The pancreas is a gland in the abdomen lying in the curvature of the stomach as it empties into the duodenum. The pancreas functions primarily as an exocrine gland, although it also has endocrine function. The exocrine cells of the pancreas are called acinar cells that produce an alkaline fluid known as pancreatic juice that contains various digestive enzymes. The pancreatic juice is released through the ampulla of Vater into the duodenum to aid in the digestive process as well as buffer acidic fluid released from the stomach (Fig. 23-1).

These enzymes are produced and stored as inactive proenzymes within zymogen granules to prevent autolysis and digestion of the pancreas. The zymogen granules are also responsible for enzyme transport to the pancreatic duct. Amylase and lipase are released from the zymogen granules in the active form, whereas the proteolytic enzymes are activated in the duodenum by enterokinase. Enterokinase triggers the conversion of trypsinogen to the active protease, trypsin. Trypsin then activates the other proenzymes to their active enzymes. The pancreas contains a trypsin inhibitor to prevent autolysis.

FIGURE 23-1. Anatomic structure of the pancreas and biliary tract. (From Berardi RR, Montgomery PA. Pancreatitis. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy: A Pathophysiologic Approach, 7th ed. New York: McGraw-Hill, 2005:660, with permission.)

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