The human body is a complex mechanism that consists of a large number of different systems. All these systems should work smoothly, in case of any malfunctions, they should freely restore their performance. The digestive system is one of the key systems that ensures the normal functioning of a person. The key point in the digestive system are enzyme systems, including the gall bladder. Its main task is the emulsification of fats. In this article we will analyze in detail the mechanism of bile formation, the work of the sphincters, which regulate the flow of bile into the duodenum.
How is the enzyme system of the digestive tract?
The main organs of the enzyme system of the gastrointestinal tract are: liver, gall bladder and pancreas. These three organs are interconnected and perform one common function - food fermentation.
The liver produces many substances, including bile. It looks like a greenish liquid that promotes the digestion of fats. After the liver has developed bile, it enters the gallbladder through the duct. The gall bladder is a reservoir of bile. During a meal, bile enters the intestine, namely the duodenum, where fat is emulsified.
A little lower under the liver is the pancreas. It is a parenchymal organ that promotes digestion by producing digestive juices that help break down food.
It is worth noting that the production of enzymes in these organs occurs around the clock, so nature has come up with "dispensers" that dispense the flow of bile and other enzymes into the duodenum. These dispensers are called sphincters of the gallbladder and liver, pancreas.
Anatomy and physiology of the gallbladder. Sphincter of Lutkens
From the point of view of anatomy, the gallbladder is divided into three parts: the bottom of the bladder, the body and in the proximal part - the neck of the organ. It is from the neck of the bladder that the cystic duct departs. The location of the Lutkens-Martynov sphincter is right here - at the junction of the gallbladder into the cystic duct. This sphincter was discovered by the scientist Lutkens in 1926, in his works he described in detail the functions of this sphincter, the mechanism of its work.
The Lutkens sphincter is something like a bundle of circular, smooth muscle fibers. During digestion, it opens, thereby allowing bile to exit the bladder into the lumen of the duodenum. Under ordinary conditions, it rhythmically opens and closes, thereby making it possible to freely pass the hepatic bile into the gall bladder.
Sphincter Mirizzi
This sphincter is a bundle of smooth muscle fibers that acts as a valve. The objective of this valve is to regulate the flow of bile from the liver, gall bladder into the duodenum. This sphincter is located in the common bile duct, namely at the confluence of the common hepatic duct and the cystic bile duct.
Sphincter of Oddi
This sphincter was discovered back in the seventeenth century, but its physiology was not studied at that time. At the end of the 19th century, the scientist Ruggiero Oddi described in detail the anatomy and physiology of this entity.
The sphincter of Oddi is located in the descending part of the duodenum, namely in the large duodenal papilla. This sphincter has two tasks. Firstly, it contributes to the dosed supply of bile from the biliary tract into the lumen of the duodenum. Secondly, it prevents the return of intestinal contents into the pancreatic and bile ducts.
The sphincter itself is a complex muscle, which consists of 2 types of muscles: constrictor muscles that clamp the papilla, dilator muscles that relax the papilla.
The sphincter itself is always in a state of tension, but this does not prevent it from feeding bile from the bile ducts into the lumen of the duodenum around the clock in miserable amounts. During digestion, the sphincter opens for a long time (from 30 seconds to 2 minutes), at which point the bile flows continuously from the bile ducts into the duodenum with a continuous stream.
When closed, the sphincter of Oddi raises the pressure in the biliary tract. If the sphincter does not open for a long time, and the pressure, therefore, does not drop, this can provoke stagnant processes in the biliary tract, as well as in the liver and gall bladder.
Diseases of the biliary system
The most common disorders that are associated with the bile duct are dyskinesia of the bile duct. DZhP can arise at untimely or inconsistent opening or closing of sphincters of a biliary system. Also, dyskinesia of the bile ducts can be observed with insufficient or rapid constriction of the gallbladder.
Dyskinesia of the bile ducts is a common disease among all pathologies in gastroenterology. Failure in the biliary system associated with a malfunction of one or more sphincters leads to stagnant processes in the gallbladder, pancreas, and liver.
Two types of biliary duct dyskinesia should be distinguished. The only difference is how fast the bile moves along the bile ducts. If the flow of bile occurs too quickly, then such dyskinesia will be hyperkinetic. If the flow of bile through the ducts is not fast enough, then we are talking about hypokinetic dyskinesia. It should be noted that hyperkinetic dyskinesia is most common in young people. As for hypokinetic dyskinesia, it is typical for people over 40 years old.
Symptoms in these two types of diseases are slightly different, but they are united by one thing - pain. If the patient has hypokinetic dyskinesia, then he will feel pain for a long period (from several hours to several days). She is most often herpes zoster.
In patients with a hyperkinetic form, pain occurs during and immediately after a meal. It is sharp and cramping, a bit like biliary colic.
Disruption of the sphincter Martynov
In patients who have disrupted the sphincter of Lutkens and Oddi, there is a high risk of developing congestive processes in the gallbladder itself. Symptoms of cholestasis are itching of the skin, darkening of urine. Due to the fact that bile does not exit through the bile ducts, feces in these patients are colorless.