We likely don’t give our pancreas much thought unless something goes wrong and we need to seek medical attention. But what does the pancreas do, exactly? Simply put, the pancreas is an important organ that is part of our digestive and endocrine systems.
Here, we’ll take a closer look at the vital role the pancreas plays in overall well-being, plus potential pancreatic issues, symptoms, and treatments.
Where Is the Pancreas?
Measuring about six inches long, the pancreas is an organ located in the upper abdomen. It lies next to the duodenum (the first part of the small intestine), and just below the liver and gallbladder. The pancreas is shaped like a long flat pear on its side, with the thinner end (tail) pointing towards the left-hand side of the body.
The pancreas can be broadly divided into the head, neck, body and tail. The head of the pancreas is the largest part. It contains the end of the main pancreatic duct, which spans the whole pancreas and carries pancreatic digestive enzymes, which are fed into it from small ducts across the pancreas. It also contains the end of the common bile duct, which carries bile from the liver and gallbladder, another important digestive enzyme.
These ducts join together to form the ampulla of Vater, a small opening at the head of the pancreas that enters the duodenum, where the pancreatic and bile ducts release their secretions into the small intestine. At this point, the stomach also meets the duodenum and releases partially digested food into the intestine, which mixes with these secretions.
The pancreas contains two primary types of cells:
- Exocrine cells, which make up the majority of cells in the pancreas
- Endocrine cells, which are clusters of these cells, also known as the islets of Langerhans
The islets of Langerhans are located throughout the pancreas and contain various types of endocrine cells — alpha, beta, delta, epsilon, and upsilon. These cells secrete a range of hormones, including glucagon, insulin, gastrin, amylin, somatostatin, ghrelin, and pancreatic polypeptide.
What Does the Pancreas Do?
The main job of the pancreas is to make digestive juices (pancreatic enzymes), which is the exocrine function, and hormones, which is the endocrine function. Hormones act as messengers to different parts of the body, controlling how they function.
Pancreatic Hormones
The endocrine function of the pancreas is to make hormones that are released into the bloodstream. These include insulin, which helps the body effectively use its primary energy source (glucose), and glucagon, which raises blood glucose levels if they are too low.
Digestive Enzymes of the Pancreas
The exocrine function of the pancreas is to make digestive pancreatic juices in the exocrine glands, which are then secreted into the duodenum in the small intestine. They combine with bile and intestinal secretions to further digest the food that has arrived partially digested from the stomach. The small intestine walls absorb water and nutrients from the digested food into the bloodstream.
Pancreatic enzymes include:
- Amylase: This enzyme digests carbohydrates, breaking down their starches into sugars for energy in the body.
- Lipase: Your body uses this, along with bile from the liver, to break down fats. Without enough fat, the body struggles to absorb the essential fat-soluble vitamins A, D, E and K.
- Protease: This breaks down proteins and protects your body from bacteria and yeasts that may be found in the intestines.
- Trypsin and chymotrypsin: These enzymes are also involved in the digestion of proteins.
What Are the Warning Signs of Issues With the Pancreas?
If the pancreas isn’t functioning properly, it can affect the whole body. This includes the body’s ability to digest food, use nutrients, and regulate blood sugars.
Symptoms can include:
- Increased thirst (polydipsia)
- Frequent urination, including at night (polyuria)
- Losing weight unintentionally
- Abdominal pain, which may spread around to the back in pancreatitis
- Exhaustion with no apparent cause
- Increased or reduced appetite
- Blurred vision
- Numbness or tingling sensations in the hands or feet
- Jaundice (yellowing of the skin and/or eyes)
- Nausea or vomiting
- Diarrhea, or unusually greasy, foul-smelling, or light-colored stools
- Dark urine
- Ulcers that take a long time to heal
- Picking up repeated infections
- Very dry or itchy skin
- Unexplained fever
What Are Some Challenges to Pancreatic Function?
What does the pancreas do when there are issues impeding its function? Below are five pancreatic issues and their symptoms.
Diabetes
Diabetes occurs when blood glucose levels (sugars) are too high (hyperglycemia), either because the pancreas can’t make enough insulin, or any at all, or the body cannot utilize it properly.
If insulin levels are too low, glucose can’t enter the body’s cells and builds up in the bloodstream. This can lead to issues all over the body, including the eyes, kidneys, heart, and nerves.
There are three main types of diabetes:
- Type 1: This usually affects younger people, but it's not always the case. It’s thought to be caused by autoimmune and environmental factors (such as viruses) in genetically susceptible individuals. Someone with type 1 diabetes will need to take insulin every day for the rest of their life.
- Type 2: This type of diabetes is more commonly seen in adults, although children and young adults can also develop it. Risk factors include genetics, obesity, and a lack of exercise. Symptoms can take years to appear, and some people may not notice any.
- Gestational diabetes: This can occur during pregnancy and affect the health of both the mother and child. It often occurs with no symptoms or mild ones, such as increased thirst or urinating more often.
Other possible symptoms of diabetes include unintentional weight loss, increased hunger, feeling very tired, blurred vision, numbness or tingling sensations in the hands and feet. Someone with diabetes may also have ulcers that take a long time to heal, pick up repeated infections, and have very dry skin.
Pancreatitis
Pancreatitis is inflammation of the pancreas. It can be acute (comes on suddenly) or chronic (lasts a long time). The most common causes for both are excess alcohol consumption, gallstones blocking the common bile duct, genetic conditions, and certain medications.
Pancreatitis is caused when the digestive enzymes produced by the pancreas attack the pancreas itself. It can cause severe abdominal pain that may spread to the person’s back. Other symptoms can include nausea and vomiting, diarrhea, greasy, foul-smelling stools, unexplained weight loss, fever, and jaundice. In chronic pancreatitis, the person may not experience symptoms until it has caused complications.
Pancreatic Cancer
Pancreatic cancer can occur in either the exocrine or endocrine cells of the pancreas. Exocrine cancers are the most common, with adenocarcinoma accounting for 95% of pancreatic cancers. This type of cancer leads to a reduction of pancreatic digestive enzymes and symptoms like unintentional weight loss. Cancer of the endocrine cells, also known as neuroendocrine cancer, is comparatively rare.
In early pancreatic cancer, people often don’t have any symptoms, so it’s often detected in the later stages when it may have already spread and is more difficult to treat. Pancreatic cancer accounts for 3% of U.S. cancer cases, and there is currently no standard pancreatic cancer screening test.
Symptoms to look out for are abdominal pain, unintentional weight loss, reduced appetite, jaundice, and a change in urine color (darker) or stool (lighter). Recent-onset diabetes, in a small minority of cases, can also be associated with pancreatic cancer.
Risk factors include smoking, getting older, and a family history of pancreatic cancer. If cancer is found early when it’s localized, the chances of living at least five years after treatment are up to 10 times more likely than if it has spread.
Exocrine Pancreatic Insufficiency (EPI)
EPI is a rare condition when the pancreas can’t make enough digestive enzymes, the enzymes can’t reach the intestine properly, or the intestine struggles to use them properly. Over time, this leads to the small intestine being unable to digest food properly. As a result, the person may not be receiving enough nutrients from food (malabsorption), leading to a range of health issues.
This condition is more likely to occur in people with a pancreatic condition such as pancreatitis, pancreatic cancer, cystic fibrosis (which can affect the pancreas among other organs), or after pancreatic surgery.
Benign Pancreatic Tumors or Cysts
Intraductal papillary mucinous neoplasms (IPMNs) are cysts that can be precancerous, meaning they have the ability to turn into cancer over time. They need to be closely monitored, and often there are no symptoms. However, if they are present, symptoms might include jaundice, unintentional weight loss, and pale, foul-smelling stools. They are often picked up incidentally on scans done for another reason.
If you experience any of the symptoms listed for these conditions, it’s important to seek medical attention with your healthcare provider.
What Tests Can Be Carried Out for Pancreatic Symptoms?
In addition to your healthcare practitioner taking a full medical history and carrying out any relevant physical examinations, various tests can be done to assess whether someone has a condition affecting the pancreas.
- Blood tests: These might include blood glucose tests, liver function tests, lipid profile (to look at blood fat levels), amylase (to look for pancreatitis), inflammation or infection markers, tumor markers, or autoantibodies, depending on the potential cause.
- Urine test: This looks for glucose and ketones to screen for possible diabetes and for a complication of diabetes called diabetic ketoacidosis.
- Stool test: This test looks for stool changes showing that fats aren’t being absorbed properly in the body.
- Imaging scans: These tests include abdominal ultrasound (either outside the body or inside the body using a camera called an endoscope), magnetic resonance imaging (MRI), or computed tomography (CT) scans to look for pancreatic cancer, pancreatitis, tumors, or cysts.
- Biopsies: These are tissue samples taken from the pancreas to look for cancer.
- Laparoscopy: This keyhole surgery looks at the pancreas and takes any samples needed.
- ERCP (endoscopic retrograde cholangiopancreatography): This involves a flexible tube-shaped camera (an endoscope) being placed through a person’s mouth into the stomach so X-rays can be taken of the pancreas.
- MRCP (magnetic resonance cholangiopancreatography): This is when an MRI scanner takes images as an IV dye travels through the pancreatic and biliary systems.
What Are the Options for Treating Pancreatic Symptoms?
Treatment options depend on the cause of pancreatic issues. For type 1 diabetes, the primary treatment is insulin (either via daily injection or a pump). However, for type 2 diabetes, the first step might be lifestyle changes — such as eating a healthy, balanced diet and exercising more — and medication.
Treatment for pancreatic cancer will depend on the type and stage of the cancer and whether it has spread. Options include surgery, which ranges from removing part of the pancreas to removing the entire pancreas (and some of the surrounding structures). Other options include radiation therapy, chemotherapy, ablation, embolization, targeted therapy, and immunotherapy.
Acute pancreatitis is treated in a hospital with initial treatment often including fluids via an IV, oxygen, antibiotics, and treating the underlying cause. Treatment options for chronic pancreatitis include lifestyle changes, enzyme supplements, steroid medications, and in some cases, surgery. Treatment for IPMN can involve surveillance or surgery.
Can You Live Without a Pancreas?
Yes, someone could live without a pancreas. However, the person would need to take supplements for life to replace the enzymes and hormones that absorb nutrients from their food and regulate blood sugar levels. This will include insulin unless the surgeon has been able to successfully transplant some of the insulin-producing endocrine cells into the liver.
Get Proactive About Your Pancreatic Health
In summary, what does the pancreas do? We’ve learned that it has two key roles. One is to produce digestive enzymes and hormones that allow the body to break down food and absorb its nutrients. The second is to keep blood sugar levels in check.
There are a range of conditions that affect how the pancreas works, many of which we have covered here. They don’t all show symptoms in the early stages, so it’s important to be aware of symptoms and to take a proactive approach to your pancreatic health.
With that in mind, you may want to consider Ezra’s Full Body MRI to screen for any signs of pancreatic abnormalities, as well as assessing up to 12 other organs.
Detecting pancreatic conditions, including asymptomatic pre-cancerous conditions, and changing any modifiable risk factors can improve outcomes. Learn more about your cancer risk factors with Ezra’s free 5-minute risk tool, and empower your health journey.
