• Pancreas is a glandular organ in
the digestive system and endocrine
system of vertebrates.
• Hormones like insulin, glucagon
• Pancreatic juice containing
• Endocrine portion contains islets
of langerhans which has 4 types of
α cells - glucagon
β cells - insulin
δ cells - somatostatin
γ cells – pancreatic polypeptide
• Exocrine portion contains 2 types
of cells: duct cells and acinar cells
• Acinar cells secrete digestive
Pancreatic enzymes are natural chemicals that help break down fats, proteins and carbohydrates.
A normally functioning pancreas secretes about 8 cups of fluid, called pancreatic juice, daily
into the duodenum, the portion of the small intestine that connects with the stomach. This fluid
contains pancreatic enzymes and helps neutralize stomach acid as it enters the small intestine.
Lipase works with bile from the liver to
Lack of needed fats and fat-soluble
break down fat molecules so they can be
A shortage may cause:
Diarrhea and/or fatty stools.
used by the body.
Proteases break down proteins. They
Allergies or the formation of toxic
help keep the intestine free of parasites
such as bacteria, yeast and protozoa.
digestion of proteins.
Amylase breaks down carbohydrates
Diarrhea due to the effects of
(starch) into sugars which are more
undigested starch in the colon.
easily absorbed by the body. This
enzyme is also found in saliva.
Normal level of Pancreatic Enzymes
Pancreatic lipase : 10-140 units per liter(U/L)
Pancreatic amylase : 23-85 units per liter(U/L)
Trypsin : 115-350ng/ml
Chymotrypsin : 2.3-51.4 U/g of stool
• The enzymes also include steapsin, carboxypeptidase, elastases & nucleases.
Pancreatic enzyme assay:
1. Plasma Enzymes
We can measure the plasma trypsin by immunoassay. In pancreatic
insufficiency, low level of plasma trypsin in adults is diagnosed. The children with
fibrocystic disease have normal pancreatic function initially, the level of plasma
trypsin may be high.
In acute pancreatitis, total plasma amylase activity is usually significantly
increased by release of this plasma amylase enzyme from damaged cells.
2. Faecal Enzymes
Faecal elastase level and faecal trypsin level is tested.
Because of the bacterial degradation in the intestinal lumen, faecal trypsin level is
In infants with diarrhoea, the absence of enzymes indicates the fibrocystic disease of
3. Secretin Stimulation Test
Secretin is a hormone made by
the small intestine. Secretin stimulates the
pancreas to release a fluid that neutralizes
stomach acid and aids in digestion. The
secretin stimulation test measures the ability
of the pancreas to respond to secretin.
This test may be performed to determine the
activity of the pancreas in people with
diseases that affect the pancreas (for
example, cystic fibrosis or pancreatic
During the test, a health care professional
places a tube down the throat, into the
stomach, then into the upper part of the
small intestine. Secretin is administered by
vein and the contents of the duodenal
secretions are aspirated (removed with
suction) and analyzed over a period of
about two hours.
4. PABA Test
A synthetic peptide labelled with PABA is taken orally and the product of its
digestion by chymotrypsin, PABA, is absorbed and excreted in the urine.
Urinary excretion of PABA is significantly reduced in chronic pancreatitis.
5. PLT - Pancreato Lauryl Test
A standard meal is taken following an overnight fast along with a test food (with
PLT). One or more blood tests or a urine test is then made to see if the test food
has been digested (by the pancreatic enzymes) and then absorbed. Here
fluorescein dilaurate is used.
Disorders of the Pancreas
•Pancreatic disorders are rarely associated with
•3 types of pancreatic disorders:
1. Acute Pancreatitis
2. Chronic Pancreatitis
3. Carcinoma of Pancreas
Malabsorption of disaccharides
• Duodenum is the first section of the small intestine in most higher vertebrates.
• Site for iron absorption, chemical digestion.
• In Latin, „digitorum‟ means “twelve fingers‟ breadth”.
• It is a hollow jointed tube about 25 - 38 cm long, roughly horse-shoe shaped.
•It receives partially digested food from the stomach.and begins the absorption
Since healthy human body depends on the normal functioning
of the pancreas, the pancreatic enzyme assay is needed to check
the normal level of the enzymes in duodenum and blood
•Lawrence A. Kalpan, Amadeo J.Pesce (2009),Clinical Chemistry,5th
Ed.,Mosby Inc., Elsevier Inc. New York, 253-265.