Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, M.D.
21 November 2001

WHAT DOES THE PANCREAS DO?

     A relatively silent but critically important organ in the body is the pancreas.  It lies in the mid epigastric area against the back of the abdominal wall.  If one puts a finger right into the solar plexus area, the pancreas is about 3 inches behind this.  It’s about 4-6 inches longs, perhaps an inch thick and 1-2 inches wide.  It has a long tube that runs through the middle of it called the pancreatic duct.  This tube connects to something called the common bile duct that drains all of the secretions from the liver into the intestine.  Thus all the secretions from the pancreas also drain into the intestine through the common bile duct.  Therein lies the route some of the ugly problems that can come from pancreatic disease.

    The pancreas makes the most comprehensive digestive juice that the body has.  If one takes pancreatic secretions that run through the pancreatic duct and put them on a piece of meat pretty soon you have broth.  Pancreatic secretions will dissolve almost any food stuff.

    So if the pancreas doesn’t work, one could conclude that the person wouldn’t digest their food very well.  The person would be hungry and would eat but when the food got into the intestine it simply would not digest, running on through the small bowel into the colon where the bacteria ferments the food that hasn’t been digested.  This fermentation process results in lots of gas, lots of diarrhea and cramping abdominal pain.  Weight loss is an expected part of this problem and the person has what is called medically the malabsorption syndrome.

    Fortunately, if the problem is simply that the pancreas isn’t working, its function in this regard can be replaced by taking a pill that is made from hog pancreas.  Everyone knows that hogs can digest almost anything including tin cans.  If a person has malabsorption syndrome, taking 2 or 3 pills with each meal or when they eat a snack, will digest the food normally and the problem can be corrected.

    Unfortunately, things are rarely that simple.  When the pancreas doesn’t work, most often it is because of some disease, the most common two being: pancreatitis or cancer of the pancreas. Cancer of the pancreas is usually silent until very late in the course of the illness.  The only curative treatment is surgical.  Chemotherapy is not predictably effective although in certain cases, responses to chemotherapy do occur.

    Pancreatitis comes from three common causes.  The first of these is very high levels of fat in the blood.  There is a type of  fat in the blood called triglycerides.  Basically, these are sugars that the person has eaten, has not used and instead are changed into triglycerides by the liver.  Triglycerides are then carried off to the fat deposits around the body and stored until needed.  In certain situations, the amount of fat made by the liver is excessive or the amount of fat made  is  not  disposed  of  fast enough and the triglyceride level in the blood rises to very high levels of nearly 1500 to 2000 mg%.  The normal value is only 150 mg%.  When these very high triglyceride levels occur, pancreatitis sometimes occurs.  Other causes of pancreatitis include alcoholic excess, most commonly in binge drinkers.  Lastly, pancreatitis occurs in people who have gallstones that block off the common bile duct and prevent the secretion of the pancreatic juices into the intestine.  When this occurs, the pancreatic juices back up in the pancreas and begin to leak into the tissue of the pancreas.  When this occurs, it digests itself. There aren’t many bigger disasters in all of medicine.

     An example, recently was seen. in which as lady had had gallstones for many years. Periodically, she would develop pain in the right upper abdomen.  On several occasions, she came to the hospital and the presence of gallstones was clearly shown.  She was advised that this is a dangerous situation and that surgical removal of the gallstones was an important step to prevent further problems.  For reason of her own, she was “afraid of surgery” and elected to keep her gallstones.  Unfortunately, her gallstones were small enough that they could come out of the gallbladder, run down the common bile duct, and block it off at the point where it normally enters the intestine.  This resulted in a back up of the pancreatic juices into the pancreas and she developed acute pancreatitis.  For the first day, she was hurting a great deal then was hospitalized to get relief of her discomfort.  As the pancreas continued to digest itself, she became sicker and developed a condition called multi-system organ failure where the lungs kidneys and the circulatory system all begin to fail together.  She died in 48 hours in spite of all medical attempts to save her.

    In addition to being a potentially fatal condition, pancreatitis often leaves the person with a pancreas that doesn’t work and tends to get sick again and again with recurrent episodes of abdominal pain.  One can take pills to replace the digestive capability that is lost but the recurrent pain problems and the recurrent pancreatitis can be very difficult to deal with.

    The best defense against this type of problem is to have lipids checked and to make sure that very high triglyceride levels are not present, avoid binge alcoholic behavior and if a person has gallstones that are causing recurrent episodes of abdominal pain, get the gallstones out before they cause major trouble.

    A second and completely independent function of the pancreas is to make insulin. Sprinkled all through the pancreas are tiny nests of cells called the Islets of Langerhans that make insulin and several other hormones.  People with diabetes have a problem with the insulin secreting cells in the Islets of Langerhans.  Fortunately, this does not affect the digestive capability of the pancreas at all but diabetes can be a major problem by itself.  When the person has pancreatitis, unfortunately the Islets of Langerhans are destroyed also and diabetes is an expected accompaniment.  In this situation, insulin shots are almost always required.

    These articles are written primarily directed at preventive medicine.  The adage about an ounce of prevention being worth a pound of cure has remained valid for eons and describe the situation for pancreatic disease and diabetes perfectly.  Your local clinics are well equipped to help diagnose and deal with both pancreatic and diabetic problems.