Exocrine Pancreas

The exocrine pancreas is strategically located in the anterior abdominal cavity adjacent to the stomach, duodenum, and liver to enable secretion of digestive enzymes into the small intestine, and to convert ingesta into absorbable proteins, carbohydrates, and lipids. Additionally, it provides a scaffold, or foundation, and microenvironment for pancreatic islet cells, which provide the embedded endocrine function of the pancreas that enables hepatic and peripheral tissue modulation of blood glucose, among other functions. In spite of its close proximity to the small intestine and potentially toxic ingesta, its unique function in producing digestive enzymes, and proximity to the common bile duct containing bile salts and acids, it is seldom a prominent target of toxicity studies. Individual case reports in humans and animals, in concert with epidemiologic studies published in medical journals, provide insight into risks of pancreatic toxicity as either idiosyncratic events with few subsequent reports, or consistent reproducible mechanisms of action that closely link exposure to drugs or xenobiotics to both acute and chronic pancreatitis. Epidemiologically, pancreatic injury has been associated with a range of environmental pollutants and with consumption of mycotoxins, and has longstanding links to alcoholism and smoking tobacco. These examples highlight the need for biomarkers that are predictive of early onset of pancreatic injury as well as the clinical outcome for the individual.