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Pancreas
Dr Sruthi P.K
Anatomy
Digestive gland that lies retroperitoneally
and transversely across posterior abdominal
wall posterior to stomach between
duodenum on the right and spleen on the
left.
EXOCRINE PANCREAS
Compound tubulo
alveolar gland
Acinar cells lining the alveoli have
secretory granules in their apical part.
When activated, they secrete enzymes.
Columnar epithelial cells lining
pancreatic ducts secrete watery juice
rich in HCO3-.
Enzymes present in pancreatic juice
get activated only after they mix with
duodenal contents.
Intercalated ducts receive secretions
from acini and pass it on to interlobular
ducts.
 Pancreatic digestive enzymes are
secreted by pancreatic acinar cells and
watery juice rich in sodium bicarbonate
is secreted by ductal epithelial cells
leading from the acini.
The combined product then flows
through main pancreatic duct of
Wirsung that joins the common bile
duct before it empties into major
duodenal papilla on 2nd part of
duodenum through the ampulla of
Vater, surrounded by the sphincter of
Oddi.
Secretions also pass through accessory
pancreatic duct of Santorini into
duodenum about 2 mm above the main
duct on minor duodenal papilla.
Pancreatic Juice
Colourless fluid
1200-1500 ml / day
Specific Gravity varies between 1.010-
1.018
pH varies between 7.8-8.4.
Composition of Pancreatic
Juice
99.5% water
Organic
0.5% solids
Inorganic
Organic Inorganic
Alpha Amylase Na+
Proteases K+
Lipolytic enzymes Ca2+
Trypsin inhibitor Mg2+
Nucleases Zn2+
Traces of albumin HCO3-
and globulin Cl-
SO42-
HPO42-
Actions of enzymes
Alpha Amylase
o Hydrolyzes Starch , Glycogen and other
complex carbohydrates except cellulose
to form disaccharides and
trisaccharides.
Proteases
o Trypsin
Secreted as inactive trypsinogen.
Enterokinase / Enteropeptidase secreted
by duodenal mucosal cells activates
trypsinogen to trypsin.
o Once formed trypsin activates
trypsinogen - An autocatalytic reaction.
o Trypsin converts proteins into peptides.
o Chymotrypsin secreted as inactive
chymotrypsiogen. Once activated it
converts proteins into peptides.
o Carboxypeptidases A and B secreted as
inactive procarboxypeptidases A and B.
Once activated it converts peptides into
aminoacids.
o Elastase secreted as inactive proelastase.
o Collagenase
All activated by trypsin
Trypsin inhibitor
o Protects pancreas from autodigestion.
Lipolytic enzymes
o Pancreatic lipase
Hydrolyzes neutral fat into fatty acids and
monoglycerides.
o Cholesterol ester hydrolase
Hydrolyzes cholesterol esters to cholesterol.
o Phospholipase A2
Hydrolyzes lysophospholipids into phosphoryl
choline.
o Pancreatic Colipase
Secreted as pro Colipase. Once activated, necessary
Nucleases
o Hydrolyzes nucleic acids into
nucleotides.
Mechanism of secretion of
HCO3 -
 CO2 diffuses into ductal cells and binds with
H2O to form H2CO3.
 H2CO3 dissociates to form HCO3- and H+.
 H+ extrudes into blood via NaH exchanger.
 HCO3- flows into lumen via Cl-HCO3-
exchanger.
 Na also moves into lumen to maintain
electrical neutrality via tight junctions.
 Cl- diffuses back into lumen via Cl- channels.
• Mechanism of
secretion of HCO3-
ions
Actions of bicarbonate
HCO3- neutralizes acidic chyme and

protects intestinal mucosa from acid.
HCO3- also provides optimum pH for the
activation of pancreatic enzymes.
Functions of Pancreatic
Juice
1) Enzymes help in the digestion of
proteins, fats, carbohydrates and
nucleic acids in food.
2) Alkaline pH neutralizes acidic chyme
that enters duodenum. (BUFFER)
Regulation of
pancreatic secretion
Neural Humoral
Vagus Gastrin
Secretin
Cholecystokinin
Pancreatic secretion occurs
in 3 phases
1) Cephalic Phase
2) Gastric Phase
3) Intestinal Phase
Cephalic Phase
 Occurs before food enters the stomach.

Sight,Smell,Thought of Chewing and
food Swallowing
Cerebral cortex Mouth
Dorsal nucleus of Vagus stimulated
Vagus stimulates enteric neurons
Acetyl Choline Noradrenaline

acinar secretions
ductal secretions
CORTEX Sight,Smell, & thought of food
DMN
VAGUS
VAGUS Enteric neuron
Ach
Chewing NE
Gastric Phase
Occurs when food enters the stomach
Gastric Phase
When stomach is distended by food
 Vagus is stimulated and produces low

volume of pancreatic juice rich in
enzymes and HCO3-.
 Aminoacids and peptides stimulate antral
G cells . Gastrin is released to blood & it
stimulates the production of enzyme
rich pancreatic secretion.
gu s
Va
Distension
Vagus
Amino acids
Gastrin
Intestinal Phase
Occurs when food enters small intestine.
Intestinal Phase
When chyme enters duodenum and jejunum
① Digestive products stimulate vagovagal reflex
and increases pancreatic secretion
② low pH (<4.5) of acidic chyme causes
secretion of Secretin by S cells among
epithelial cells of duodenum and jejunum.
③ Aminoacids, fatty acids and monoglycerides
present in chyme stimulates the release of
Cholecystokinin Pancreozymin (CCK-PZ) by I
cells of duodenum and jejunum.
Digestive Products Acidic Chyme
Vagovagal
I cells of S cells of
Reflex
duodenum duodenum
Acinar cells
and Ductal CCK Secretin
cells
Acinar
Ductal cells
Enzymes cells
and
HCO3- Enzymes HCO3-
Functions of Secretin
1) It stimulates duct cells to release large
amount of watery juice rich in HCO3-.
2) Stimulates the secretion of bile.
3) Contraction of pyloric sphincter causing
delay in gastric emptying and preventing
reflux of duodenal contents into stomach.
4) Potentiates effect of CCK-PZ on pancreas.
Functions of CCK-PZ
1) It stimulates acinar cells to release low volume
of pancreatic juice rich in enzymes.
2) Stimulates contraction of gall bladder to release
bile.
3) Potentiates effect of Secretin.
4) Inhibits gastric motility.
5) Increases small and large intestinal motility.
6) Increase secretion of enterokinase from
duodenum.
Applied Aspects
Acute Pancreatitis:
• Autodigestion by proteolytic enzymes.
• Acute pain in upper abdomen, nausea,

vomiting
• Elevated Serum Amylase

Chronic Pancreatitis:
• It causes Diabetes Mellitus.
• Digestive disturbances:
Steatorrhoea:
presence of excess fat in faeces.
raised fecal fat content , foul smelling, pale,

greasy stools.
• Raised fecal Nitrogen contents due to
incomplete Proteolysis.
• Carbohydrate digestion and absorption

remains
nearly normal.
Pancreatectomy:
Same features as described above.
Pancreatic Function Tests
• Serum Amylase ( 50-120 units/L)
• Fecal Fat excretion Test (5-6gm/day)
• Lundh Test: For Trypsin activity.
• Secretin and CCK stimulation Test
• Cytological tests: for cancer cells

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Pancreas

HCO3- neutralizes acidic chyme and

 Occurs before food enters the stomach.

Dorsal nucleus of Vagus stimulated

Vagus stimulates enteric neurons

Acetyl Choline Noradrenaline

VAGUS Enteric neuron

 Vagus is stimulated and produces low

• Autodigestion by proteolytic enzymes.

• Acute pain in upper abdomen, nausea,

• Elevated Serum Amylase

• It causes Diabetes Mellitus.

raised fecal fat content , foul smelling, pale,

• Carbohydrate digestion and absorption

• Fecal Fat excretion Test (5-6gm/day)

• Lundh Test: For Trypsin activity.

• Secretin and CCK stimulation Test

• Cytological tests: for cancer cells

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