obesity, surgical interventions on the gland, Schwachmann's syndrome, congenital enzyme deficiency, agenesis or hypoplasia of the organ, as well as Johanson syndrome - Blizzard.
Pathogenetic causes of exocrine gland insufficiency include:
- fibrosis and atrophy of the organ (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: fibrocalculous, alcoholic, syphilitic);
- pancreatic necrosis (deathgland cells);
- formation of stones in the 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 deficiency.
Absolute enzyme deficiency of the gland is due to suppression of the secretion of bicarbonates and enzymes against the background of a decrease in the volume of the organ. Relative insufficiency is due to a reduced flow of pancreatic juice into the intestine due to obstruction of the lumen of the ducts of the gland by a tumor, stone, scars.
Scars on the pancreas occur as a result of the death of cells in the parenchyma of the organ. 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. The most important in the clinical picture of this pathology is the syndrome of maldigestion, which is characterized by inhibition of the digestive processes in the intestine. Undigested fats in the colon stimulate the production of colonocytes - diarrhea and polyfecal matter develop, feces acquire a fetid odor, gray color, its surface is shiny and oily. There may also be undigested food particles in the stool.
Protein maldigestion contributes to the appearance of protein-energy malnutrition, whichmanifested by dehydration, progressive weight loss, deficiency of trace elements and vitamins, anemia. Weight loss is greatly influenced by a diet low in carbohydrates and fats, as well as the fear of eating, which forms in many patients with chronic pancreatitis.
The symptoms of exocrine pancreatic insufficiency are quite unpleasant. Dysmotility of the stomach (dyspeptic disorders, feeling of fullness) can be due to both exacerbation of pancreatitis and the influence of exocrine gland insufficiency 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-destructive genesis, leading to violations of its functions. What are the consequences of pancreatitis, few people know. With an exacerbation of the disease, pain occurs in the abdomen and left hypochondrium, dyspeptic symptoms, icterus of the sclera and skin are observed.
The main causes of pancreatitis in adults (ICD-10 code K86) are cholelithiasis and alcohol abuse, which is quite toxic to the parenchyma of this organ. In cholelithiasis, the inflammatory process becomes the result of the infection moving from the bile ducts to the gland through the lymphatic vessels, the development of biliary hypertension, or the reflux of bile into the gland.
Conservative treatment of this disease includesset of measures. Therapy is based on the following principles:
- diet required;
- pancreatic insufficiency to be corrected;
- pain syndrome needs to be eliminated;
- complications must be prevented.
In the treatment of pancreatitis, it is necessary to exclude the use of alcohol, taking drugs that can have a damaging effect on the pancreas (antibiotics, antidepressants, sulfonamides, diuretics: hypothiazide and furosemide, indirect anticoagulants, indomethacin, brufen, paracetamol, glucocorticoids, estrogens and many others).
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 mellitus, weight loss, and pancreatic cancer can also occur.
Diagnosis
The main role in detecting enzyme deficiency in pancreatitis in adults (ICD-10 code K86) is played by special tests (probeless and probeless), which are often combined with X-ray, ultrasound and endoscopic methods. Probe diagnostics is considered more expensive and may cause discomfort to patients, but its results are more accurate. Probeless procedures are cheaper, they are easily tolerated, but they make it possible to determine thisa 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, lactoferrin are examined.
Indirect Lund Probing is similar to the previous method, however, gland secretion is stimulated by introducing food into the probe.
The basis of probeless techniques is the introduction into the body of certain substances that can interact with pancreatic enzymes in the blood and urine. The study of the metabolic products of this interaction provides an opportunity to evaluate the exocrine functions of the gland. Tubeless tests include: pancreato-lauryl, bentyramide, trioleic, iodolipol and others.
It is possible to determine the level of pancreatic activity in some indirect ways: by the level of absorption of plasma amino acids by the pancreas, through a qualitative analysis of the coprogram, determining the volume of fat, trypsin and fecal chymotrypsin, elastase-1 in the feces.
Instrumental methods for diagnosing the disease are: x-ray of the peritoneum, CT, MRI, ultrasound of the pancreas, ERCP.
Treatment of pathology
Treatment of exocrine pancreatic insufficiency is usually complex. It includes correction of nutritional status, replacement and etiotropic therapy, as well as symptomatic treatment. Etiotropic therapy is aimed at preventing the progression of gland cell death. Lifestyle modification consists in eliminating the consumption of alcohol and smoking. It is also planned to increase the amount of protein in the diet, reduce the amount of fat, and take vitamins.
The main method of treatment for hr. pancreatitis is enzyme replacement (for life). The indication for enzyme replacement therapy is steatorrhea with a loss of more than 15 g of fat per day, a progressive protein-energy deficiency.
Microgranular enzyme preparations in acid-resistant shells and in gelatin capsules, which dissolve in the stomach, provide 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.
