What is the pancreas where is the ache?
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What is the pancreas?
The pancreas is an important organ of the digestive system with a mixed function: external (exocrine) and internal (endocrine). The function of external secretion is the secretion of pancreatic juice which contains digestive enzymes necessary for complete digestion. The endocrine function is to develop appropriate hormones and the regulation of metabolic processes: carbohydrate, fat and protein.
What does a pancreas do?
Every day the pancreas produces 500-1000 ml of pancreatic juice consisting of enzymes, salts and water. The enzymes produced by the pancreas, called "preferente" and produced it in an inactive form. When you hit a lump of food in the duodenum secrete hormones, which starts the chain of chemical reactions that activates the enzymes of pancreatic juice. The most powerful stimulant of the pancreatic secretion – hydrochloric acid of the gastric juice, which, when ingested in the small intestine stimulates the secretion of the mucous membrane of the intestine secretin and pancreozymin, acting in turn on the production of pancreatic enzymes.
These enzymes include:
- Amylase, breaks down carbohydrates;
- Trypsin and chymotrypsin that are involved in the process of digestion of protein which starts in the stomach;
- The lipase responsible for the breakdown of fats that have already been affected bile received from gallbladder.
Advanced pancreatic juice contains micronutrients in the form of acidic salts, which provides it an alkaline reaction. It is necessary for the neutralization of the acid component of the food received from the stomach, and creating suitable conditions for the absorption of carbohydrates.
Secretion of pancreatic juice is regulated by neural mechanisms associated with food intake, i.e.the diverse composition of the food stimulates the production of different volume and enzyme content of the juice. It accumulates in the interlobular ducts, which join the main excretory duct, into the duodenum.
Internal secretory function of the gland is to allocate it into the blood the hormones insulin and glucagon. They are produced by groups of cells, interspersed between the slices and non-excretory ducts – the so-called islets of Langerhans, located in considerable quantities in the tail of the gland. Islets of Langerhans are composed mainly of alpha cells and beta cells. The number of healthy people reaches 1-2 million.
- Insulin is produced by beta cells and is responsible for the regulation of carbohydrate and lipid (fat) metabolism. Under his influence glucose comes from the blood into the tissues and cells of the body, thereby the sugar level in the blood decreases. Beta cells constitute 60-80% of the islets of Langerhans.
- Glucagon is produced by alpha cells and is an antagonist of insulin, ie, increases the level of glucose in the blood. Also alpha-cells participate in the development of substance lidocaine, prevent fatty liver. Their share in the islets of Langerhans – about 20%.
Islets of Langerhans contain in small amounts in other cells, for example, Delta-cells (1%), secreting the hormone ghrelin, responsible for appetite and stimulates food intake. PP cells (5%) produce pancreatic polypeptide, formed by 36 amino acids and inhibits the secretion of the pancreas.
The destruction of beta cells leads to inhibition of insulin production that can trigger the development of diabetes. Symptoms are constant thirst, itching, increased urine separation.
The pancreas is in close relationship with other organs of the digestive tract. Any damage or failures in the activities negatively affect the entire digestive process.
Where is the pancreas in humans?
The pancreas is in the abdomen behind the stomach, closely adhering to it and the duodenum, at the level of the top (first or second) lumbar vertebrae. In the projection on the abdominal wall it is on 5-10 cm above the navel. The pancreas has an alveolar-tubular structure and consists of three divisions: head, body and tail.
The head of the pancreaslocated in the bend of the duodenum so that the gut covers it in the shape of a horseshoe. It is separated from the body of the gland furrow, which forms the portal vein. The blood supply of the pancreas is performed through the pancreatic-duodenal artery blood flow occurs through the portal vein.
In the body of the pancreas distinguish the front, rear and bottom surfaces. Also in this release the top, front and bottom edges. The front surface adjacent to the rear wall of the stomach, a little below. The rear surface adjacent to the spine and the abdominal aorta. On it are the vessels of the spleen. The bottom surface is located below the root of the transverse colon. Tail gland has a conical shape pointing up and to the left and comes to the gates of the spleen.
The pancreas is composed of 2 types of tissue that perform different functions (endocrine and exocrine). The main fabric consists of small lobules – acini, which are separated from each other layers of connective tissue. Each segment has its own excretory duct. Smallest ducts connected to each other and merge into a common excretory duct, which passes deep in the gland along its entire length, from the tail to the head. The right side of the head duct opens into the duodenum, connecting with the common bile duct. Thus pancreatic secret gets into the duodenum.
Between slices located groups of cells (islets of Langerhans), which are the excretory ducts but is provided with a network of blood vessels and secrete insulin and glucagon directly into the blood. The diameter of each islet is 100 - 300 microns.
The size of the pancreas
For its size the pancreas ranks second to the liver among the organs that produce the enzymes. Its formation starts already in the fifth week of pregnancy. A newborn child of iron has a length of up to 5 cmhave a one year old – 7 cmto 10 years of age it amounts to 15 cm in length. The final dimensions it reaches in adolescence, by the age of 16.
The head of the pancreas is the widest part, its width is up to 5 cm and more, the thickness varies from 1.5 to 3 cm. The body of the gland is the longest part, its average width is 1.75-2.5 cm. Tail length – up to 3.5 cmwidth about 1.5 cm.
Because of the deep location, diagnosis of pathologies of the pancreas is very difficult. Sothe important point of diagnosis is ultrasound examination, which allows to determine the shape and size of the gland, whereby it is possible to draw conclusions about her condition.
All sizes of body, and possible causes of their changes in detail is captured in the ultrasound Protocol. In a steady state of iron has a homogeneous structure. A small deviation from the normal size of the head, body and tail is permissible only with good performance of biochemical analysis of blood.
Size of pancreas was normal
Length of gland of an adult is 15 to 22 cmthe weight of approximately 7080 grams. Cap thickness should not exceed 3 cmother data indicate pathology.
The function of the digestive enzymes of the pancreas
The exocrine function is to develop the following enzymes included in the composition of pancreatic juice: trypsin, lipase and amylase:
- Trypsin cleaves peptides and proteins. Initially it is produced by the pancreas as inactive trypsinogen, which is activated by enterokinase (enteropeptidase) – enzyme secreted by the mucous membrane of the intestine. The pancreas is the only organ in the body that produces trypsin, therefore, determine his or her level is more important in the study of the pancreas than the analysis of other enzymes. Determination of the activity of trypsin is an important step in the diagnosis of acute pancreatitis and the identification of its pathogenesis.
- Lipase is a water – soluble enzyme that digests and dissolves the triglycerides (neutral fats). It is produced in the form of inactive prolipase, and then under the influence of other enzymes and bile acids moves into the active form. Lipase breaks down neutral fats into fatty acids and glycerol. Also this enzyme is involved in energy metabolism, providing delivery to the tissues of polyunsaturated fatty acids and the absorption of some fat-soluble vitamins. In addition to the pancreas, lipase is produced by the liver, intestines, lungs, and every kind of lipase is the catalyst for the splitting of a certain group of fats. When hypofunction of the pancreas in the first place is reducedthe activity of lipase. The first indication of this is fatty stools, gray and yellow.
Amylase (alpha-amylase) required for the processing of the consumed carbohydrates. It is secreted by the pancreas and (to a lesser extent) of the salivary glands. Changes in the content of this enzyme in the blood is typical for many diseases (diabetes, hepatitis , etc.), but first and foremost it indicates acute or chronic pancreatitis.
Unlike other substances involved in the process of digestion, the pancreatic enzymes are only released during meals to their active secretion begins after 2-3 minutes after contact with food in the stomach and lasts 12-14 hours. Enzymes can perform their functions only in the presence of sufficient amounts of bile produced by the liver. Bile activates the enzymes and also breaks lipids into small droplets, i.e. prepares them to fission. Pancreatic enzymes are produced in inactive form and are activated only in the lumen of the duodenum under the action of enterokinase.
Symptoms of insufficient pancreatic enzymes
Disorders of secretion, its decline and the deficit of pancreatic enzymes in the adult are usually the consequence of chronic pancreatitis – inflammation of this organ, which is accompanied by gradual degeneration of the glandular tissue in the connective.
On the first place among the causes of pancreatitis is alcohol abuse, among other reasons, you can highlight wrong, poor nutrition, concomitant disease (cholelithiasis), infections, trauma, some medications.
The lack of trypsin, lipase and amylase causes serious disruption of the digestive process.
Common symptoms of a pancreas problem:
- pain in upper left abdomen under the ribs, which often occur after meals, but may not be associated with meals;
- the reduction or complete disappearance of appetite;
the rumbling in the stomach, flatulence;
- change the color and consistence of stool.
The severity of these symptoms depends on the extent of damage of the gland. As a result of poor digestion the body lacks nutrients, and metabolic disorders can lead to osteochondrosis, osteoarthritis, atherosclerosis of vessels.
For deficiency of lipasecharacterized by steatorrhea (excessive excretion of fat with stool), a chair can have a yellow or orange color, sometimes the release of liquid fat without stool; liquid stool, oily.
The lack of amylase has intolerance of foods rich in carbohydrates, frequent, loose, watery voluminous stool from excess starch, malabsorption (impaired absorption of nutrients in the small intestine accompanied by diarrhea, beriberi, weight loss), high content of conditionally pathogenic microflora in the intestines.
The lack of trypsin is expressed in a moderate or severe creatore (increased content of nitrogen in the feces and undigested muscle fibers, ie, protein), stool mushy, stinking may develop anemia.
Because the process of breakdown of complex food molecules is broken, and it is not absorbed in full by the body, even the nourishing diet can be a weight loss, vitamin deficiency, dry skin, brittle nails and hair. When you receive a bad processed food from the small intestine into the large intestine occurs flatulence (flatulence and waste gases), too rapid defecation.
When reduced secretion of pancreatic enzymes is assigned to replacement therapy, however, enzymes of plant origin are unable to fully compensate for the insufficiency of the external secretion.
If the violation of the outflow of enzymes in the intestine, this can lead to irritation of the tissues of the gland and its swelling and in consequence to the destruction and necrosis.
With the defeat of the islets of Langerhans is suppressed insulin production and clinical symptoms of diabetes mellitus type 1, the severity of which will depend on the number of present and fully working beta cells. Deficiency in the secretion of glucagon is as much felt as there are other hormones with similar action: for example, the steroid hormones produced by the adrenal glands and increases the level of glucose in the blood.
It hurts the pancreas?
The most common pathology of the pancreas is pancreatitis (acute or chronic), stones in the excretory ducts, adenocarcinoma of the pancreas, diabetes, necrosis.
When inflammation (pancreatitis) and damage to the pancreas are the following symptoms:
- Pain in left side under ribs;
- Heart palpitations;
- Yellowness of the skin and whites of the eyes;
- Vomiting, diarrhea;
- In some cases a state of shock.
In acute pancreatitis the pain is severe, sharp, starts suddenly, can be tinea in nature, i.e. to cover the entire left side to go back. The pain is not removed by antispasmodics, decreases in the sitting position or when tilted forward. In some cases, physically there is an increase in the pancreas: the feeling of fullness inside, the pressure on the ribs, which interferes with normal breathing.
The more pain, the more increases the gag reflex. Sometimes vomiting begin before the pain: it usually occurs in the morning or during a meal, the result of gastric spasm. Vomiting has a bitter or sour taste, after it comes temporary relief. It can be both the recurrent and systematic. In the case of an acute attack of pancreatitis should visit a doctor and treatment in hospital, because in itself, this disease will not pass. Incessant vomiting when the stomach is cleaned by the probe and carried out the introduction of special enzymes to soothe the excessive aggressiveness of the stomach and pancreas.
Pancreatitis symptoms sometimes similar to the symptoms of degenerative disc disease of the lumbar spine, attack of pyelonephritis or herpes zoster. To differentiate pancreatitis: osteochondrosis, painful palpation of the vertebrae; shingles (herpes) on the skin rash appears; in acute pyelonephritis the pain is worse when tapped on the back in the projection of the kidneys and in the urine and then blood appears. All of these symptoms with pancreatitis are absent.
In the case of chronic pancreatitis pain less severe exacerbations usually occur after violation of the diet (eating large quantities of fatty foods) and alcohol abuse. Today is not precisely determined, how alcohol affects the pancreas: either it prevents the outflow of pancreatic juice, or changes its chemical composition, thereby provoking an inflammatory response. Another reason could be a blockage in the output flow cancer of the gall stones. In chronic pancreatitis increases the risk of the cancer process in the pancreas: cancer occurs in 4 cases out of 100 patients with pancreatitis.
With persistent pain syndrome canto be a feeling of addiction, and people will not be so acutely feel the pain. The danger is that you can skip the development of necrosis or serious complications. The human body has a certain amount of strength and resilience and can a long time to regulate metabolic processes even if there are some violations, but with the depletion of domestic resources, the development of tissue necrosis of the pancreas can be very fast and to be irreversible.
How to treat pancreas?
If you suspect pancreatitis doctor interrogates and examines the patient, paying attention to the color of his skin and mucous membranes. Sometimes the pain may have different localization, depending on which part of the gland is damaged. If it hurts above the belly button in the right upper quadrant, then in the pathological process involved the head of the gland, if in the left tail. Vague girdle pain in the upper abdomen indicates the defeat of the entire gland. To differentiate problems with the pancreas and transverse colon in the following way: the doctor performs palpation of the painful area first, in the supine position, and then on the left side. With the defeat of the pancreas pain lying on the side will be less strong in case of problems with the transverse colon will remain the same.
From the laboratory analyses are assigned to determine levels of amylase, lipase, trypsin in the blood serum. In the General analysis of blood observed increase in the level of white blood cells. Additionally can be used to study the activity of liver enzymes: ALT and alkaline phosphatase, and bilirubin, their increase may be a symptom of an attack of pancreatitis provoked by gall stones. Also conducted a urine test for amylase using PABA (RAVA)-test examination of feces for the presence of chymotrypsin, trypsin and high fat content. To detect disorders of carbohydrate metabolism defines the amount of glucose in the blood.
From instrumental methods can be applied:
- Radiography is specified, the pancreas is enlarged or not;
- CT scan or MRI for diagnosis, detection of pancreatic necrosis or fluid accumulation in the abdominal cavity;
- Ultrasound to study the structure and nature of the contours of the gland, a condition common excretory duct, determine the presence of gallstones.
During an attack of acute pancreatitis shouldstarvation for 1-2 days, as the pancreatic juice in this case would produce in a minimum amount, and the load from the gland will be removed. Usually the appetite is reduced or even disappears for a few days before the exacerbation. During this period you should drink alkaline water (mineral water without gas, a solution of baking soda) or a decoction of rose hips.
When severe abdominal pain, severe vomiting or mild pain within a few days, be sure to contact the health facility, as these symptoms may also be signs of cholecystitis, appendicitis, peptic ulcer or intestinal obstruction.
In the case of acute pancreatitis requires hospitalization and treatment in hospital. To prevent dehydration and normalize blood pressure is dropper. Appointed painkillers and drugs that suppress the secretion of enzymes. In the first 3-4 days they are administered intravenously, and after some relief is taken in pill form. In order to reduce pain at the area of the pancreas can put ice.
Learn more: Medications used in the treatment of pancreatic
Most commonly used antispasmodics: Baralgin, no-Spa, Papaverine, Drotaverine, with moderate pain can Acetaminophen or Ibuprofen. Sometimes analgesics: Aspirin, Paracetamol. Can also be used anticholinergic and antihistamine drugs: Atropine, Platifillin, Diphenhydramine.
To relieve pain and prevent irritation and ulceration of the gastric mucosa used drugs in the form of suspensions and gels that neutralize the hydrochloric acid (Almagel, aluminium phosphate gel) and a means of reducing its production (Controloc, Omez, Omeprazole, Gastrozol, Perceptin, Acid). In hospitals prescribe H2 blockers Ranitidine, Famotidine or similar Acidex, Zoran, Heterogen, Pepcidine.
To reduce the development of enzymes used Contrycal or Aprotinin. After removal of an acute attack and in chronic pancreatitis is appointed by enzymatic therapy to support the functions of the pancreas and improve digestion. The most common drugs – Pancreatin, Mezim, Festal, Kreon, Panzinorm. However, they are based on pork protein, so if you have allergic reactions to pork them can not be accepted. Children have such an allergic reaction can cause intestinal obstruction. In this case, are assigned to plant drugs on the basis of rice fungus or papain: Ûniènzim, Amilaza, Pepys.
Enzymes taken immediately after a meal, the dosedoctor individually. The treatment course is long, often maintenance therapy is becoming essential for all life.
Other drugs stimulate pancreatic secretion pilocarpine, morphine, vitamin a, magnesium sulphate, lower – histamine and atropine. For violation of exocrine function of the prescribers of insulin to regulate the level of blood sugar. Self-medication for the lesions of the pancreas is unacceptable. This may result in its necrosis, diabetes or blood poisoning.
Complications of chronic pancreatitis may be a blockage of the blood vessels of the organ, the bile duct, cyst glands, infection or necrosis of its tissues (necrosis).
The pancreas is a very delicate and sensitive organ, so any intervention is highly undesirable. Surgery may be required when blockage of the gland ducts, the presence of cysts with stones in the gallbladder (sometimes also removes the gallbladder), if necessary, to remove part of the pancreas due to the development of pancreatic necrosis.
How to care for the pancreas?
In the framework of the program "Health", the chief doctor of the polyclinic EXPERT, MD, Professor Sabir Mehdiyev Nasreddinovich tells how to preserve the health of the pancreas:
Find out more: the Most effective recipes to restore the pancreas!
The role of diet in the treatment of pancreatic
Diet is a very important element in the treatment and prevention of exacerbations of pancreatitis. If we neglect any of these medications can be powerless. As a qualitative and quantitative ratio of enzymes produced by the gland varies with the composition of food per meal products, it is recommended to reduce the load on the hardware go to a separate food, i.e. to eat proteins and carbohydrates at different meals. You should also not overeat: daily caloric intake should not exceed the rate corresponding to age, sex and cost of physical energy.
- Fatty foods, fried foods;
- Sausages, canned food, smoked products, pickles;
- Jelly, jelly;
- Acidic juices;
- Strong tea and coffee;
- Confectionery (cakes), ice cream;
- Hot spices, spices and seasonings,mustard, horseradish.
- Chicken, Turkey, rabbit, fish – cod, bream, perch, pike;
- Dishes, steamed;
- Kefir, yogurt;
- Sour curd, fresh cheese;
- Vegetables boiled or baked;
- Vegetables, cereals, noodle soups;
Rice, oatmeal, buckwheat, pasta;
- Butter and oil without heat treatment;
Kissel, compote, jelly.
orshenin Elena Ivanovna, doctor-gastroenterologist