The role of the pancreas is unusually great. This organ of external (exocrine) and internal (endocrine) secretion is involved in the digestive process and regulation of lipid, carbohydrate and protein metabolism in the body. Problems in the work of the body affect 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). With 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 fusion of the smaller ducts of the organ lobules, has an average length of 20 cm. This channel often terminates in the duodenum, at the site of the formation of such an organ as the 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 by the produced pancreatic juice.
The size and shape of the Wirsung duct in many people do not coincide and depend on the individual structure of the body. In most, it combines with the common bile duct (choledochus) and enters the duodenum. The ratios of its final departments together with the common duct can be different. There are 4 types of them:
- The joint flow of both ducts into the intestine, where they form a kind of ampoule. The sphincter of Oddi at the same time, covering both ducts, with its contraction completely closes them. A similar type is observed in 55% of cases.
- The connection of both ducts near the duodenum without the formation of a common ampoule. This type is characteristic in 33.6%.
- Separate flow into the duodenum of each of the ducts. This is a fairly rare type of ratio, found in 4%.
- Merging of ducts at a considerable distance from Vater's nipple. Both of them open into the duodenum and touch their walls. About 8.5% of cases show that this merger is separate.
These anatomical features are quite important with 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 relationship with the duodenum play a considerable role in understanding and developing a number of symptoms of pathologies and pancreatic cancer.
Ultrasound picture
Modifications of the pancreas (violation of the organ parenchyma) 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, to see the contours, the presence of pathologies, as well as the state of the ducts of the gland. Signs of certain diseases, diagnosed upon examination, probable deviations are also shown, which can cover the Wirsung duct of the pancreas.
By the way, it is worth noting that many healthy 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 with ultrasound
More often, diseases such as acute and chronic pancreatitis , pancreolithiasis, cysts and other pathologies are detected.
A diffuse increase in the parenchyma of the gland often causes acute pancreatitis. During the examination, the contours of the organ are blurred, blind spots may occur 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 undergo changes. Its contours do not become fuzzy and uneven. Gland tissue echo is reduced. In the presence of fibrosis, compaction of the parenchyma is observed, the Wirsung duct is deformed and narrowed, and its walls are sealed. Often a violation of the patency of the ducts of the gland is detected. 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 inflammatory processes of the gland or impaired outflow of enzymes. Initially, stagnation in the ducts of the organ is observed, which is expressed by the expansion of the Wirsung duct. At the next stage of the development of the pathological condition, protein is precipitated in pancreatic juice and calcifications are deposited, which in an ultrasound scan is expressed as a diffuse increase in the echogenicity of the parenchyma. A neglected form of the disease leads to pancreolithiasis.
The structure of the gland can be affected by pathological conditions of other internal organs (chronic heart failure, hepatitis, cirrhosis).
Deviations detected in the pancreas may be due to its various diseases, but more often pancreatitis and pancreolithiasis are causative factors.
Pancreatitis
From a clinical point of view, pancreatitis (an inflammatory process of the pancreas) can occur in 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 obstruction of the duct. With prolonged inflammation, the gland enzymes begin to digest their own cells. The cause of inflammation can also be damage to the gland due to its edema.
Acute pancreatitis is more often caused by the presence of gallstones that block the ducts, or by alcoholism, the result of which is the obstruction of the small ducts of the organ.
Pancreolithiasis
Pancreatolithiasis 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 pains 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 by ultrasound revealed that the Wirsung duct is expanded, and observed stretching the walls of small ducts.
However, it is worth remembering that the ultrasound picture does not provide complete information for the diagnosis. Additional examinations are needed. Since often when detecting diffuse modifications of the pancreas or liver, for example, the Wirsung duct is not visualized. Other diagnostic methods help to study it in more detail.
Diagnostic difficulty
The complexity of the diagnosis of the pathologies under consideration is associated with the location of the pancreas. It is located deep enough in the human body. Her 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 the urine, in the blood, in the duodenal contents). To establish exocrine insufficiency of the gland, it is necessary to determine the fecal elastase in the feces. An important blood test, glycemia assessment, abdominal sonography, dopplerography are also important.
To obtain axial sections of the abdominal organs, an MRI is prescribed.
In rather difficult situations, diagnostic laparoscopy is also performed . As pancreatic ducts and bile duct pathologies often also affect the pancreas, ERCP is required.
MR cholangiography
Magnetic resonance cholangiopancreatography with obstructive form of 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 pancreatic duct. It makes it possible to obtain the most accurate information about the state of these organs, determine the presence of polyps, calculi, strictures, visualize the changes in the vessels and lymph nodes.
Treatment
Treatment of diffuse changes revealed in the pancreas can be carried out by conservative and surgical 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, they do not undergo reverse development.
Restoring the normal structure of the organ is possible only with timely adequate therapy and observing all the recommendations of a specialist.