Diseases of the digestive system are quite common pathologies that are found in the vast majority of the world's inhabitants. However, not everyone knows that many gastrointestinal diseases arise due to pathological conditions of the large duodenal papilla. From the materials of our article, the reader learns about what BDS 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 large duodenal papilla (BDS) is the anatomical structure of the hemispherical shape, which is located on the mucous membrane of the descending part of the duodenum. In the medical literature, BDS can be found under other names - the large papilla of the duodenum, or the papilla of the papilla. And yet, what is BDS? This is a structure from 2 mm to 2 cm in size, which performs a very important function - it connects the common bile duct, the main pancreatic duct and the duodenum. BDS regulates the flow of bile and pancreatic juice into the small intestine and prevents intestinal contents from entering the ducts.
In the structure of the BDS, pathological changes can occur under the influence of various factors - a variety of pathogenic microflora, pressure fluctuations and changes in acid-base balance, stagnation in the cavity, etc. In addition, the structure of the organ can be disturbed by migration along the bile duct of stones or other dense structures.
Pathology BDS
Diseases of the large 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 diagnostics, medical practice often encounters a huge number of unsatisfactory results in the treatment of patients with gallstone disease or pancreatitis, which developed against the background of violations in the structure of the BDS.
Tumor neoplasms are considered a common pathology of BDS - hyperplastic polyps account for up to 87% of benign tumors. Polyps, as a rule, do not degenerate into malignant tissues. Adenomas are a rare disease, BDS cancer makes up 25% of all malignant neoplasms. Stenosis of the BDS is diagnosed in 4-40% of patients. As a rule, BDS pathologies are interconnected with gallstone disease (cholelithiasis), which occurs in every tenth inhabitant.
Classification of diseases of the BDS
Diseases of the large duodenal papilla are classified into two large groups:
Primary diseases include those disorders that occur and are localized within the structure of the BDS - papillitis (inflammatory disease); spastic stenosis of the BDS, which can later transform into papillosclerosis; age-related changes in the BDS; congenital malformations; benign and malignant neoplasms - lipomas, melanomas, fibromas, adenomas, polyps, papillomas.
Secondary diseases of the BDS are stenosis 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, unstable stool.
There is the concept of combined stenosis - a violation of the BDS function 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 the BDS are caused by inflammation of the pancreas, the manifestations of the disease will be similar to signs 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 - the pathology can develop rapidly, taking an acute form, or not manifest itself for a long time, which is typical for a 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 can be girdle-like and not stop even after taking antispasmodics or analgesics. This is what BDS is and what are the consequences of the violation of its functions.
In addition to pain with pancreatitis, there is a vomiting reflex, muscle weakness, dizziness. The main signs of pancreatitis in an ultrasound scan are a change in the shape and unevenness of the edges of the pancreas. When diagnosed in the body, cysts can be detected. I must say that the disease is difficult. And with untimely intervention, it can be fatal.
Spastic stenosis of the BDS
Stenosis of the BDS is a pathology with a benign course, which is due to 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 the active infectious process in the folds leads to the development of fibrous tissue and stenosis of the areas of the BDS ampoule.
As you know, the age of a person directly affects the structure of the BDS. Older people with gallstone disease suffer from an atrophic-sclerotic form of chronic papillitis. The contingent, whose age has not reached the sixty-year milestone, is subject to hyperplastic changes in the BDS (adenomatous, adenomyomatous).
In recent years, due to the fact that endoscopes are used in the diagnosis of BDS diseases, it has become possible to clearly distinguish between stenotic and catarrhal (non-stenotic) 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 causes a chronic infection that spreads with lymph flow.
Forms of BDS stenosis
Three forms of stenosis are distinguished depending on morphological features:
- inflammatory sclerotic stenosis is a pathology characterized by various degrees of fibrosis;
- fibrocystic stenosis - a disorder in which, together 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 glandular hyperplasia occurs, as well as hypertrophy of smooth muscle fibers and proliferation of fibrous fibers, a violation very often occurs in older people.
In addition to this, cicatricial stenosis of the BDS is classified:
Primary stenosis does not cause changes in the bile ducts. Pathology is caused by degenerative changes of the papilla itself, which are manifested in atrophy of the muscle layer. Sometimes primary stenosis is a congenital pathology.
Secondary stenosis is a consequence of existing changes in the structure due to injury to the papilla by stone migration or surgical intervention.
Depending on the extent of the spread of the disease, stenosis of the BDS is divided:
Diagnostics
Today, medicine uses several fairly effective methods for diagnosing diseases of the BDS. Let us consider in more detail some of them.
Endoscopic ultrasonography is a technique in which, using an optical device, an endoscope, a study of the structure of the BDS is carried out. A photo of a papilla taken with a similar study is given above.
Transabdominal ultrasonography is a screening examination method 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 gallbladder cavity and its contractility, the presence / absence of intracavitary inclusions.
The next diagnostic method for BDS pathologies is ultrasound cholecystography
- a manipulation by which the motor-evacuation
function of the gallbladder is examined within two hours from the moment of taking the choleretic breakfast.
Dynamic hepatobyl scintigraphy is a procedure based on an assessment of the absorption and 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 gastroduodenoscopy, an assessment of the condition of the BDS is carried out, as well as monitoring the nature of the receipt of bile. In addition to these methods, computed tomography and laboratory diagnostics exist.
BDS: treatment
The basis of the therapy of BDS stenosis is the task to restore 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 to achieve success in treatment:
- psychotherapy, treatment of neurosis, stabilization of the hormonal background, stress minimization, rest, proper diet;
- treatment of abdominal organs pathologies,
- 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 sessions of psychotherapy.
An important component of successful treatment is a diet:
- fractional meal;
- refusal of alcohol and carbonated drinks, as well as smoked and fried foods;
- restriction in the 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.
Often, stenosis of the BDS is treated with surgical methods. Distinguish between corrective and non-corrective operations. The first group includes endoscopic PST, BDS bougieurage.
In the period of remission, in addition to the diet, patients are recommended maintenance therapy - daily walking, morning exercises, and swimming benefit.
To summarize the above, it can be summarized that many
gastrointestinal diseases occur against the background of a malfunction in one small structure. Such violations lead to serious problems in the body and often can only be corrected surgically. This is what BDS is.