The pancreas is a large organ in the abdomen that lies behind the stomach, but is also attached to the first section of the small intestines. A pancreatic duct carries sodium bicarbonate and digestive enzymes from the organ to the small intestines. These substances are necessary for the digestion and absorption of food, including fats and the fat-soluble vitamins.
Pancreatectomy
Pancreatectomy is the medical name for the removal of the pancreas. A total pancreatectomy involves the removal of the entire pancreas, as well as the spleen, the common bile duct, the gallbladder, a portion of the stomach and small intestines, and some of the lymph nodes. A partial pancreatectomy will remove part of the pancreas. This surgery may need to be performed because of a traumatic injury to the pancreas, or as part of the treatment for pancreatic cancer, chronic pancreatitis or a tumor called an insulinoma, as described in "Current Diagnosis & Treatment: Surgery."
Functions of the Pancreas
The pancreas has exocrine and endocrine functions. The term exocrine function refers to the job of the pancreas to make and release sodium bicarbonate and enzymes that are vital for the digestion and absorption of food. This function takes up approximately 85 percent of the pancreatic tissue, according to William Fisher, M.D., professor in the Department of Surgery at Baylor College of Medicine, writing in "Schwartz's Principles of Surgery." The endocrine function is its production and release of the insulin, somatostatin and glucagon hormones. A pancreatectomy can cause vitamin deficiencies if it affects its production and release of sodium bicarbonate and the digestive enzyme lipase.
Fat-Soluble Vitamins and the Pancreas
The digestive enzymes do not work in an acidic environment, so sodium bicarbonate is released from the pancreas to enter the small intestines to neutralize the acid there and allow the enzymes to become active. The pancreas releases the lipase digestive enzyme to help break down fats. Vitamins A, E, K and D are fat-soluble vitamins, or vitamins that must have fat to be metabolized and absorbed. After the pancreas has been removed, a deficiency of sodium bicarbonate or lipase creates a risk of developing a deficiency in the fat-soluble vitamins; monthly injections are recommended, per Herrmann Delbruck, Professor for Clinical Rehabilitation Sciences at the University of Witten, writing in the "Rehabilitation and Palliation of Cancer Patients."
Symptoms of Fat-Soluble Vitamin Deficiencies
In the November 2009 issue of "The Official Journal of the International Hepato-Pancreato-Biliary Association," Helmut Friess wrote about a disorder called exocrine pancreatic insufficiency, which is common after the pancreas has been removed. The term exocrine insufficiency refers to the exocrine functions of the pancreas and its inability to make and release enough sodium bicarbonate and digestive enzymes after surgery. The symptoms of this disorder include fatty bowel movements, weight loss, malnutrition and deficiencies in vitamins A, E, K and D. The bowel movements are fatty because without enough lipase, fat is lost in the bowel movement instead of being broken down and absorbed.
References
- "Current Diagnosis & Treatment: Surgery"; Gerard Doherty, M.D.; 2010
- "Handbook of Pathophysiology"; Elizabeth Corwin, MSN, Ph.D., FNP; 2000
- "Harrison's Principles of Internal Medicine"; Anthony Fauci, M.D., Dennis Kasper, M.D., Dan Longo, M.D. et al.; 2008
- "HPB"; Diagnosing Exocrine Pancreatic Insufficiency After Surgery; H. Friess, C. Michalski; 2009
- "Rehabilitation and Palliation of Cancer Patients"; Herrmann Delbruck; 2007
- "Schwartz's Principles of Surgery"; F. Charles Brunicardi, M.D.; 2010
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