Pancreatic secretion and pressure biomechanics in pancreatic acinus

The article highlights the mechanism of the mathematical model of acinus, the components of the formation of pressure in its cavity and the formation of pancreatic juice. It has been established that the mechanism for creating pressure in the acinus cavity is similar to the intraductal one. In this case, the question remains open about the causes of such high pressure, which is measured in several hundred millimeters of a mercury column, especially since, as histologically established, the pancreas and its ducts do not have muscle structures, and those rudiments of myofibrils, which are noted in some places of the flow system, of course, cannot ensure the development of such pressure. The increase in pressure in the cavity of the acinus is associated with the phenomenon of osmosis in its cells. Since cell membranes have the property of conductivity, as a result of osmosis, water through the membrane first passes from the blood to the cell, then from the cell through the membrane into the acinus cavity. In addition to the mechanism of osmosis through the membrane, in the cells of the acinus epithelium, there is a filtering mechanism through the pores of the layer of connective tissue to the lymph channel. It has now been established that, together with simple osmosis, the phenomenon of electroosmosis takes place in secreting cells and organs of excretion, not only accelerates the transfer of substances, but also increases the pressure on the other side of the membrane against the gradient by almost several first-order units. Thus, the outflow of fluid from the acinus cavity proceeds continuously, but only with a change in the speed of movement, it is determined by the pressure drop in the acinus – tubule – excretory duct system, the opening of the Oddi sphincter and the pulse of the cardiovascular wave, which creates dynamic pressure in the capillary. This whole mechanism, as a result, leads to the filling of the cavity of the acinus and the creation of a certain pressure in it.

Pancreatic type dysfunction of oddi sphincter in children

Anatomical and functional characteristics of the pancreas and its close relationship to adjacent organs, primarily duodenum and biliary tract, cause its frequent involvement in pathological process. Difficulties in differentiation of functional and organic pathology of the pancreas are associated not only with the difficulties of diagnostic of functional diseases, but also with the problems of classification and definitions. As to realities of today optimal version is one proposed by the authors of ICD 10 and found further development in the materials of the Rome III consensus - namely the Oddi sphincter dysfunction in pancreatic type. Under this diagnosis there is the possibility for logical explanation of involvement of pancreas in pathological process. The article also describes the diagnostic criteria for the Oddi sphincter dysfunction in pancreatic type, which includes clinical, laboratory and instrumental signs. It is noted that the recommended set of instrumental examination in modern pediatric practice is not only unimplementable, but just is not necessary. The usefulness of the recommended methods (including procedures that are potentially dangerous in terms of developing pancreatitis) for functional disorders is discussing. In the article the issues of nutrition of children with diseases of the pancreas, as well as the program of medical correction of dysfunction of the sphincter of Oddi in pancreatic type, are described.

PRELIMINARY RESULTS OF APPLICATION OF ERCP IN THE TREATMENT OF SOME PANCREATOBILINARY DISEASES

Background and objectives: ERCP is helpful technique in the diagnosis and treatment of some pancreatobilinary diseases. Purposes of this study are studying clinical characteristics, imaging of patients pancreatobilinary diseases indicated for ERCP as well as treatment results and safety of ERCP in the treatment of some pancreatobilinary diseases. Materials and methods: a observational study of results of ERCP application in the patients with bilinary stones and Oddi sphincter stenosis, pancreatic tumors at Quangnam Central General Hospital from 6/2013 till 5/2015. Results: Among 30 patients selected for study, there are 26 patients with bile duct stones (86.6%), 1 patients with Oddi sphincter stenosis and 1 bile duct stenosis (6.7%) and 2 patients with pancreatic tumors (6.7%). In patients with bile duct stones, 12 patients were complicated by obstructive jaundice. Among them, 11 patients were complicated by bilinary infection (42.3%), 5 patients had hyperamylasemia (19.2%), 2 patients were complicated by acute pancreatitis (7.7%); in patients with Oddi sphincter stenosis and 1 bile duct stenosis, in patients with pancreatic tumors. The complete success rate of stone removing is 81.3% in common bile duct stones. The complete success rate of stone removing is 42.9% in common bile duct stones combined with hepatic duct stones. We can not remove stones in all 3 patients with only hepatic duct stones. The complication rate of ERCP is 13.3%, including 2 acute pancreatitis (6.7%), 2 bleeding (6.7%). Conclusions: Bile duct stones are the commonest pancreatobilinary diseases which were selected for ERCP. ERCP is the safe, effective technique in the treatment of pancreatobilinary diseases. Key words: (Endoscopic Retrograde Cholangio-Pancreatography: ERCP);