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Exocrine Function of the Pancreas: Title and subTitle BreakReappraisal of Some Physiological and Biochemical Principles FREE

Bernard J. Haverback, MD
[+] Author Affiliations

Read before the Section on Gastroenterology during the 113th annual convention of the American Medical Association, June 23, 1964.

Reprint requests to 2025 Zonal Ave, Los Angeles 90033 (Dr. Haverback).


From the University of Southern California School of Medicine, Los Angeles.


JAMA. 1965;193(4):279-283. doi:10.1001/jama.1965.03090040023007
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A clear understanding of the biochemical and physiological principles regulating the formation and flow of the constituents in pancreatic juice would be helpful in elucidating some aspects of pancreatic diseases. In the consideration of pancreatitis and its complications, in addition to biochemical and physiological principles, certain features of the normal anatomy of the gland should be understood. Because there has been much discussion and controversy concerning the relationship of the "common channel" to pancreatitis, a description of the variations in the anatomy of the intraduodenal bile duct and pancreatic duct (duct of Wirsung) is relevant. In about 30% of people the pancreatic duct is completely separated from the common duct, both ducts opening separately into the duodenum at the ampulla of Vater. In about one third, the two ducts join with 2 mm of a common opening into the duodenum. Such a short common channel is not considered to be

REFERENCES

Haverback, B.J., et al: " Acute Pancreatitis ," in Tice-Harvey Practice of Medicine , ed 7, J. Harvey, (ed.), Hagerstown, Md: W.F. Prior Co., Inc., 1964;, pp 537-552A.
Herskovic, T., et al:  Relationship Between Calcium in Pancreatic Secretion and Blood Calcium in Normal and Hypercalcemic States , read before the American Gastroenterological Association Meeting, June, 1963 .
Janowitz, H.D., and Drieling, D.A.: " Pancreatic Secretion of Fluid and Electrolytes ," in Ciba Foundation Symposium on Exocrine Pancreas: Normal and Abnormal Functions , A.V.S. De Reuck and M. P. Cameron (eds.), Boston: Little, Brown & Co., 1961;, pp 115-133.
Preston, F.W., and Kukral, J.C.:  Surgical Physiology of Pancreas , Surg Clin N Amer 42:203-318, 1962;.
Neurath, H.: " Consideration of Occurrence, Structure and Function of Proteolytic Enzymes of Pancreas ," in Ciba Foundation Symposium on Exocrine Pancreas: Normal and Abnormal Functions , A. V. S. De Reuck and M. P. Cameron (eds.), Boston: Little, Brown & Co., 1961;, pp 67-85.
Haverback, B.J., et al:  Trypsin, Trypsinogen, and Trypsin Inhibitor in Human Pancreatic Juice (Mechanism for Pancreatitis Associated with Hyperparathyroidism) , Amer J Med 29:424-433, 1960;.
Neurath, H.:  Protein Digesting Enzymes , Sci Amer 211:68-79, 1964;.
Haverback, B.J., et al:  Protein Binding of Pancreatic Proteolytic Enzymes . J Clin Invest 41:972-980, 1962;.
Kunitz, M., and Northrop, J.H.:  Isolation From Beef Pancreas of Crystalline Trypsinogen, Trypsin, Trypsin Inhibitor and Inhibitor-Trypsin Compound , J Gen Physiol 19:991-1007 ( (July) ) 1936;.
Mehl, J.W.; O'Connell, W.; and DeGroot, J.:  Macroglobulin From Human Plasma Which Forms Enzymatically Active Compound With Trypsin , Science 145:821-822, 1964;.
McGeachin, R.L., and Lewis, J.P.:  Electrophoretic Behavior of Serum Amylase , J Biol Chem 234:795-798 ( (April) ) 1959;.
Dreiling, D.A.; Janowitz, H.D.; and Josephberg. L.J.:  Studies in Serum Iso-Amylase: I. Electrophoretic Analysis of Blood Amylase and Pattern Changes Observed in Pancreatic Disease , Ann Intern Med 58:233-244 ( (Feb) ) 1963;.
Wilding, P.:  Use of Gel Filtration in Study of Human Amylase , Clin Chim Acta 8:918-924 ( (Nov) ) 1963;.
Bernard, C.:  Du Suc Pancreatique et de sou Role dans les Phenomenes de la Digestion , C R Soc Biol 1:99, 1850;.
Bayliss, W.M.. and Starling, E.H.:  Mechanism of Pancreatic Secretion , J Physiol 28:325, 1902;.
Jorpes, J.E., and Mutt, V.: " Gastrointestinal Hormones Secretin and Cholecystokinin: Exocrine Pancreas ," in Ciba Foundation Symposium on Exocrine Pancreas: Normal and Abnormal Functions A. V. S. De Reuck and M. P. Cameron (eds.), Boston: Little, Brown & Co., 1961;, pp 150-164.
Lagerlof, H.O.:  Pancreatic Function and Pancreatic Disease, Studied by Means of Secretion , Acta Med Scand , (suppl 128) , pp 1-289. 1942;.
Preshaw, R.M., and Grossman, M.I.:  Stimulation of Pancreatic Secretion by Extracts of Pyloric Gland Area of Stomach , Gastroenterology 48:36-44 ( (Jan) ) 1965;.
Grossman, M.I.: " Nervous and Hormonal Regulation of Pancreatic Secretion ," in Ciba Foundation Symposium on Exocrine Pancreas: Normal and Abnormal Functions , A. V. S. De Reuck and M. P. Cameron (eds.), Boston: Little, Brown & Co., 1961;, pp 208-220.
Wang, C.C., and Grossman, M.L.:  Physiological Determination of Release of Secretin and Pancreozymin From Intestine of Dogs With Transplanted Pancreas , Amer J Physiol 164:527-545 ( (Feb) ) 1951;.
White, T.T.; McAlexander, R.A.; and Magee, D.F.:  Effect of Gastric Distension on Duodenal Aspirates in Man , Gastroenterology 44:48-51 ( (Jan) ) 1963;.
Gregory, R.A., and Tracy, H.J.:  Constitution and Properties of Two Gastrins Extracted From Hog Antral Mucosa , Gut 5:103-117 ( (April) ) 1964;.

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Haverback, B.J., et al: " Acute Pancreatitis ," in Tice-Harvey Practice of Medicine , ed 7, J. Harvey, (ed.), Hagerstown, Md: W.F. Prior Co., Inc., 1964;, pp 537-552A.
Herskovic, T., et al:  Relationship Between Calcium in Pancreatic Secretion and Blood Calcium in Normal and Hypercalcemic States , read before the American Gastroenterological Association Meeting, June, 1963 .
Janowitz, H.D., and Drieling, D.A.: " Pancreatic Secretion of Fluid and Electrolytes ," in Ciba Foundation Symposium on Exocrine Pancreas: Normal and Abnormal Functions , A.V.S. De Reuck and M. P. Cameron (eds.), Boston: Little, Brown & Co., 1961;, pp 115-133.
Preston, F.W., and Kukral, J.C.:  Surgical Physiology of Pancreas , Surg Clin N Amer 42:203-318, 1962;.
Neurath, H.: " Consideration of Occurrence, Structure and Function of Proteolytic Enzymes of Pancreas ," in Ciba Foundation Symposium on Exocrine Pancreas: Normal and Abnormal Functions , A. V. S. De Reuck and M. P. Cameron (eds.), Boston: Little, Brown & Co., 1961;, pp 67-85.
Haverback, B.J., et al:  Trypsin, Trypsinogen, and Trypsin Inhibitor in Human Pancreatic Juice (Mechanism for Pancreatitis Associated with Hyperparathyroidism) , Amer J Med 29:424-433, 1960;.
Neurath, H.:  Protein Digesting Enzymes , Sci Amer 211:68-79, 1964;.
Haverback, B.J., et al:  Protein Binding of Pancreatic Proteolytic Enzymes . J Clin Invest 41:972-980, 1962;.
Kunitz, M., and Northrop, J.H.:  Isolation From Beef Pancreas of Crystalline Trypsinogen, Trypsin, Trypsin Inhibitor and Inhibitor-Trypsin Compound , J Gen Physiol 19:991-1007 ( (July) ) 1936;.
Mehl, J.W.; O'Connell, W.; and DeGroot, J.:  Macroglobulin From Human Plasma Which Forms Enzymatically Active Compound With Trypsin , Science 145:821-822, 1964;.
McGeachin, R.L., and Lewis, J.P.:  Electrophoretic Behavior of Serum Amylase , J Biol Chem 234:795-798 ( (April) ) 1959;.
Dreiling, D.A.; Janowitz, H.D.; and Josephberg. L.J.:  Studies in Serum Iso-Amylase: I. Electrophoretic Analysis of Blood Amylase and Pattern Changes Observed in Pancreatic Disease , Ann Intern Med 58:233-244 ( (Feb) ) 1963;.
Wilding, P.:  Use of Gel Filtration in Study of Human Amylase , Clin Chim Acta 8:918-924 ( (Nov) ) 1963;.
Bernard, C.:  Du Suc Pancreatique et de sou Role dans les Phenomenes de la Digestion , C R Soc Biol 1:99, 1850;.
Bayliss, W.M.. and Starling, E.H.:  Mechanism of Pancreatic Secretion , J Physiol 28:325, 1902;.
Jorpes, J.E., and Mutt, V.: " Gastrointestinal Hormones Secretin and Cholecystokinin: Exocrine Pancreas ," in Ciba Foundation Symposium on Exocrine Pancreas: Normal and Abnormal Functions A. V. S. De Reuck and M. P. Cameron (eds.), Boston: Little, Brown & Co., 1961;, pp 150-164.
Lagerlof, H.O.:  Pancreatic Function and Pancreatic Disease, Studied by Means of Secretion , Acta Med Scand , (suppl 128) , pp 1-289. 1942;.
Preshaw, R.M., and Grossman, M.I.:  Stimulation of Pancreatic Secretion by Extracts of Pyloric Gland Area of Stomach , Gastroenterology 48:36-44 ( (Jan) ) 1965;.
Grossman, M.I.: " Nervous and Hormonal Regulation of Pancreatic Secretion ," in Ciba Foundation Symposium on Exocrine Pancreas: Normal and Abnormal Functions , A. V. S. De Reuck and M. P. Cameron (eds.), Boston: Little, Brown & Co., 1961;, pp 208-220.
Wang, C.C., and Grossman, M.L.:  Physiological Determination of Release of Secretin and Pancreozymin From Intestine of Dogs With Transplanted Pancreas , Amer J Physiol 164:527-545 ( (Feb) ) 1951;.
White, T.T.; McAlexander, R.A.; and Magee, D.F.:  Effect of Gastric Distension on Duodenal Aspirates in Man , Gastroenterology 44:48-51 ( (Jan) ) 1963;.
Gregory, R.A., and Tracy, H.J.:  Constitution and Properties of Two Gastrins Extracted From Hog Antral Mucosa , Gut 5:103-117 ( (April) ) 1964;.
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