Diseases of the digestive system are fairly common pathologies that occur in the vast majority of the world's inhabitants. However, not everyone knows that many diseases of the gastrointestinal tract occur due to pathological conditions of the major duodenal papilla. From the materials of our article, the reader will learn about what OBD is, what types of diseases of this structure are known to medicine, how pathological conditions are diagnosed and what kind of therapy is carried out.
The concept of BDS
The major duodenal papilla (MDP) is a hemispherical anatomical structure located on the mucosa of the descending part of the duodenum. In the medical literature, OBD can be found under other names - the large duodenal papilla, or the papilla of Vater. And yet, what is BDS? This is a structure ranging in size from 2 mm to 2 cm, which performs a very important function - it connects a commonbile duct, main pancreatic duct and duodenum. BDS regulates the flow of bile and pancreatic juice into the small intestine and prevents intestinal contents from entering the ducts.
Pathological changes can occur in the structure of the OBD under the influence of various factors - a variety of pathogenic microflora, pressure fluctuations and changes in the acid-base balance, congestion in the cavity, etc. In addition, the structure of the organ can be disturbed by the migration of stones through the bile duct or other dense structures.
BDS pathologies
Diseases of the major duodenal papilla are very diverse. With the development of modern diagnostic methods, conclusions about functional disorders in this structure are much more common than previously thought. However, due to untimely and rather difficult diagnosis, medical practice often encounters a huge number of unsatisfactory results in the treatment of patients with cholelithiasis or pancreatitis, which developed against the background of disturbances in the OBD structure.
Tumor-like neoplasms are considered a common pathology of OBD - hyperplastic polyps account for up to 87% of benign neoplasms. Polyps, as a rule, do not degenerate into malignant tissues. Adenomas are a rarer disease; OBD cancer accounts for up to 25% of all malignant neoplasms. OBD stenosis is diagnosed in 4-40% of patients. As a rule, OBD pathologies are interconnected with cholelithiasis (GSD), which occurs in every tenth inhabitant.
Classification of OBD diseases
Diseases of the major duodenal papilla are classified into two large groups:
- primary,
- secondary.
Primary diseases include those disorders that occur and are localized within the structure of the OBD - papillitis (inflammatory disease); spastic stenosis of the BDS, which can later transform into papillosclerosis; age-related changes in BDS; congenital anomalies; benign and malignant neoplasms - lipomas, melanomas, fibromas, adenomas, polyps, papillomas.
Secondary diseases of OBD are stenoses caused by gallstone disease. Symptoms of the disease are directly related to the cause that caused it. So, if the pathological process is a consequence of a disease of the biliary system, the course of the disease will be similar to the signs of cholelithiasis, a pathology characterized by the formation of stones in the gallbladder or bile ducts, accompanied by a feeling of heaviness in the hypochondrium, flatulence, heartburn, and unstable stool.
There is a concept of combined stenosis - a violation of the function of the OBD that arose against the background of a duodenal ulcer. In this case, there is a lack of BDS.
Pancreatitis
If the pathological processes in the structure of OBD are caused by inflammation of the pancreas, the manifestations of the disease will be similar to those of pancreatitis.
Pancreatitis is an inflammatory process in the pancreas. It is noteworthy that the picture of the course of the disease can be different - pathology can develop rapidly, taking acuteform, or not manifest itself for a long time, which is typical for the chronic form of the course.
The main symptom of acute pancreatitis is a very severe cutting pain in the upper abdomen - right or left hypochondrium. The pain may be girdle in nature and not stop even after taking antispasmodics or analgesics. This is what a BDS is and these are the consequences of a violation of its functions.
In addition to pain in pancreatitis, there is a gag reflex, muscle weakness, dizziness. The main signs of pancreatitis on ultrasound are changes in the shape and uneven edges of the pancreas. When diagnosing, cysts can be detected in the organ. I must say that the disease is severe. And with untimely intervention, it can lead to death.
Spastic stenosis OBD
BDS stenosis is a pathology with a benign course, which is caused by obstruction of the bile and pancreatic ducts due to inflammatory changes and cicatricial narrowing of the papilla. How is everything going? The passage of the stone causes injury to the papilla, and an active infectious process in the folds leads to the development of fibrous tissue and stenosis of the areas of the OBD ampulla.
As you know, the structure of the OBD is directly affected by the age of a person. Elderly people with cholelithiasis suffer from an atrophic-sclerotic form of chronic papillitis. The contingent whose age has not reached the sixty-year mark is subject tohyperplastic changes in BDS (adenomatous, adenomyomatous).
In recent years, due to the fact that endoscopes are used in the diagnosis of OBD diseases, it has become possible to clearly distinguish between stenosing and catarrhal (non-stenosing) papillitis. The first form of pathology is associated with gallstone disease. If stones do not form in the body, then the development of the disease is caused by a chronic infection that spreads with the lymph flow.
Forms of OBD stenosis
Depending on morphological features, there are three forms of stenosis:
- inflammatory sclerotic stenosis is a pathology characterized by varying degrees of fibrosis;
- fibrocystic stenosis - a disorder in which, along with the formation of fibrosis, small cysts are formed - sharply expanded glands due to compression by muscle fibers;
- adenomyomatous stenosis is a pathology in which adenomatous hyperplasia of the glands occurs, as well as hypertrophy of smooth muscle fibers and proliferation of fibrous fibers, a violation very often occurs in the elderly.
In addition, cicatricial stenosis of OBD is classified:
- to primary,
- secondary.
Primary stenosis does not cause changes in the bile ducts. Pathology is caused by degenerative changes in the papilla itself, which manifest itself in atrophy of the muscle layer. Sometimes primary stenosis is congenital.
Secondary stenosis is the result of already existing changes in the structure due to injury to the papilla by migration of stones orsurgery.
Depending on the extent of the spread of the disease, stenosis of the OBD is divided:
- on isolated,
- common.
Diagnosis
Today, medicine uses several fairly effective methods for diagnosing OBD diseases. Let's take a closer look at some of them.
Endoscopic ultrasonography is a technique in which an optical device - an endoscope - is used to study the structure of the OBD. A photo of a papilla taken during a similar study is shown above.
Transabdominal ultrasonography is a screening method of examination using ultrasound, which allows you to very accurately identify structural changes in the gallbladder, liver, pancreas, and ducts. In addition, the technique determines the homogeneity of the cavity of the gallbladder and its contractility, the presence / absence of intracavitary inclusions.
The next method for diagnosing OBD pathologies is ultrasound cholecystography, a manipulation that examines the motor-evacuation function of the gallbladder within two hours from the moment of taking a choleretic breakfast.
Dynamic hepatobiliary scintigraphy is a procedure based on the assessment of the absorptive-excretory function of the liver. Fractional chromatic duodenal sounding allows you to determine the tone of the gallbladder; colloidal stability of the hepatic fraction of bile and its bacteriological composition. With gastroduodenoscopyan assessment of the condition of the OBD is carried out, as well as monitoring the nature of the flow of bile. In addition to these methods, there are computed tomography and laboratory diagnostics.
OBD: treatment
The therapy of OBD stenosis is based on the task of restoring the normal outflow of bile and pancreatic juice into the duodenum. In accordance with this task, there are a number of principles, following which will help achieve success in treatment:
- psychotherapy, treatment of neurosis, stabilization of hormonal levels, minimization of stress, rest, proper diet;
- treatment of pathologies of the abdominal organs,
- elimination of dyspeptic factors.
In order to eliminate neurotic disorders, sedatives, infusions or decoctions of various herbs are used. In addition, the patient is shown psychotherapy sessions.
An important component of successful treatment is diet:
- fractional meal;
- avoiding alcohol and carbonated drinks, as well as smoked and fried foods;
- limited intake of egg yolks, muffins, creams, strong coffee and tea;
- frequent consumption of cabbage, wheat bran and buckwheat porridge;
- taking antispasmodics that relieve pain attacks.
Stenosis of the OBD is often treated with surgical methods. There are corrective and non-corrective operations. The first group includes endoscopic PST, BDS bougienage.
During the period of remission, in addition to the diet, patients are recommended supportingtherapy - daily walking, morning exercises, swimming benefits.
Summarizing the above, we can summarize that many diseases of the gastrointestinal tract occur against the background of a malfunction of one small structure. Such violations lead to serious problems in the body and are often amenable to correction only by surgery. That's what BDS is.
