The role of the pancreas is unusually great. This organ of external (exocrine) and internal (endocrine) secretion is involved in the digestive process and the regulation of lipid, carbohydrate and protein metabolism in the body. Problems in the work of the body are reflected in the state of the Wirsung duct. Acute inflammation of the gland is expressed by its expansion, and in chronic pancreatitis its expansion is observed, alternating with areas of stenosis (narrowing). In diseases of the gland in the excretory duct, changes occur that are detected using modern diagnostic methods.
Wirsung duct
The main pancreatic duct stretches along the entire length of the pancreas, reaching its posterior surface. The Wirsung duct, formed from the confluence of smaller ducts of the lobules of the organ, has an average length of 20 cm. This canal often ends in the duodenum, at the site of the formation of suchorgan like a sphincter. The constructive connection of the excretory duct of the gland with the duodenum is quite functional, its result is the processing of the intestinal contents produced by the pancreatic juice.
The size and shape of the Wirsung duct do not match in many people and depend on the individual structure of the body. In most, it combines with the common bile duct (choledochus) and exits into the duodenum. The ratios of its terminal divisions, together with the common duct, may be different. There are 4 types of them:
- Joint flow of both ducts into the intestine, where they form a kind of ampoule. At the same time, the sphincter of Oddi, covering both ducts, completely closes them with its contraction. This type is observed in 55% of cases.
- Connection of both ducts near the duodenum without the formation of a common ampulla. This type is typical in 33.6%.
- Separate confluence into the duodenum of each of the ducts. This is a fairly rare type of ratio found in 4%.
- Confluence of ducts at a considerable distance from Vater's nipple. Both of them open into the duodenum and touch their walls. Approximately 8.5% of cases show that this merger is separate.
These anatomical features are quite important in the likelihood of developing pathological modifications of the Wirsung duct. The relationship of the common bile duct with the main duct and with the head of the gland, their connection with the duodenum play a significant role in understanding and developing a number of symptoms of pathologies and cancer.pancreas.
Ultrasonic picture
Modifications of the pancreas (violation of the parenchyma of the organ) can be caused by various causative factors. They are visible during ultrasound examination, which allows you to assess the size and structure of the parenchyma, see the contours, the presence of pathologies, as well as the state of the ducts of the gland. Signs of individual diseases diagnosed during the examination also show probable abnormalities that may affect the pancreatic duct of Wirsung.
By the way, it is worth noting that many he althy people may experience symptoms of diffuse changes associated with the environmental situation and the use of products with various preservatives and stabilizers.
Signs of pathologies on ultrasound
Diseases such as acute and chronic pancreatitis, pancreolithiasis, cysts and other pathologies are more often detected.
Diffuse enlargement of the gland parenchyma often causes acute pancreatitis. During examination, the contours of the organ are blurred, blind spots can be observed in its structure, which may be the result of hemorrhage or necrosis of the gland. The expansion of the Wirsung duct and other ducts of the gland is determined.
In the chronic form of pancreatitis, the size of the organ may not change. Its contours do not become fuzzy and uneven. The echo signal of the gland tissue is reduced. In the presence of fibrosis, the parenchyma becomes thickened, the Wirsung duct is deformed and narrowed, and its walls are thickened. Oftenrevealed violation of the patency of the ducts of the gland. Such inflammatory changes are a consequence of the formation of cysts and calcifications.
The formation of stones in the parenchyma, or pancreolithiasis, is the result of inflammation of the gland or a violation of the outflow of enzymes. Initially, there is stagnation in the ducts of the organ, which is expressed by the expansion of the Wirsung duct. At the next stage in the development of the pathological condition, protein is deposited in the pancreatic juice and calcifications are deposited, which on ultrasound is expressed as a diffuse increase in the echogenicity of the parenchyma. The advanced form of the disease leads to pancreolithiasis.
Pathological conditions of other internal organs (chronic heart failure, hepatitis, cirrhosis) can affect the structure of the gland.
Deviations detected in the pancreas may be due to its various diseases, but more often the causative factors are pancreatitis and pancreolithiasis.
Pancreatitis
From a clinical point of view, pancreatitis (an inflammatory process of the pancreas) can occur in an acute or chronic form. The cause of the disease may be the cessation of the flow of juice produced by the body into the duodenum due to blockage of the duct. With prolonged inflammation, the enzymes of the gland begin to digest their own cells. The cause of inflammation may also be damage to the gland due to its swelling.
Acute pancreatitis is more often caused by the presence of gallstones,which block the ducts, or alcoholism, which results in obstruction of the small ducts of the organ.
Pancreolithiasis
Pancreolithiasis is a pathological condition characterized by the formation of stones in the Wirsung duct of the gland or its branches. Signs of the disease are spasmodic pain in the epigastric zone, radiating to the lumbar region.
The presence of stones, preventing the outflow of pancreatic juice, leads to digestive disorders. With such stagnation, ultrasound reveals that the Wirsung duct is dilated, and there is stretching of the walls of small ducts.
However, it is worth remembering that the ultrasound picture does not provide complete information for making a diagnosis. Additional surveys are needed. Since often when diffuse modifications of the pancreas or liver are detected, for example, the Wirsung duct is not visualized. Other diagnostic methods help to study it in more detail.
Difficulty in diagnosis
The complexity of diagnosing the considered pathologies is related to the location of the pancreas. It is located deep enough in the human body. Its research should be carried out only by qualified specialists and include advanced instrumental and laboratory techniques. This is a thorough study of the level of pancreatic enzymes (pancreatic isoamylase, lipase, trypsin in urine, blood, duodenal contents). To establish exocrine pancreatic insufficiency, it is necessary todetermine the indicators of fecal elastase in feces. Complete blood count, glycemia assessment, abdominal sonography, dopplerography are important.
MRI is prescribed to obtain axial sections of the abdominal organs.
In rather difficult situations, diagnostic laparoscopy is also performed. Since the work of the pancreas is often also affected by the pathology of the pancreatic ducts and bile ducts, ERCP is mandatory.
MR-cholangiography
Magnetic resonance cholangiopancreatography in obstructive pancreatitis allows a detailed study of the state of the Wirsung duct. This is one of the most modern methods of non-ionizing examination of the gallbladder, its ducts and the pancreatic duct. It makes it possible to obtain the most accurate information about the state of these organs, to determine the presence of polyps, calculi, strictures in them, to visualize changes in the vessels and lymph nodes.
Treatment
Treatment of diffuse changes detected in the pancreas can be carried out by conservative and operative methods. The choice of the correct treatment tactics largely depends on the nature of the pathology, the presence of concomitant diseases and the general condition of the patient.
Often due to untimely diagnosis and treatment, echogenic signs are irreversible, do not regress.
Restoration of the normal structure of an organ is possible only with timely adequate therapy and compliance with allexpert advice.
