The pancreas is an unpaired glandular organ located in the retroperitoneal space at the level of 1-11 lumbar vertebrae. The length of the gland is on average 18-22 cm, the average weight is 80-100 g. It distinguishes 3 anatomical sections: head, body and tail. The head of the pancreas is adjacent to the duodenum, and the tail is located at the hilum of the spleen. The thickness of the gland various departments is 1.5-3 cm. The anterior and inferior surfaces of the body of the pancreas are covered with peritoneum. The pancreas has a thin connective tissue capsule and weakly expressed connective tissue septa. Anterior to the pancreas are the stomach and the initial section of the DP K. The head of the pancreas lies in the horseshoe bend of the duodenum.

Behind the head of the pancreas are the inferior vena cava and portal veins, right renal artery and vein, common bile duct. The aorta and splenic vein are adjacent to the posterior surface of the body, and behind the tail are left kidney with its artery and vein, and the left adrenal gland (see Fig. 1-2).

Rice. 1-2. Topographic anatomy pancreas. The figure schematically shows an image of a transverse section of the upper abdominal cavity

The main (Wirsungian) duct of the pancreas is formed by the confluence of the lobular ducts and passes through the thickness of the organ from the tail to the head, closer to the posterior surface. The diameter of the MPD in an adult is 1-2 mm in the region of the tail and body and 3-4 mm in the region of the head, where the MPD merges with the accessory (Santorini) duct in 60% of cases (see Fig. 1-3).

Rice. 1-3. The structure of the pancreas. The anatomical relationship of the common bile duct and pancreatic ducts is shown

The pancreatic duct merges with the common bile duct, forming the liver-pancreatic ampulla, and opens into the duodenum at the top of its large (Vater's) papilla. In 20-25% of cases, the ducts flow into the duodenum separately, which depends on various options for the development of the ductal system (see Fig. 1-4). So, in 10% of cases, atrophy of the terminal section of the Wirsung duct occurs and the pancreas drains through the santorini duct - this developmental option is called a split pancreas (pancreas division) and is referred to as an anomaly in the development of the organ. The length of the HPP is 18-20 cm.

Rice. 1-4. Anatomical configuration of the intrapancreatic ductal system. Approximate percentages of each are shown. options development

The intramural sections of the common bile duct and pancreatic duct, as well as the hepatopancreatic ampulla, are surrounded by smooth muscle fibers that form the sphincter of Oddi, which regulates the portioned flow of bile and pancreatic juice into the duodenum. The location of the Vater's nipple is variable, but most often it is located 12-14 cm from the pylorus. The sphincter of Oddi has a rather complex structure and is not formally common to both ducts (see Fig. 1-5).

Rice. 1-5. The structure of the sphincter of Oddi

The following muscle formations that form the sphincter of Oddi are described.

The complex muscle of the papilla of the duodenum, consisting of the muscles:

Sphincter of the base of the papilla;

papilla dilator;

Sphincter opening of the papilla.

Own sphincter of the common bile duct (Westphal sphincter), located on the border with the sphincter of the base of the papilla.

Own sphincter of the pancreatic duct.

As for the structural features of the smooth muscle formations of the sphincter of Oddi themselves, in general they are identical to other smooth muscle cells in all internal organs.

As can be seen from the figure, the sphincter functions in such a way that it not only separates the common bile duct and the GLP from the lumen of the duodenum, but also separates the above ducts from each other for a long distance.

The sphincter apparatus of the system of bile secretion and pancreatic ducts performs complex functions, on the one hand, ensuring the rational use of bile and pancreatic juice by limiting the flow of bile and pancreatic juices into the duodenum between meals, and, on the other hand, preventing the reverse flow of bile and intestinal contents into the bile ducts and GLP and facilitating (facilitating) the filling of the gallbladder. These functions are also due to the ability of the sphincter to create a high pressure gradient between the duct system and the duodenum. The sphincter of Oddi increases the pressure in the common bile duct, due to which this value differs by different levels bile duct - from 4 to 10 mm Hg.

These functions, first of all, are performed by the sphincter of Westphal (i.e. sphincter ductus choledochi) located in the common bile duct, in front of the ampulla, and the sphincter of the hepatic-pancreatic ampulla, working in conjunction with the sphincter pancreatic duct. In addition, the sphincter apparatus of the major duodenal papilla is responsible for regulating pressure in the duodenal cavity.

At the same time, the muscular formations of the sphincter of Oddi also work as a powerful pump, providing an intensive flow of bile and pancreatic secretions into the duodenal cavity during digestion.

The motor activity of the sphincter apparatus of Vater's nipple is under the control of complex neurohumoral mechanisms. Sphincter mediators include enkephalins and endorphins, substance P, nitric oxide, vasoactive intestinal polypeptide (VIP), neuropeptide Y, cholecystokinin (CK) and calcitonin-related peptide.

Thus, separate parts of the sphincter of Oddi prevent the reflux of the contents of the duodenum into the Wirsung duct and bile ducts, bile into the MPD, and pancreatic secretions into the bile duct system. Pressure measurement by microcannulation of the ducts indicates more high pressure in the pancreatic duct compared to the pressure in the common bile duct. Whether this pressure difference has any physiological significance is still not known for certain.

The head of the pancreas receives blood supply through the hepatic artery (a. hepatica), anterior and posterior pancreaticoduodenal arteries. The isthmus and body of the pancreas are variantly supplied by outgoing branches of the common hepatic and gastroduodenal arteries, as well as the right gastroepiploic artery. In the region of the isthmus, the so-called dorsal pancreatic artery sometimes lies variantly departing from the common hepatic, superior mesenteric, celiac, splenic or gastroduodenal artery. Located on the border of the body and head of the pancreas, it serves as an anastomotic boundary landmark. The body of the pancreas receives blood from the splenic artery through a large branch - the large pancreatic artery of Hapler. It can depart with one or two rattling trunks, widely anastomosing with each other and with other arteries.

As a result of the connection of the pancreatic artery in the area of ​​the body and tail of the pancreas, two intraorgan anastomoses are formed, located along the lower and upper edges of the organ. Together with the arterial arches of the head, these anastomosing branches form a closed peri-pancreatic arterial circle, extending along the anterior and posterior surface of the pancreas along its entire length, branches that anastomose with each other. Thus, the arterial system of the pancreatic parenchyma is a three-dimensional intraorganic network of widely anastomosing vessels.

Venous outflow is carried out by the same name venous vessels running parallel to the arteries. All blood flowing from the pancreas enters the portal vein and then to the liver. Lymphatic drainage from the pancreas occurs through The lymph nodes located along the course of the blood vessels (parapyloric, pancreatoduodenal lymph nodes and lymph nodes of the hilum of the spleen).

The pancreas is one of the "champions" in terms of blood flow per 100 g of tissue: on an empty stomach, blood flow is 50-180 ml / min per 100 g of tissue, and with stimulated secretion - up to 400 ml / min per 100 g of tissue. An insignificant feature of the blood supply to the pancreas is the high diffusion permeability of blood vessels: at rest it is 0.1-0.3 ml/min per 100 g of pancreatic tissue; with functional hyperemia, it increases to 1.5-20 ml / min per 100 g. The data presented indicate the high needs of the gland in blood supply and, consequently, in plastic materials, energy and oxygen, as well as in the elimination of metabolites.

The pancreas has sympathetic and parasympathetic innervation - from the celiac plexus and vagus nerves. Autonomic innervation includes efferent (motor) and afferent (sensory) nerve fibers. Centre sympathetic innervation is located in the segments of the spinal cord Th5-Th9, then, as part of the sympathetic nerves, the axons of neurons are sent to the celiac plexus and pancreas. These nerves innervate the intrapancreatic blood vessels and ganglions, and also carry fibers of pain sensitivity.

Parasympathetic innervation is carried out by the vagus nerve. The pancreas also receives innervation from the neurons of the metasympathetic nervous system. Finally, the pancreas contains a number of nerve fibers that control blood vessels, acinar and islet cells- these nerve fibers braid the acini of the gland, are located around the vasculature and around the islets of Langerhans. The main neurotransmitters responsible for the exocrine function of the pancreas are acetylcholine, VIP, gastrin-releasing peptide, etc. The combination of nervous and humoral regulation makes up the system of control over the activity of the pancreas. Thus, neurons in the pancreas are involved in the process of controlling the endocrine and exocrine functions of the organ.

The innervation of the biliary system, pancreas and duodenum has a common origin, which predetermines the close relationship between their functioning. The biliary system also receives innervation from the nervous sympathetic and parasympathetic structures. The fibers of the sympathetic nerves, heading from the sympathetic trunk, through the splanchnic nerves enter the stellate ganglion, where they meet with the fibers vagus nerve. Besides, bile ducts innervates the right phrenic nerve.

Nerve fibers of sympathetic and parasympathetic origin are also found directly in the region of the sphincter apparatus of the gallbladder and the biliary duct system. In the gallbladder cystic duct and the common bile duct have nerve plexuses and ganglia similar to those in the duodenum.

Numerous nerve fibers lie in the muscle layer, around the blood vessels and in the mucous membrane of the bile secretion system. The plexuses of the biliary system and pancreas are closely related to the autonomic nervous system DPC, its plexuses, which is essential in coordinating the activities of these bodies and the rest of gastrointestinal tract(GIT).

Maev I.V., Kucheryavy Yu.A.

One of the most important internal organs human body in general and the digestive system in particular is the pancreas. Failures in her work are quite common. At the same time, it is important not to miss the moment to apply for qualified help. Therefore, knowledge about the location of the pancreas and the nature of pain in its ailments is valuable for everyone.

Where is the pancreas located?

The anatomical location of the pancreas is in the abdominal cavity, at the level of I - II lumbar vertebrae. The organ fits snugly against the back wall of the stomach. The duodenum wraps around the pancreas in the form of a horseshoe. In an adult, the size of the pancreas is 20 - 25 cm, weight - 70 - 80 grams.

The organ has 3 sections: head, body and tail. The head is located near the bile duct, the body is behind the stomach and slightly below it, near transverse colon, tail - near the spleen. When projected onto the front surface abdominal wall the gland is located above the navel at 5 - 10 cm. The head - with right side from the midline, the tail goes under the left hypochondrium.

Two essential functions pancreas - exocrine and endocrine. The exocrine function consists in the production (secretion) of pancreatic juice, which is necessary for the digestion of food in the duodenum. Digestive enzymes of pancreatic juice secreted by the pancreas:

• trypsin and chymotrypsin involved in the processes of protein digestion;
• lactase and amylases, necessary for the breakdown of carbohydrates;
• lipases that break down fats already exposed to bile.

In addition to enzymes, pancreatic juice contains substances that neutralize the acidic environment of gastric juice to protect the intestinal mucosa from acid exposure. The endocrine function of the gland is to produce insulin and glucagon, hormones that are involved in carbohydrate metabolism. Under the influence of insulin, glucose in the blood decreases, under the influence of glucagon it rises. At normal levels of insulin and glucagon carbohydrate metabolism proceeds adequately, with shifts - diabetes mellitus may occur.

Abdominal pain and symptoms digestive processes occur in various diseases. It is important to understand when painful manifestations are associated with pancreatic pathology, and to take the necessary measures in time.

The main symptoms of pancreatic disease

Any problems associated with reduced production of pancreatic enzymes are accompanied by typical symptoms. Most frequent signs- Pain and indigestion. In women and men, the symptoms are the same. Depending on the severity of the process, the intensity of pain, as well as the severity of dyspeptic phenomena, may be different. The most indicative disorders in violation of the pancreas:

• the presence of pain syndrome; localization of pain - the upper part of the abdominal cavity, the left hypochondrium; pain may or may not be associated with eating;
• frequent nausea, vomiting is possible;
• violation of appetite in the direction of decrease up to complete absence;
• bloating and rumbling in the abdomen (the occurrence of flatulence);
• stool disorders, more often - diarrhea; in the feces there may be impurities of undigested fibers, fat;
• signs of intoxication (rapid heartbeat, fatigue, general weakness, sweating, headaches);
• an increase in the size of the liver;
• color change skin(jaundice), often - in the projection of the pancreas.

Diseases associated with a decrease in the production of enzymes:

• acute pancreatitis (inflammation of the pancreas, often accompanied by swelling);
• chronic pancreatitis;
• tumor processes in the pancreas;
• development of diabetes;
• pancreatic necrosis.

How does the pancreas hurt in humans?

Pain due to changes in the pancreas may be different nature- pulling blunt or cutting sharp, up to dagger (with peritonitis). It depends on the nature and extent of the lesion of the gland, as well as on the involvement of the peritoneum sheets (peritonitis) in the inflammatory process.

Acute pancreatitis with edema is characterized by a sharp sudden pain, often encircling, extending to the upper abdomen, left side and lumbar region. Due to edema, there is a feeling of fullness at the location of the pancreas, pressure on inner surface ribs. In such cases, taking antispasmodics is ineffective. The pain may decrease slightly only in a sitting position with the body tilted forward and down.

At the height of the pain (and sometimes before it occurs), vomiting may begin, which is repeated several times and does not always bring relief. The contents of the vomit may be eaten food or bile (in the case of an empty stomach), the taste is sour or bitter.

Similar symptoms ( sharp pain, vomiting) can also be observed during exacerbations of osteochondrosis in lumbar spine, kidney disease and herpes zoster. An additional study will help determine the suspicion of pancreatitis. At lumbar osteochondrosis there is pain in the vertebrae during their palpation, with problems with the kidneys - an increase in pain when tapping on the lower back, with shingles, there is a characteristic rash on the skin. Pancreatitis is characterized by the absence of all of these symptoms.

Chronic pancreatitis is characterized by pains of somewhat lesser intensity, and they occur most often due to violations of the dietary regimen. The danger of exacerbations of chronic pancreatitis is the occurrence of tumors of the pancreas, including malignant (cancer).

Diagnostics

Treatment should be prescribed by a specialist doctor after a thorough diagnosis. In the event of a pain attack, it is imperative to contact medical institution for qualified help. It is necessary to carry out:

1. Laboratory research:

• general and detailed blood test;
• the level of pancreatic enzymes in the blood serum;
• biochemical blood tests for glucose, activity of liver enzymes and bilirubin;
• urinalysis for amylase levels;
• analysis of feces for the level of enzymes and fats.

2. Ultrasound procedure abdominal cavity to identify the state of the structure, determine the contours of the pancreas, the patency of the bile ducts, the presence or absence of stones in gallbladder or ducts.

3. X-ray - in the absence of the possibility of an ultrasound for the same purpose.

4. Computed tomography or MRI to obtain more accurate data on the state of the abdominal organs.

How to treat diseases of the pancreas?

After thorough examination, even if no urgent surgery is required, hospitalization is necessary. An acute attack of pancreatitis is treated in a hospital by creating rest in compliance with bed rest. Full fasting is prescribed for 1 - 2 days. Introduced injection solutions painkillers and antispasmodic drugs(Baralgin, Platifillin), anticholinergics (Atropine). An ice pack is applied to the epigastric region several times for 0.5 hours.

What medications to take - the attending physician decides. Drugs that reduce the enzymatic activity of the pancreas (Trasilol, Kontrykal, Gordox, Aprotinin) are injected intravenously. To prevent dehydration, special saline solutions are also dripped in the dosage prescribed by the doctor. Already after removal acute symptoms sparing special diet and enzyme replacement therapy - drugs for oral administration that improve digestion (Creon, Mezim-forte, Pancreatin, Panzinorm, Festal, Enzistal).

How to eat?

IN acute period diseases are allowed weak broths and decoctions, cereals on the water, food either boiled or steamed:

• rubbed;
• in the form of puree;
• in the form of a soufflé.

In the future, meat, fish, poultry with a low fat content should be used for cooking. Gradually introduced into the diet dairy products, eggs, compotes, kissels. A strict diet is prescribed for 3 months. During periods of remission of chronic pancreatitis, the diet must also be observed. Individual recommendations are best obtained from your doctor.

Recommended meat dishes from lean meats, poultry, especially rabbit meat, veal. Dairy products should be low in fat. Soups are better cooked on vegetable broths. From drinks, herbal decoctions, compotes, teas, kissels are useful. At chronic pancreatitis, as well as after the transferred acute illness necessary fractional nutrition: 6 to 8 times a day in small portions.

What to exclude from the diet?

With pancreatic problems, the following foods and drinks are strictly contraindicated:

• alcohol;
• carbonated drinks;
• coffee and cocoa;
• sweet juices;
• offal;
• smoked meats;
• spicy, salty, pickled, fried foods;
• chocolate and confectionery, especially with high content fat (cakes and cakes with cream).

The pancreas (pancreas) is an important organ of the gastrointestinal tract, which is responsible for the excretion of digestive enzymes and regulation of carbohydrate metabolism in the body. Pathologies of this important digestive and endocrine organ have characteristics, which are manifested in the localization, nature of the pain syndrome and accompanying symptoms. However, patients who do not know what functions the pancreas performs, where it is located and how this organ hurts, may not recognize anxiety symptoms and do not see a doctor in time.

What is the pancreas

The pancreas (PJG) is internal organ digestive and endocrine systems, which consists of two parts: exocrine (exocrine) and intrasecretory (endocrine).

The exocrine part of the gland is represented by cells that produce pancreatic juice (acini) and a branched duct system that ensures the outflow of digestive juice from the acini and its delivery to the intestine. Small ducts of the pancreas merge into larger ones, which then flow into the main (virsung) duct.

The pancreatic duct system closely connects the gland with the bile ducts and the duodenum. Such anatomical structure causes the fact that more than 30% of pancreatic pathologies are secondary and develop due to diseases of nearby organs.

The intrasecretory part of the gland is significantly inferior to the exocrine in size: its mass is no more than 2% of the total mass of the organ. This part is small islands endocrine tissue(Islets of Langerhans), which are surrounded by the exocrine part of the pancreas. The islets of Langerhans are located mainly in the caudal part of the organ.

Severe diseases of the exocrine part of the gland can also affect the islets of Langerhans: they hormonal function may be broken when severe inflammation the main mass of the parenchyma of the pancreas or the presence of a large cancerous neoplasm.

Organ functions

In accordance with the structure of iron, it has two functions: exocrine and endocrine.

Every day, the exocrine cells of the organ produce 0.5-1 liter of pancreatic juice, which consists of water, acid salts and digestive enzymes that break down incoming nutrients before they are delivered to the intestines.

Substances produced by acini are inactive proenzymes, which excludes damage to the secreting tissue itself. When food enters the duodenum, several biochemical reactions which lead to the activation of pancreatic enzymes.

Stimulation of the enzymatic function of the pancreas occurs when the stomach and intestines interact. Gastric juice, which contains hydrochloric acid, enters small intestine and stimulates the production of cholecystokinin and secretin, which activate the activity of acini.

The exocrine gland secretes the following enzymes:

1. Amylase. This enzyme decomposes complex carbohydrates to easily digestible disaccharides and oligosaccharides.
2. Lipase (cholesterolesterase, phospholipase A and lipase). Lipases break down fats that have been pretreated with bile acids. Bile activates the first two enzymes and inhibits the action of the third, but pancreatic juice contains colipase, which retains the lipase structure.
3. Protease (trypsin, chymotrypsin, elastase, carboxy- and aminopeptidase). Proteases are involved in the digestion of protein compounds. They cleave the peptide bonds of proteins and separate amino acids from them.

Pancreatic juice has an alkaline pH, which allows it to neutralize the action of gastric juice in the digestion of carbohydrate foods.

Exocrine function is regulated by the nervous system, which links the intensity of pancreatic enzyme production to the diet. The composition of the juice depends on the ratio of proteins, fats and carbohydrates in the food.

The islets of Langerhans (the endocrine part of the pancreas) consist of 5 types of cells, each of which produces its own hormone:

1. Alpha cells. These cells produce the hormone glucagon, which raises blood sugar levels when physical activity, i.e., it acts opposite to insulin. Also, this part of the islets of Langerhans plays an important role in the prevention fatty hepatosis. The proportion of alpha cells is up to 20% of the mass of the endocrine part of the pancreas.
2. Beta cells. They are responsible for the production of insulin and regulate carbohydrate and fat metabolism. With the participation of this hormone, body tissues accumulate glucose, reducing its content in the blood. Beta cells are the most significant part of the intrasecretory part of the organ: their share is up to 80% of the mass of endocrine islets.
3. delta cells. Cells of this type produce the hormone somatostatin, which inhibits the activity of several endocrine glands, including the pancreas. This hormone is also produced in the main regulatory organ endocrine system- hypothalamus. The proportion of delta cells in the intrasecretory part of the pancreas does not exceed 10%.
4. PP cells. They are responsible for the secretion of pancreatic polypeptide (PP), which inhibits the production of enzymes of the gland itself and stimulates the production of gastric juice. The proportion of PP cells is up to 5% of the mass of the endocrine part of the organ.
5. Epsilon cells. Epsilon-type cells, whose proportion is less than 1% of the mass of endocrine islets, produce the so-called. The "hunger hormone" ghrelin, which stimulates appetite.

Destruction of alpha and beta cells leads to grave consequences for the body, because hormones that regulate carbohydrate metabolism are produced only in the pancreas.

Where is the human pancreas located

The pancreas is located in the abdominal cavity at the level of the first lumbar vertebrae (in newborns, at the level of the last thoracic vertebrae). In the horizontal position of the body, it is located under the stomach, which determines its name. The organ closely adjoins the duodenum, stomach (separated from it only by a stuffing bag), aorta and large intra-abdominal vessels (inferior vena cava and left renal vein).

The PJ is made up of three parts:

1. heads. The head of the pancreas is covered by the duodenum, which forms a kind of horseshoe around this part of the organ. The head is separated from the body by a groove containing the portal vein.
2. Bodies. The anterior surface of the body of the gland is located near rear wall stomach, back - adjacent to the intra-abdominal aorta and lumbar vertebrae. Bottom part body pancreas is located just below the root of the colon.
3. tail. The tail of the organ, having the shape of a cone, enters the left hypochondrium and reaches the spleen.

Size of the pancreas

The size of the pancreas varies depending on the age of the person. In newborns, the length of this important digestive organ does not exceed 5 cm, and its weight is 3. By the age of 1 year, the length of the gland reaches 7 cm, by 10 years - 15 cm. The pancreas acquires its final size and weight only at 16 years.

The length of the gland in an adult is 15–23 cm, and the weight is 70–80 g. The width of the head of the gland starts from 5 cm, the thickness is in the range of 1.5–3 cm, and the length is up to 3.2 cm.

The body is the longest part of the organ, but not the widest: the body of the pancreas is 1.75 to 2.5 cm wide.

The width of the tail of the gland does not exceed 1.5 cm, and the length is 3-3.5 cm.

Deviations from normal sizes PZhZh is acceptable only within small limits and in the absence of signs of pathologies in the results of laboratory diagnostics.

How the organ hurts

The specificity of the pain syndrome depends on the localization of the lesion of the gland, its type (diagnosis) and the presence of concomitant or primary pathologies that cause pancreas disease.

The defeat of the head of the gland is accompanied by pain and discomfort "under the spoon" (in the middle part of the abdomen) or the right hypochondrium. Despite the predominantly left-sided location of the organ, local inflammation or neoplasm of the head can cause pain on the right. When the body is affected, pain is clearly felt to the left of the median line, and with a disease of the tail, to the left of the navel.

Inflammation of the entire gland is manifested by diffuse girdle pain in the upper abdomen.

The nature of the pain and the time of its onset can be as follows:

• sharp cutting or intense aching, not dependent on food intake (with acute inflammation of the gland);
• aching that occurs after eating, subsides when bending forward (with chronic inflammation, cysts, tumors);
• aggravated at the end of a meal (with blockage of the ducts and an increase in intraductal pressure);
• any nature of discomfort, accompanied by night pains (damage to the duodenum, complicated by pancreatic disease);
• pancreatic colic (with stones in the pancreas).

With atrophy of the functional tissue of the gland and the progression of enzymatic deficiency, the severity of the pain syndrome subsides. Dull It's a dull pain is replaced by colicky, which does not have an exact localization.

Pain in the region of the gland can radiate to many parts of the body: with pathologies, the pancreas can get sick left half sternum, retrosternal and epigastric regions, left hand and scapula, lower back and even the lower jaw. In some cases pain syndrome felt immediately in the entire abdominal cavity.

Determine the cause of pain without consulting a doctor and additional research difficult. Pathologies of the pancreas are often mistaken for an exacerbation chronic pathologies heart, kidney and back and are not diagnosed in time.

What diseases can be

The diseases of the pancreas include the following pathologies:

1. Acute pancreatitis. Inflammation of the pancreas is the most common disease of this organ. It is accompanied by pain, diarrhea, a bursting feeling under the ribs, nausea and other symptoms. Pain syndrome in acute inflammation is poorly affected by antispasmodics and painkillers.
2. Chronic inflammation of the gland. In a chronic process, the pain is less intense and occurs when overeating, drinking alcohol, fatty and irritating food to the gland.
3. enzymatic deficiency. Enzyme deficiency can be congenital or acquired (for example, in chronic pancreatitis). Pathology is manifested by a change in the color and amount of stool, darkening of urine, nausea, a feeling of excessive filling of the stomach, weight loss and symptoms of protein and microelement deficiencies.
4. Stones in LJ. Calcifications in the tissues of the gland are formed mainly with alcoholic damage to the organ, parathyroiditis and a burdened family history. Burning pains in the upper abdomen, characteristic of this pathology, are accompanied by nausea, vomiting with bile, increased fat content of feces, increased salivation and etc.
5. Cysts and fistulas. Liquid formations limited to the capsule may be asymptomatic (if not large sizes cysts) or manifest as signs of enzymatic deficiency, jaundice, pain in the left hypochondrium and epigastrium, nausea and vomiting (with duodenal compression). Fistulas occur as a result of spontaneous rupture of a cyst, acute destructive pancreatitis, or gland contusion.
6. benign neoplasia. Hypertrophy of the fatty, glandular or connective tissue part of the gland may not show any symptoms for a long time. For large sizes benign tumors jaundice occurs due to pressure bile ducts and intestinal obstruction. An increase in the volume of glandular tissues can cause seizures increased heart rate, hand tremor and partial paralysis of the limbs.
7. Cancer of the gland. Malignant diseases are characterized by digestive disorders (loss of appetite, pain in the hypochondrium, discoloration of urine and feces) and general symptoms (weakness, rapid weight loss). With tumors of the endocrine part of the gland, symptoms of hormonal imbalance appear.
8. Diabetes mellitus type 1. Autoimmune damage to the beta cells of the islets of Langerhans leads to a decrease in insulin production and the impossibility of glucose uptake by insulin-dependent body tissues. Diabetes mellitus is manifested by frequent urination, intense thirst and increased appetite. In the absence of the introduction of artificial insulin, severe complications occur (diabetic blindness, kidney damage, polyneuropathy, coma).

With the exception of acute pancreatitis (its symptoms are less common in women than in men), diseases of the pancreas develop with the same frequency in patients of different sexes.

Who to contact

The diagnosis and treatment of diseases of the pancreas is carried out by a gastroenterologist. With benign and malignant formations it is necessary to consult an oncologist and a surgeon, and in case of pathologies of the intrasecretory part of the gland - an endocrinologist.

Diagnostics

In the diagnosis of pancreatic diseases, the following methods are used:

1. External examination, questioning of the patient and collection of anamnesis. The primary diagnosis can be established on the basis of characteristic symptoms (pain in the left hypochondrium and epigastric region, nausea, diarrhea, dark urine) and results external examination(jaundice and pallor of the skin, pain when probing the gland).
2. Hardware research methods. Determine the size and structure of the components of the gland, as well as clarify the presence comorbidities The gastrointestinal tract is possible with the help of ultrasound diagnostics, computed and magnetic resonance imaging, radiography and duodenography, contrast examination of the ducts (ERCP) and fibroesophagogastroduodenoscopy (FGDS). If a tumor is found, a biopsy is performed and histological examination specifying the degree of malignancy of neoplasia.
3. Laboratory diagnostics. Blood, urine and stool tests can determine the concentration of glucose, pancreatic enzymes, insulin and total protein(marker inflammatory processes in organism).
4. Load tests. Functional (load) tests show the quality of food digestion and the secretory activity of the pancreas. The most common exercise methods are the secretin-cholecystokinin test, the hydrochloric acid test, the Lund test, the para-aminobenzoic acid test, and the breath test.

Therapy Methods

Depending on the diagnosis, treatment for the pancreas may include the following types drugs:

• antispasmodics;
• enzymes;
• drugs that reduce secretion of hydrochloric acid and neutralizing its action (antacids);
• drugs to stimulate and inhibit the function of the gland;
• decongestants (antihistamines);
• insulin etc.

In acute pancreatitis, hospital treatment. To prevent weight loss and dehydration, the patient is given intravenously nutrients and physiological solution. Necessary medicines taken parenterally (in the first 3-4 days) or orally.

Diet therapy is an important part treatment course with inflammation and other diseases of the pancreas. To increase the effectiveness of treatment, the following rules must be observed:

1. Don't overeat. calories daily ration should not significantly exceed the norm corresponding to age and physical activity patient. daily rate food should be divided into 5-6 meals.
2. Adhere to the rules of separate nutrition. The quantitative ratio of produced enzymes and acid-base balance pancreatic juice depends on the qualitative composition of the food consumed. To facilitate the work of the pancreas, for the duration of treatment, you should switch to separate meals and avoid simultaneous use protein and carbohydrate foods.
3. Refuse products that adversely affect the pancreas. The recommended diet for pancreatic disease is table number 5 according to Pevzner.

Functions of the pancreas.

I. Exocrine. It is secretion pancreatic juice- a mixture of digestive enzymes that enter the duodenum and break down all the components of the chyme;

II. Endocrine. It is the production of hormones.

Pancreas - parenchymal lobular organ.

The stroma of the gland is represented by a capsule that merges with the visceral peritoneum and trabeculae extending from it. The stroma is thin, formed by loose fibrous tissue. Trabeculae divide the gland into lobules. In layers of loose fibrous tissue there are excretory ducts of the exocrine part of the gland, vessels, nerves, intramural ganglia, lamellar Vater-Pacini bodies.

The parenchyma is formed by a combination of secretory sections ( acini), excretory ducts and the islands of Langerhans. Each lobule consists of exocrine and endocrine parts. Their ratio is ≈ 97:3.

Exocrine part of the pancreas is a complex alveolar-tubular protein gland. The structural and functional unit of the exocrine part is pancreaticacinus. It is formed by 8-14 acinar cells ( acinocytes) and centroacinous cells ( centroacinocytes). Acinar cells lie on the basement membrane, have a conical shape and pronounced polarity: the basal and apical poles differ in structure. The expanded basal pole is evenly stained with basic dyes and is called homogeneous. The narrowed apical pole is stained with acid dyes and is called zymogenic, because it contains granules of zymogen - proenzymes. At the apical pole of acinocytes there are microvilli. The function of acinocytes is the production of digestive enzymes. Activation of enzymes secreted by acinocytes normally occurs only in the duodenum under the influence of activators. This circumstance, as well as enzyme inhibitors and mucus produced by the cells of the epithelium of the ducts, protect the pancreatic parenchyma from autolysis (self-digestion).

pancreas, lobule , drawing, high magnification:

1 - terminal section (acinus):

a - apical (oxyphilic) part of the cell, contains a zymogen,

b - basal (basophilic) - homogeneous part of the cell;

2 - hemocapillary;

3 - islet of Langerhans (insula).

Endocrine part of the gland. The structural and functional unit of the endocrine part of the pancreas is islet of Langergansa (insula). It is separated from the acini by a loose fibrous unformed tissue. The islet is made up of cells. insulocytes, between which lies loose fibrous connective tissue with hemocapillaries of the fenestrated type. Insulocytes differ in their ability to stain with dyes. In accordance with this, type A, B, D, D1, PP insulocytes are distinguished.

B cells (basophilic insulocytes) are stained blue with basic dyes. Their number is about 75% of all cells of the islet. They are located in the center of the insula. The cells have a developed protein-synthesizing apparatus and secretory granules with a wide light rim. Secretory granules contain hormone insulin in combination with zinc. The function of B-insulocytes is the production of insulin, which lowers the level of glucose in the blood and stimulates its uptake by the cells of the body. In the liver, insulin stimulates the formation of glycogen from glucose. [With a lack of insulin production, diabetes mellitus is formed].

A-cells (acidophilic) - make up 20-25% of all cells of the islet. They are located on the periphery of the insula. They contain granules stained with acidic dyes. In an electron microscope, the granules have a narrow rim. Cells also contain a developed protein-synthesizing apparatus and secrete a hormone glucagon . This hormone is an insulin antagonist (contrinsular hormone), as it stimulates the breakdown of glycogen in the liver and increases blood glucose levels.

D-cells make up about 5% of the endocrine cells of the islet. They are located on the periphery of the insula. Contains moderately dense granules without a light rim. The granules contain a hormone somatostatin, which inhibits the function of A, B-cells of islets and acinocytes. It also has a mitosinhibitory effect on various cells.

D1-cells contain granules with a narrow rim. Work out vasointestinal polypeptide, lowering arterial pressure and stimulating the production of pancreatic juice. The number of these cells is small.

PP cells(2-5%) are located on the periphery of the islets, sometimes they can also be found in the exocrine part of the gland. They contain granules of various shapes, densities and sizes. Cells produce pancreatic polypeptide which inhibits the exocrine activity of the pancreas.

Theoretical information about the structure and main functions of the pancreas

Basic functions of the pancreas

The pancreas in the digestive system is the second largest organ after the liver in importance and size, which has two important functions. Firstly, it produces two main hormones, without which carbohydrate metabolism will be unregulated - glucagon and insulin. This is the so-called endocrine or incretory function of the gland. Secondly, the pancreas contributes to the digestion of all food that has entered the duodenum, i.e. is an exocrine organ with extractor functionality.

The gland produces juice containing proteins, trace elements, electrolytes and bicarbonates. When food enters the duodenum, juice also enters there, which, with its amylases, lipases and proteases, the so-called pancreatic enzymes, splits nutrients and promotes their absorption by the walls of the small intestine.

The pancreas produces about 4 liters of pancreatic juice per day, which is precisely synchronized with the supply of food to the stomach and duodenum. complex mechanism The functioning of the pancreas is provided by the participation of the adrenal glands, parathyroid and thyroid glands.

The hormones produced by these organs, as well as hormones such as secretin, pancrosin and gastrin, which are the result of the activity of the digestive organs, determine the adaptability of the pancreas to the type of food taken - depending on the components contained in it, the gland produces exactly those enzymes that can provide their maximum efficiency.

The structure of the pancreas

The speaking name of this organ indicates its location in the human body, namely: under the stomach. However, anatomically, this postulate will be valid only for a person who is in lying position. In a person standing straight, both the stomach and the pancreas are approximately at the same level. The structure of the pancreas is clearly shown in the figure.

The structure of the pancreas

Anatomically, the organ has an elongated shape, somewhat resembling a comma. It is accepted in medicine conditional division glands into three parts:

• Head, no larger than 35 mm, adjacent to the duodenum, and located at the level of I - III of the lumbar vertebra.
• The body is triangular in shape, no larger than 25 mm and localized near the 1st lumbar vertebra.
• The tail, not exceeding 30 mm in size, is of a pronounced conical shape.

The total length of the pancreas in the normal state is in the range of 160-230 mm.

The thickest part of it is the head. The body and tail gradually narrow, ending at the hilum of the spleen. All three parts are combined in a protective capsule - a shell formed by connective tissue.

Localization of the pancreas in the human body

Relative to other organs, the pancreas is located in the most rational way and is located in the abdominal cavity.

Anatomically, the spine passes behind the gland, in front is the stomach, to the right of it, from below and above - duodenum, on the left - the spleen. The abdominal aorta, lymph nodes, and celiac plexus are located in the posterior part of the body of the pancreas. The tail is to the right of the spleen, near the left kidney and left adrenal gland. The sebaceous bag separates the gland from the stomach.

The location of the pancreas relative to the stomach and spine explains the fact that in the acute phase the pain syndrome can be reduced in the patient's sitting position, leaning slightly forward. The figure clearly shows that with this position of the body, the load on the pancreas is minimal, since the stomach, which has shifted under the action of gravity, no longer affects the gland with its mass.

Histological structure of the pancreas

The pancreas has an alveolar-tubular structure, due to two main functions - to produce pancreatic juice and secrete hormones. In this regard, the gland has an endocrine part, approximately 2% of the mass of the organ, and an exocrine part, which is about 98%.

The exocrine part is formed by pancreatic acini and a complex system of excretory ducts. The acinus consists of approximately 10 cone-shaped pancreatocytes connected to each other, as well as centroacinar cells (epithelial cells) of the excretory ducts. Through these ducts, the secret produced by the gland first enters the intralobular ducts, then into the interlobular ducts, and, finally, as a result of their fusion, into the main pancreatic duct.

The endocrine part of the pancreas consists of the so-called islets of Langerans, localized in the tail and located between the acini (see figure):

Islets of Langerans are nothing more than a cluster of cells, the diameter of which is approximately 0.4 mm. Total iron contains about one million of these cells. The islets of Langerans are separated from the acini by a thin layer of connective tissue, and are literally pierced by myriads of capillaries.

The cells that form the islets of Langerhans produce 5 types of hormones, of which 2 types, glucagon and insulin, are produced only by the pancreas, and play a key role in regulating metabolic processes.