Pancreas

The pancreas is an organ of the digestive

system and endocrine system of
vertebrates. In humans, it is located in the
abdomen behind the stomach and
functions as a gland. The pancreas is a
mixed or heterocrine gland, i.e., it has both
an endocrine and a digestive exocrine
function.[2] 99% of the pancreas is
exocrine and 1% is endocrine.[3][4][5][6] As
an endocrine gland, it functions mostly to
regulate blood sugar levels, secreting the
hormones insulin, glucagon, somatostatin
and pancreatic polypeptide. As a part of
the digestive system, it functions as an
exocrine gland secreting pancreatic juice
into the duodenum through the pancreatic
duct. This juice contains bicarbonate,
which neutralizes acid entering the
duodenum from the stomach; and
digestive enzymes, which break down
carbohydrates, proteins and fats in food
entering the duodenum from the stomach.
 Pancreas

Anatomy of the pancreas

Details

Pronunciation /ˈpæŋkriəs/

Precursor Pancreatic buds

System Digestive system and

endocrine system

Artery Inferior
pancreaticoduodenal
artery, anterior
superior
pancreaticoduodenal
 artery, posterior
superior
pancreaticoduodenal
artery, splenic artery

Vein Pancreaticoduodenal
veins, pancreatic
veins

Nerve Pancreatic plexus,

celiac ganglia, vagus
nerve[1]

Lymph Splenic lymph nodes,

celiac lymph nodes
and superior
mesenteric lymph
nodes
 Identifiers
Latin pancreas

Greek Πάνκρεας (Pánkreas)

MeSH D010179 (https://mes

hb.nlm.nih.gov/recor
d/ui?ui=D010179)

TA98 A05.9.01.001 (https://

ifaa.unifr.ch/Public/E
ntryPage/TA98%20Tr
ee/Entity%20TA98%2
0EN/05.9.01.001%20
Entity%20TA98%20E
N.htm)

TA2 3114 (https://ta2view

er.openanatomy.org/?
id=3114)
FMA 7198 (https://bioporta
l.bioontology.org/onto
logies/FMA/?p=class
es&conceptid=http%3
A%2F%2Fpurl.org%2F
sig%2Font%2Ffma%2
Ffma7198)

Anatomical terminology

Inflammation of the pancreas is known as

pancreatitis, with common causes
including chronic alcohol use and
gallstones. Because of its role in the
regulation of blood sugar, the pancreas is
also a key organ in diabetes mellitus.
Pancreatic cancer can arise following
chronic pancreatitis or due to other
reasons, and carries a very poor prognosis,
as it is often only identified after it has
spread to other areas of the body.

The word pancreas comes from the Greek

πᾶν (pân, "all") & κρέας (kréas, "flesh"). The
function of the pancreas in diabetes has
been known since at least 1889, with its
role in insulin production identified in
1921.

Structure
 The pancreas (shown here in pink)
sits behind the stomach, with the
body near the curvature of the
duodenum, and the tail stretching to
touch the spleen.

The pancreas is an organ that in humans

lies in the abdomen, stretching from
behind the stomach to the left upper
abdomen near the spleen. In adults, it is
about 12–15 centimetres (4.7–5.9 in)
long, lobulated, and salmon-coloured in
appearance.[7]

Anatomically, the pancreas is divided into

a head, neck, body, and tail. The pancreas
stretches from the inner curvature of the
duodenum, where the head surrounds two
blood vessels: the superior mesenteric
artery and vein. The longest part of the
pancreas, the body, stretches across
behind the stomach, and the tail of the
pancreas ends adjacent to the spleen.[7]

Two ducts, the main pancreatic duct and a

smaller accessory pancreatic duct run
through the body of the pancreas. The
main pancreatic duct joins with the
common bile duct forming a small
ballooning called the ampulla of Vater
(hepatopancreatic ampulla). This ampulla
is surrounded by a muscle, the sphincter
of Oddi. This ampulla opens into the
descending part of the duodenum. The
opening of the common bile duct into
main pancreatic duct is controlled by
sphincter of Boyden. The accessory
pancreatic duct opens into duodenum with
separate openings located above the
opening of the main pancreatic duct.[7]

Parts

The head of the pancreas sits within the

curvature of the duodenum, and wraps
around the superior mesenteric artery and
vein. To the right sits the descending part
of the duodenum, and between these
travel the superior and inferior
pancreaticoduodenal arteries. Behind
rests the inferior vena cava, and the
common bile duct. In front sits the
peritoneal membrane and the transverse
colon.[7] A small uncinate process
emerges from below the head, situated
behind the superior mesenteric vein and
sometimes artery.[7]

The neck of the pancreas separates the

head of the pancreas, located in the
curvature of the duodenum, from the body.
The neck is about 2 cm (0.79 in) wide, and
sits in front of where the portal vein is
formed. The neck lies mostly behind the
pylorus of the stomach, and is covered
with peritoneum. The anterior superior
pancreaticoduodenal artery travels in front
of the neck of the pancreas.[7]

The body is the largest part of the

pancreas, and mostly lies behind the
stomach, tapering along its length. The
peritoneum sits on top of the body of the
pancreas, and the transverse colon in front
of the peritoneum.[7] Behind the pancreas
are several blood vessels, including the
aorta, the splenic vein, and the left renal
vein, as well as the beginning of the
superior mesenteric artery.[7] Below the
body of the pancreas sits some of the
small intestine, specifically the last part of
the duodenum and the jejunum to which it
connects, as well as the suspensory
ligament of the duodenum which falls
between these two. In front of the
pancreas sits the transverse colon.[8]

The pancreas narrows towards the tail,

which sits near to the spleen.[7] It is usually
between 1.3–3.5 cm (0.51–1.38 in) long,
and sits between the layers of the
ligament between the spleen and the left
kidney. The splenic artery and vein, which
also passes behind the body of the
pancreas, pass behind the tail of the
pancreas.[7]
Blood supply

The pancreas has a rich blood supply, with

vessels originating as branches of both
the coeliac artery and superior mesenteric
artery.[7] The splenic artery, the largest
branch of the celiac trunk, runs along the
top of the pancreas, and supplies the left
part of the body and the tail of the
pancreas through its pancreatic branches,
the largest of which is called the greater
pancreatic artery.[7] The superior and
inferior pancreaticoduodenal arteries run
along the back and front surfaces of the
head of the pancreas adjacent to the
duodenum. These supply the head of the
pancreas. These vessels join together
(anastamose) in the middle.[7]

The body and neck of the pancreas drain

into the splenic vein, which sits behind the
pancreas.[7] The head drains into, and
wraps around, the superior mesenteric and
portal veins, via the pancreaticoduodenal
veins.[7]

The pancreas drains into lymphatic

vessels that travel alongside its arteries,
and has a rich lymphatic supply.[7] The
lymphatic vessels of the body and tail
drain into splenic lymph nodes, and
eventually into lymph nodes that lie in
front of the aorta, between the coeliac and
superior mesenteric arteries. The
lymphatic vessels of the head and neck
drain into intermediate lymphatic vessels
around the pancreaticoduodenal,
mesenteric and hepatic arteries, and from
there into the lymph nodes that lie in front
of the aorta.[7]

Microanatomy
 This image shows a pancreatic islet
when pancreatic tissue is stained and
viewed under a microscope. Parts of
the digestive ("exocrine") pancreas
can be seen around the islet, more
darkly. These contain hazy dark
purple granules of inactive digestive
enzymes (zymogens).

A pancreatic islet that uses

fluorescent antibodies to show the
location of different cell types in the
pancreatic islet. Antibodies against
glucagon, secreted by alpha cells,
show their peripheral position.
Antibodies against insulin, secreted
by beta cells, show the more
widespread and central position that
these cells tend to have.[9]

The pancreas contains tissue with an

endocrine and exocrine role, and this
division is also visible when the pancreas
is viewed under a microscope.[10]

The majority of pancreatic tissue has a

digestive role. The cells with this role form
clusters (Latin: acini) around small ducts,
and are arranged in lobes that have thin
fibrous walls. The cells of each acinus
secrete inactive digestive enzymes called
zymogens into the small intercalated ducts
which they surround. In each acinus, the
cells are pyramid-shaped and situated
around the intercalated ducts, with the
nuclei resting on the basement membrane,
a large endoplasmic reticulum, and a
number of zymogen granules visible within
the cytoplasm. The intercalated ducts
drain into larger intralobular ducts within
the lobule, and finally interlobular ducts.
The ducts are lined by a single layer of
column-shaped cells. There is more than
one layer of cells as the diameter of the
ducts increases.[10]

The tissues with an endocrine role within

the pancreas exist as clusters of cells
called pancreatic islets (also called islets
of Langerhans) that are distributed
throughout the pancreas.[9] Pancreatic
islets contain alpha cells, beta cells, and
delta cells, each of which releases a
different hormone. These cells have
characteristic positions, with alpha cells
(secreting glucagon) tending to be
situated around the periphery of the islet,
and beta cells (secreting insulin) more
numerous and found throughout the
islet.[9] Enterochromaffin cells are also
scattered throughout the islets.[9] Islets are
composed of up to 3,000 secretory cells,
and contain several small arterioles to
receive blood, and venules that allow the
hormones secreted by the cells to enter
the systemic circulation.[9]

Variation
The size of the pancreas varies
considerably.[7] Several anatomical
variations exist, relating to the
embryological development of the two
pancreatic buds. The pancreas develops
from these buds on either side of the
duodenum. The ventral bud rotates to lie
next to the dorsal bud, eventually fusing. In
about 10% of adults, an accessory
pancreatic duct may be present if the main
duct of the dorsal bud of the pancreas
does not regress; this duct opens into the
minor duodenal papilla.[11] If the two buds
themselves, each having a duct, do not
fuse, a pancreas may exist with two
separate ducts, a condition known as a
pancreas divisum. This condition has no
physiologic consequence.[12] If the ventral
bud does not fully rotate, an annular
pancreas may exist, where part or all of
the duodenum is encircled by the
pancreas. This may be associated with
duodenal atresia.[13]

Gene and protein expression

10,000 protein coding genes (~50% of all

human genes) are expressed in the normal
human pancreas.[14][15] Less than 100 of
these genes are specifically expressed in
the pancreas. Similar to the salivary
glands, most pancreas-specific genes
encode for secreted proteins.
Corresponding pancreas-specific proteins
are either expressed in the exocrine
cellular compartment and have functions
related to digestion or food uptake such as
digestive chymotrypsinogen enzymes and
pancreatic lipase PNLIP, or are expressed
in the various cells of the endocrine
pancreatic islets and have functions
related to secreted hormones such as
insulin, glucagon, somatostatin and
pancreatic polypeptide.[16]

Development
 The pancreas originates from the foregut, a
precursor tube to part of the digestive tract, as a
dorsal and ventral bud. As it develops, the ventral
bud rotates to the other side and the two buds fuse
together.

The pancreas forms during development

from two buds that arise from the
duodenal part of the foregut, an embryonic
tube that is a precursor to the
gastrointestinal tract.[11] It is of
endodermal origin.[11] Pancreatic
development begins with the formation of
a dorsal and ventral pancreatic bud. Each
joins with the foregut through a duct. The
dorsal pancreatic bud forms the neck,
body, and tail of the developed pancreas,
and the ventral pancreatic bud forms the
head and uncinate process.[11]

The definitive pancreas results from

rotation of the ventral bud and the fusion
of the two buds.[11] During development,
the duodenum rotates to the right, and the
ventral bud rotates with it, moving to a
position that becomes more dorsal. Upon
reaching its final destination, the ventral
pancreatic bud is below the larger dorsal
bud, and eventually fuses with it. At this
point of fusion, the main ducts of the
ventral and dorsal pancreatic buds fuse,
forming the main pancreatic duct. Usually,
the duct of the dorsal bud regresses,
leaving the main pancreatic duct.[11]

Cellular development

Pancreatic progenitor cells are precursor

cells that differentiate into the functional
pancreatic cells, including exocrine acinar
cells, endocrine islet cells, and ductal
cells.[17] These progenitor cells are
characterised by the co-expression of the
transcription factors PDX1 and NKX6-1.[17]

The cells of the exocrine pancreas

differentiate through molecules that
induce differentiation including follistatin,
fibroblast growth factors, and activation of
the Notch receptor system.[17]
Development of the exocrine acini
progresses through three successive
stages. These are the predifferentiated,
protodifferentiated, and differentiated
stages, which correspond to undetectable,
low, and high levels of digestive enzyme
activity, respectively.[17]

Pancreatic progenitor cells differentiate

into endocrine islet cells under the
influence of neurogenin-3 and ISL1, but
only in the absence of notch receptor
signaling. Under the direction of a Pax
gene, the endocrine precursor cells
differentiate to form alpha and gamma
cells. Under the direction of Pax-6, the
endocrine precursor cells differentiate to
form beta and delta cells.[17] The
pancreatic islets form as the endocrine
cells migrate from the duct system to form
small clusters around capillaries.[9] This
occurs around the third month of
development,[11] and insulin and glucagon
can be detected in the human fetal
circulation by the fourth or fifth month of
development.[17]

Function
The pancreas is involved in blood sugar
control and metabolism within the body,
and also in the secretion of substances
(collectively pancreatic juice) that help
digestion. These are divided into an
"endocrine" role, relating to the secretion
of insulin and other substances within
pancreatic islets that help control blood
sugar levels and metabolism within the
body, and an "exocrine" role, relating to the
secretion of enzymes involved in digesting
substances in the digestive tract.[10]

Blood glucose regulation

 The pancreas maintains constant
blood glucose levels (shown as the
waving line). When the blood glucose
level is too high, the pancreas
secretes insulin and when the level is
too low, the pancreas secretes
glucagon.

Cells within the pancreas help to maintain

blood glucose levels (homeostasis). The
cells that do this are located within the
pancreatic islets that are present
throughout the pancreas. When blood
glucose levels are low, alpha cells secrete
glucagon, which increases blood glucose
levels. When blood glucose levels are high
beta cells secrete insulin to decrease
glucose in blood. Delta cells in the islet
also secrete somatostatin which
decreases the release of insulin and
glucagon.[9]

Glucagon acts to increase glucose levels

by promoting the creation of glucose and
the breakdown of glycogen to glucose in
the liver. It also decreases the uptake of
glucose in fat and muscle. Glucagon
release is stimulated by low blood glucose
or insulin levels, and during exercise.[18]
Insulin acts to decrease blood glucose
levels by facilitating uptake by cells
(particularly skeletal muscle), and
promoting its use in the creation of
proteins, fats and carbohydrates. Insulin is
initially created as a precursor form called
preproinsulin. This is converted to
proinsulin and cleaved by C-peptide to
insulin which is then stored in granules in
beta cells. Glucose is taken into the beta
cells and degraded. The end effect of this
is to cause depolarisation of the cell
membrane which stimulates the release of
the insulin.[18]

The main factor influencing the secretion

of insulin and glucagon are the levels of
glucose in blood plasma.[19] Low blood
sugar stimulates glucagon release, and
high blood sugar stimulates insulin
release. Other factors also influence the
secretion of these hormones. Some amino
acids, that are byproducts of the digestion
of protein, stimulate insulin and glucagon
release. Somatostatin acts as an inhibitor
of both insulin and glucagon. The
autonomic nervous system also plays a
role. Activation of Beta-2 receptors of the
sympathetic nervous system by
catecholamines secreted from
sympathetic nerves stimulates secretion
of insulin and glucagon,[19][20] whereas
activation of Alpha-1 receptors inhibits
secretion.[19] M3 receptors of the
parasympathetic nervous system act when
stimulated by the right vagus nerve to
stimulate release of insulin from beta
cells.[19]
Digestion

The pancreas has a role in digestion,

highlighted here. Ducts in the
pancreas (green) conduct digestive
enzymes into the duodenum. This
image also shows a pancreatic islet,
part of the endocrine pancreas, which
contains cells responsible for
secretion of insulin and glucagon.

The pancreas plays a vital role in the

digestive system. It does this by secreting
a fluid that contains digestive enzymes
into the duodenum, the first part of the
small intestine that receives food from the
stomach. These enzymes help to break
down carbohydrates, proteins and lipids
(fats). This role is called the "exocrine" role
of the pancreas. The cells that do this are
arranged in clusters called acini.
Secretions into the middle of the acinus
accumulate in intralobular ducts, which
drain to the main pancreatic duct, which
drains directly into the duodenum. About
1.5 - 3 liters of fluid are secreted in this
manner every day.[8][21]

The cells in each acinus are filled with

granules containing the digestive
enzymes. These are secreted in an
inactive form termed zymogens or
proenzymes. When released into the
duodenum, they are activated by the
enzyme enterokinase present in the lining
of the duodenum. The proenzymes are
cleaved, creating a cascade of activating
enzymes.[21]

Enzymes that break down proteins begin

with activation of trypsinogen to trypsin.
The free trypsin then cleaves the rest of
the trypsinogen, as well as
chymotrypsinogen to its active form
chymotrypsin.[21]
Enzymes secreted involved in the
digestion of fats include lipase,
phospholipase A2, lysophospholipase,
and cholesterol esterase.[21]
Enzymes that break down starch and
other carbohydrates include amylase.[21]
These enzymes are secreted in a fluid rich
in bicarbonate. Bicarbonate helps maintain
an alkaline pH for the fluid, a pH in which
most of the enzymes act most efficiently,
and also helps to neutralise the stomach
acids that enter the duodenum.[21]
Secretion is influenced by hormones
including secretin, cholecystokinin, and
VIP, as well as acetylcholine stimulation
from the vagus nerve. Secretin is released
from the S cells which form part of the
lining of the duodenum in response to
stimulation by gastric acid. Along with VIP,
it increases the secretion of enzymes and
bicarbonate. Cholecystokinin is released
from Ito cells of the lining of the
duodenum and jejunum mostly in
response to long chain fatty acids, and
increases the effects of secretin.[21] At a
cellular level, bicarbonate is secreted from
centroacinar and ductal cells through a
sodium and bicarbonate cotransporter
that acts because of membrane
depolarisation caused by the cystic
fibrosis transmembrane conductance
regulator. Secretin and VIP act to increase
the opening of the cystic fibrosis
transmembrane conductance regulator,
which leads to more membrane
depolarisation and more secretion of
bicarbonate.[22][23][24]
A variety of mechanisms act to ensure
that the digestive action of the pancreas
does not act to digest pancreatic tissue
itself. These include the secretion of
inactive enzymes (zymogens), the
secretion of the protective enzyme trypsin
inhibitor, which inactivates trypsin, the
changes in pH that occur with bicarbonate
secretion that stimulate digestion only
when the pancreas is stimulated, and the
fact that the low calcium within cells
causes inactivation of trypsin.[21]

Additional functions
The pancreas also secretes vasoactive
intestinal peptide and pancreatic
polypeptide. Enterochromaffin cells of the
pancreas secrete the hormones motilin,
serotonin, and substance P.[9]

Clinical significance

Inflammation

Inflammation of the pancreas is known as

pancreatitis. Pancreatitis is most often
associated with recurrent gallstones or
chronic alcohol use, with other common
causes including traumatic damage,
damage following an ERCP, some
medications, infections such as mumps
and very high blood triglyceride levels.
Acute pancreatitis is likely to cause
intense pain in the central abdomen, that
often radiates to the back, and may be
associated with nausea or vomiting.
Severe pancreatitis may lead to bleeding
or perforation of the pancreas resulting in
shock or a systemic inflammatory
response syndrome, bruising of the flanks
or the region around the belly button.
These severe complications are often
managed in an intensive care unit.[25]

In pancreatitis, enzymes of the exocrine

pancreas damage the structure and tissue
of the pancreas. Detection of some of
these enzymes, such as amylase and
lipase in the blood, along with symptoms
and findings on medical imaging such as
ultrasound or a CT scan, are often used to
indicate that a person has pancreatitis.
Pancreatitis is often managed medically
with pain reliefs, and monitoring to prevent
or manage shock, and management of any
identified underlying causes. This may
include removal of gallstones, lowering of
blood triglyceride or glucose levels, the
use of corticosteroids for autoimmune
pancreatitis, and the cessation of any
medication triggers.[25]
Chronic pancreatitis refers to the
development of pancreatitis over time. It
shares many similar causes, with the most
common being chronic alcohol use, with
other causes including recurrent acute
episodes and cystic fibrosis. Abdominal
pain, characteristically relieved by sitting
forward or drinking alcohol, is the most
common symptom. When the digestive
function of the pancreas is severely
affected, this may lead to problems with
fat digestion and the development of
steatorrhoea; when the endocrine function
is affected, this may lead to diabetes.
Chronic pancreatitis is investigated in a
similar way to acute pancreatitis. In
addition to management of pain and
nausea, and management of any identified
causes (which may include alcohol
cessation), because of the digestive role
of the pancreas, enzyme replacement may
be needed to prevent malabsorption.[25]

Cancer

Pancreatic cancer, shown here, most

commonly occurs as an
adenocarcinoma in the head of the
pancreas. Because symptoms (such
as skin yellowing, pain, or itch) do not
occur until later in the disease, it often
presents at a later stage and has
limited treatment options.
 Relative incidences of various pancreatic neoplasms, with
pancreatic cancers in red/pink color.[26]

Pancreatic cancers, particularly the most

common type, pancreatic
adenocarcinoma, remain very difficult to
treat, and are mostly diagnosed only at a
stage that is too late for surgery, which is
the only curative treatment. Pancreatic
cancer is rare in people younger than 40
and the median age of diagnosis is 71.[27]
Risk factors include chronic pancreatitis,
older age, smoking, obesity, diabetes, and
certain rare genetic conditions including
multiple endocrine neoplasia type 1,
hereditary nonpolyposis colon cancer and
dysplastic nevus syndrome among
others.[25][28] About 25% of cases are
attributable to tobacco smoking,[29] while
5–10% of cases are linked to inherited
genes.[27]

Pancreatic adenocarcinoma is the most

common form of pancreatic cancer, and is
cancer arising from the exocrine digestive
part of the pancreas. Most occur in the
head of the pancreas.[25] Symptoms tend
to arise late in the course of the cancer,
when it causes abdominal pain, weight
loss, or yellowing of the skin (jaundice).
Jaundice occurs when the outflow of bile
is blocked by the cancer. Other less
common symptoms include nausea,
vomiting, pancreatitis, diabetes or
recurrent venous thrombosis.[25]
Pancreatic cancer is usually diagnosed by
medical imaging in the form of an
ultrasound or CT scan with contrast
enhancement. An endoscopic ultrasound
may be used if a tumour is being
considered for surgical removal, and
biopsy guided by ERCP or ultrasound can
be used to confirm an uncertain
diagnosis.[25]

Because of the late development of

symptoms, most cancer presents at an
advanced stage.[25] Only 10 to 15% of
tumours are suitable for surgical
resection.[25] As of 2018, when
chemotherapy is given the FOLFIRINOX
regimen containing fluorouracil, irinotecan,
oxaliplatin and leucovorin has been shown
to extend survival beyond traditional
gemcitabine regimens.[25] For the most
part, treatment is palliative, focus on the
management of symptoms that develop.
This may include management of itch, a
choledochojejunostomy or the insertion of
stents with ERCP to facilitate the drainage
of bile, and medications to help control
pain.[25] In the United States pancreatic
cancer is the fourth most common cause
of deaths due to cancer.[30] The disease
occurs more often in the developed world,
which had 68% of new cases in 2012.[31]
Pancreatic adenocarcinoma typically has
poor outcomes with the average
percentage alive for at least one and five
years after diagnosis being 25% and 5%
respectively.[31][32] In localized disease
where the cancer is small (< 2 cm) the
number alive at five years is approximately
20%.[33]

There are several types of pancreatic

cancer, involving both the endocrine and
exocrine tissue. The many types of
pancreatic endocrine tumors are all
uncommon or rare, and have varied
outlooks. However the incidence of these
cancers has been rising sharply; it is not
clear to what extent this reflects increased
detection, especially through medical
imaging, of tumors that would be very
slow to develop. Insulinomas (largely
benign) and gastrinomas are the most
common types.[34] For those with
neuroendocrine cancers the number alive
after five years is much better at 65%,
varying considerably with type.[31]

A solid pseudopapillary tumour is a low-

grade malignant tumour of the pancreas
of papillary architecture that typically
afflicts young women.[35]

Diabetes mellitus

Type 1 diabetes

Diabetes mellitus type 1 is a chronic

autoimmune disease in which the immune
system attacks the insulin-secreting beta
cells of the pancreas.[36] Insulin is needed
to keep blood sugar levels within optimal
ranges, and its lack can lead to high blood
sugar. As an untreated chronic condition,
complications including accelerated
vascular disease, diabetic retinopathy,
kidney disease and neuropathy can
result.[36] In addition, if there is not enough
insulin for glucose to be used within cells,
the medical emergency diabetic
ketoacidosis, which is often the first
symptom that a person with type 1
diabetes may have, can result.[37] Type 1
diabetes can develop at any age but is
most often diagnosed before age 40.[36]
For people living with type 1 diabetes,
insulin injections are critical for survival.[36]
An experimental procedure to treat type 1
diabetes is pancreas transplantation or
isolated transplantation of islet cells to
supply a person with functioning beta
cells.[36]
Type 2 diabetes

Diabetes mellitus type 2 is the most

common form of diabetes.[36] The causes
for high blood sugar in this form of
diabetes usually are a combination of
insulin resistance and impaired insulin
secretion, with both genetic and
environmental factors playing a role in the
development of the disease.[38] Over time,
pancreatic beta cells may become
"exhausted" and less functional.[36] The
management of type 2 diabetes involves a
combination of lifestyle measures,
medications if required and potentially
insulin.[39] With relevance to the pancreas,
several medications act to enhance the
secretion of insulin from beta cells,
particularly sulphonylureas, which act
directly on beta cells; incretins which
replicate the action of the hormones
glucagon-like peptide 1, increasing the
secretion of insulin from beta cells after
meals, and are more resistant to
breakdown; and DPP-4 inhibitors, which
slow the breakdown of incretins.[39]

Removal

It is possible for a person to live without a

pancreas, provided that the person takes
insulin for proper regulation of blood
glucose concentration and pancreatic
enzyme supplements to aid digestion.[40]

History

The pancreas was first identified by

Herophilus (335–280 BC), a Greek
anatomist and surgeon.[41] A few hundred
years later, Rufus of Ephesus, another
Greek anatomist, gave the pancreas its
name. Etymologically, the term "pancreas",
a modern Latin adaptation of Greek
πάγκρεας,[42] [πᾶν ("all", "whole"), and
κρέας ("flesh")],[43] originally means
sweetbread,[44] although literally meaning
all-flesh, presumably because of its fleshy
consistency. It was only in 1889 when
Oskar Minkowski discovered that
removing the pancreas from a dog caused
it to become diabetic.[45] Insulin was later
isolated from pancreatic islets by
Frederick Banting and Charles Best in
1921.[45]

The way the tissue of the pancreas has

been viewed has also changed. Previously,
it was viewed using simple staining
methods such as H&E stains. Now,
immunohistochemistry can be used to
more easily differentiate cell types. This
involves visible antibodies to the products
of certain cell types, and helps identify
with greater ease cell types such as alpha
and beta cells.[9]

Other animals

Pancreatic tissue is present in all

vertebrates, but its precise form and
arrangement varies widely. There may be
up to three separate pancreases, two of
which arise from the pancreatic bud, and
the other dorsally. In most species
(including humans), these "fuse" in the
adult, but there are several exceptions.
Even when a single pancreas is present,
two or three pancreatic ducts may persist,
each draining separately into the
duodenum (or equivalent part of the
foregut). Birds, for example, typically have
three such ducts.[46]

In teleost fish, and a few other species

(such as rabbits), there is no discrete
pancreas at all, with pancreatic tissue
being distributed diffusely across the
mesentery and even within other nearby
organs, such as the liver or spleen. In a
few teleost species, the endocrine tissue
has fused to form a distinct gland within
the abdominal cavity, but otherwise it is
distributed among the exocrine
components. The most primitive
arrangement, however, appears to be that
of lampreys and lungfish, in which
pancreatic tissue is found as a number of
discrete nodules within the wall of the gut
itself, with the exocrine portions being
little different from other glandular
structures of the intestine.[46]

Cuisine

The pancreas of calf (ris de veau) or lamb

(ris d'agneau), and, less commonly, of beef
or pork, are used as food under the
culinary name of sweetbread.[47][48]

Additional images
A normal pancreas on ultrasound.

Identifying pancreas on abdominal

ultrasonography when it is partly obscured
by bowel gas.
Pancreas of a human embryo at end of sixth
week

The pancreas and its surrounding structures

Duodenum and pancreas. Deep dissection.

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External links

Media related to Pancreas at

Wikimedia Commons
Pancreas at the Human Protein Atlas (ht
tps://www.proteinatlas.org/humanprote
ome/pancreas)
 Pancreatic Diseases – English – The
Gastro Specialist (https://www.youtube.
com/watch?v=GWV9vHVmeL0&t=94s)

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