External secretory insufficiency. Violation of the internal secretion of the pancreas. But perhaps it is more correct to treat not the consequence, but the cause.

The pancreas has an alveolar-acinic structure, consists of many lobules that are at a short distance from each other, separated by layers of connective tissue. Each lobule is an accumulation of secretory epithelial cells of various shapes, in which pancreatic juice is formed.

Among the cells of the parenchyma there are specific cells that are grouped into clusters. They are called the islets of Langerhans. The value varies from 50 to 40 microns in diameter. The total mass is not more than 3% of the entire pancreas of an adult.

The pancreatic islets are richly supplied with the smallest blood vessels and capillaries, they are not equipped with excretory channels, but they have internal secretion, as a result of which they produce hormones directly into the blood. They also regulate carbohydrate processes in the human body.

Consider the physiology of the pancreas, what is the intrasecretory and exocrine functionality of the internal organ.

The role of the gland in the body

The organ of the digestive system produces various enzymes and hormones. He has two "duties" - this is the endocrine function of the pancreas (other names are endocrine, intrasecretory) and exocrine function - exocrine activity.

The internal organ is located in the abdominal cavity. It fits the back wall of the stomach, is localized at the level of the first lumbar vertebrae. This is approximately 10 centimeters above the navel closer to the left side.

The peculiarity of the body is that it has several segments. It is divided into the head and tail parts, as well as the body. The functionality of the pancreas is of great importance for the normal functioning of the whole organism as a whole. In case of malfunctions, a disorder of the digestive processes is observed. If dysfunction of the pancreatic islets is detected, diabetes mellitus develops in adults and children.

Conditionally, the pancreas can be considered as an organ of the digestive system, consisting of two parts - a numerous number of small glands and channels through which the pancreatic secret enters the duodenum.

Normally, the weight of the organ does not exceed 80 g, it produces about 1500-2000 ml of pancreatic juice per day, which creates a certain load on it. The secret is accompanied by an alkaline reaction, neutralizes the aggressive effects of gastric juice before food enters the duodenum from it. This is necessary so that hydrochloric acid does not corrode the mucous membranes.

The head of the pancreas is located next to the duodenum, in this place the common duct passes, which connects to the channel that conducts bile.

The work of the pancreas

Sugar level

Regulation of the production of pancreatic juice is a multi-level process that has certain patterns. The activity of working cells that contribute to the production of the required substances is influenced by the activity of the central nervous system.

Numerous scientific experiments have shown that the activity of the pancreas increases not only when food enters the body, but also at the sight of food, the smell of food, or just the mention of it. Such activity is due to the influence of the autonomic part of the nervous system.

In turn, the parasympathetic part also increases the activity of the pancreas through the influence of the vagus nerve. And the sympathetic department of the nervous system is focused on lowering the activity of the digestive organ.

The normal functioning of the pancreas is due to the properties of the secretion of the stomach. If an increased acidity of this is detected, this leads to mechanical expansion, as a result, the production of digestive enzymes increases.

The increase in acidity and expansion of the duodenum also lead to the production of components that are focused on stimulating the functionality of the gland. These include secretin and cholecystokinin.

The gland is not only stimulated, strengthening its work, but also inhibited. This function belongs to the sympathetic nervous system through:

• Somatostatin;
• Glucagon.

There is an amazing flexibility of the internal organ: it adapts to the daily diet, depending on the preferences of people. If there are a lot of proteins in food, trypsin is predominantly produced, if there are fats, then lipase.

exocrine activity

The exocrine and intrasecretory functions of the pancreas are responsible for many processes in the human body. Exocrine activity is observed during the digestion of food. As already noted, the gland can produce up to 2000 ml of pancreatic juice per day.

It is this secret that facilitates the process of digestion of food, since it contains digestive enzymes that break down organic components that enter the body with food.

The breakdown of carbohydrate, protein and fatty substances to the smallest molecules is revealed, which are also broken down by enzymes to an acceptable state, and subsequently they are absorbed in the intestine.

Pancreatic juice enters the duodenum and is characterized by the same osmotic pressure as blood plasma. Most of it is water and electrolyte, the smaller part contains enzymes. The concentration of electrolytes always fluctuates.

During the day, the pancreas produces up to 20 g of fermented proteins. This means that the organ, by its ability to produce enzyme substances, occupies a dominant position in the body. The release of enzymes is due to the stimulation of the organ. The process of removing enzyme components from cells does not depend on enzyme production. Basically, secretogens directly control the release of the protein from the atsionary cell.

Enzymes responsible for the hydrolysis of proteins found in the pancreatic juice are determined in an inactive form. This appears to be a kind of protection of the pancreas from self-digestion. Enzymes are activated exclusively in the duodenum. The activator is enterokinase, synthesized by the intestinal mucosa.

This is what causes the cascade phenomenon of enzymes.

Intrasecretory function

The intrasecretory part of the pancreas is responsible for the normal concentration of sugar in the human body. Glucose content is regulated by certain hormones. Their functionality is described by the endocrine mechanism of the ongoing processes. In other words, the accumulation of cells (pancreatic islets) secrete the hormone glucagon and insulin.

Insulin is focused on reducing the concentration of sugar, glucagon, on the contrary, increases the content. If there is a deficiency of insulin, then a chronic disease occurs - diabetes mellitus. It happens little, or it is not synthesized at all.

This pathology is ranked among the most complex diseases of the pancreas of internal secretion. During the course of diabetes, the functionality of the internal organ is significantly impaired, which leads to the development of complications. Against the background of the lack of correction of glycemia, there is a threat not only to health, but also to the life of the patient.

Diabetes is of the following types:

1. The first type is characterized by insulin deficiency, while glucagon is within normal limits or slightly above acceptable limits.
2. The second type of the disease occurs against the background of a normal amount of insulin, however, it manifests itself.

The intrasecretory function of the pancreas is impaired due to various reasons - age-related changes in the body, malnutrition, physical inactivity, pathologies of the digestive tract, gastrointestinal tract, etc.

Prevention of organ dysfunction

If the pancreas fails, there are problems with the work of other internal organs and systems. The pancreas appears to be a “capricious” organ that experiences a double load due to its functionality.

Gland dysfunction is of two kinds. It can work excessively (hyperfunction) or slowly (hypofunction). Inflammation is diagnosed as pancreatitis. The dominant symptom is a violation of the digestive process.

Gland dysfunction can be the result of certain diseases. These include gastritis, duodenitis, ulcerative lesions of the stomach and duodenum. Also on the list are chronic cholecystitis, biliary dyskinesia, cholelithiasis, and other diseases.

As a preventive measure for malfunctioning of the pancreas, you should adhere to the following advice from medical specialists:

• Stop smoking, reduce alcohol consumption;
• Avoid heavy physical activity;
• Lead a healthy lifestyle - a balanced diet, sports - gymnastics, breathing exercises, swimming, water aerobics;
• Periodically undergo a preventive examination by a doctor, ultrasound examination of the gallbladder;
• Visit a gastroenterologist at least once a year.

With great attention is paid to the diet. Since more than 70% of cases of pancreatitis are attributed to bad eating habits and alcohol abuse. You need to eat moderately, regularly, in small portions. Give preference to vegetables and fruits that abound in vitamins and minerals.

Pancreatic dysfunction is manifested by various symptoms. If there is pain in the upper abdomen, indigestion, nausea, and other signs, it is recommended to visit a medical facility for diagnosis.

The structure and functions of the pancreas are discussed in the video in this article.

The number of patients with organ pathology only increases every year, often this is associated with an increased increase in diseases due to exocrine pancreatic insufficiency.

Symptoms

Typical manifestations of insufficient organ functioning are associated with disturbances in the process of digestion of food. A person does not tolerate the use of fatty, fried and spicy foods.

After its adoption, there are complaints of heaviness in the epigastric region. The stool becomes unformed, plentiful, the color is faded, discolored and is poorly washed off the toilet. This is due to the presence of fat in the stool (steatorrhea). The frequency of bowel movements increases and can reach up to 6 times a day.

Moreover, the food is unable to be completely digested, the stool becomes mushy. The intestines are swollen from an excess of gases, painful colic is present.

The patient's body weight decreases, appetite disappears, weakness and decreased activity appear. Due to the low intake of fat-soluble vitamins, pain in the joints and bones occurs and osteoporosis develops, convulsive muscle contractions often join.

A lack of vitamin K leads to a decrease in blood clotting, vitamin A - increases dryness of the skin, and an insufficient amount of vitamin E increases the risk of infection, reduces libido and potency.

The patient looks pale and tired. There is shortness of breath, palpitations, fatigue.

Causes

The following mechanisms serve as the basis for the development of this state:

• Violation in the development of the pancreas and the immaturity of the organ.
• Destruction of acinar cells, which leads to a decrease in the production of enzymes.
• Difficulty in the release of pancreatic juice into the duodenum.
• Insufficient activity of enzymes due to low levels of enterokinase and bile.
• The lack of protein nutrition leads to a violation of the synthesis of enzymes.
• Dyskenesia of the small intestine and duodenum.

Absolute insufficiency

There are primary or absolute pancreatic insufficiency. It develops due to a decrease in the mass of the active tissue of the pancreas and is quite rare in practice.

Congenital diseases accompany absolute insufficiency:

• gland hypoplasia,
• hereditary pancreatitis,
• cystic fibrosis,
• anomalies of the pancreatic ducts,
• lipase deficiency.

It can also be acquired diseases - acute and chronic pancreatitis.
Relative insufficiency

Secondary or relative exocrine pancreatic insufficiency is due to accelerated transit of intestinal contents. In this condition, the pancreas is not damaged, its functions are preserved, but for certain reasons, the enzymes do not perform their task.

What causes relative deficiency of the gland:

1. If the mucous membrane of the small intestine is damaged, the production of cholecystokinin and secretin is disrupted.
2. Decrease in intraduodenal pH less than 5.5, which inactivates enzymes.
3. A disorder of intestinal motility, which is why there is a violation when mixing enzymes with a food lump.
4. An overgrowth of bacteria in the small intestine leads to the destruction of enzymes.
5. Lack of bile and enterokinase.

Pancreatic insufficiency in children

Children's organism, as well as in adults, is prone to the development of diseases of the pancreas. The appearance and course of the disease is slightly different in the clinical picture.

Cystic fibrosis (cystic fibrosis)

In children, the occurrence of pancreatitis is associated with anatomical or structural anomalies of a congenital or genetic nature. The most common form of cystic fibrosis is a monogenic autosomal recessive disease.

The reason is a mutation in the gene responsible for the composition and function of the protein. This gene is located in the epithelial cells that line the excretory ducts of the pancreas, small intestine, bronchi, lungs, and genitourinary system. The task is to regulate the electrolyte exchange between the apical cells in which this gene is located and the intercellular fluid.

With cystic fibrosis, all organs and systems of the body are affected, which gives an unfavorable prognosis and a rather complicated course of the disease. The severity of the disease increases the damage to the respiratory and digestive systems. Severe exocrine pancreatic insufficiency is characteristic.

Clinical manifestations: steatorrhea, frequent bronchitis, pneumonia, atrophic gastritis, enterocolitis. Criteria for diagnosis, in addition to clinical indicators, chlorine in sweat fluid and gene analysis. Treatment involves large doses of pancreatic drugs, anabolic steroid drugs, diet, and vitamins.

Shwachman's syndrome

Another, no less complex Shwachman syndrome (Shwachman-Diamond), is congenital. It is expressed by lipase deficiency, that is, there is a lack of an enzyme that helps to digest, dissolve and divide fats into fractions.

In the process of embryonic development of the organism, a violation occurs during the laying of the pancreas, which leads to its hypoplasia (underdevelopment). Hematological shift is expressed by neutropenia, anemia and thrombocytopenia. In children with Shwachman's syndrome, there is a lack of growth, damage to the femoral head and knee joints, hypoplasia of the phalanges of the fingers, and a narrow chest.

Clinical manifestations: steatorrhea, diabetes mellitus, recurrent respiratory infections, otitis media, sinusitis, skin infections.

Treatment is with substitution therapy, pancreatic drugs, and sometimes antibiotics.

Acute pancreatitis develops in children very rarely, however, as well as chronic.

Chronic duodenitis is characterized by damage to the mucous membrane of the small intestine, its atrophy, which leads to a violation of the production of cholecystokinin and secretin, enzymes that regulate the production of pancreatic juice.

Deficiency also occurs due to inflammatory and ulcerative lesions of the stomach and duodenum, with increased acidification in the intestine, enzymes lose their activity, the process of digestion and assimilation of food suffers.

Deficiency is also caused by diseases of the liver and the bile duct system.

Causes of pancreatitis in children:

• Anomalies in the development of the pancreas and its ducts.
• Cholelithiasis (a growing number of diseases).
• Duodenal obstruction.
• Abdominal injuries, infections.
• Intestinal diseases.

Therapy for exocrine insufficiency

There is no doubt that, along with diet, modern enzyme preparations, antisecretory and painkillers should be used for successful treatment.

In the treatment of exocrine pancreatic insufficiency, agents that contain pancreatin and pancrealipases are used. Mandatory components of medicines:

• Lipase - breaks down fats.
• Protease - proteins.
• Amylase - breaks down carbohydrates.

The splitting goes to elementary particles, which then allows them to be transported through the intestinal mucosa into the circulatory system. The nutrition of the body improves, the material for building cells is supplied.

Effective drugs that contain pancreatic enzymes are activated in the duodenum. The drug lowers the pressure inside the pancreatic ducts, thereby stopping the pain.

All medicines are made in a shell that protects the enzymes from the damaging effects of hydrochloric acid in the stomach.

A positive effect in the treatment of exocrine pancreatic insufficiency is provided by multivitamin complexes with microelements, probiotic and choleretic agents.

Treatment with enzyme preparations is contraindicated in obstructive jaundice, patients with acute hepatitis and intestinal obstruction.

Diet

Treatment of insufficiency of the gland can not be carried out without observing the diet. Requirements for food: the most sparing mechanically and chemically. Subject to restriction: fats, spices, fried foods. Carbonated drinks are excluded. Reduce the intake of carbohydrates, whole milk. The patient should eat fractionally, in small portions.

Treatment becomes more productive during fasting days. Fasting for therapeutic purposes should be carried out from 1 to 3 days. It is necessary to take a large amount of liquid: pure water, weakly brewed tea, rosehip decoctions, compote, chamomile infusion, mineral water.

Compliance with the daily regimen, eating by the hour, treatment with medications give a positive effect, improve the patient's well-being. General strengthening activities improve the quality of life: walks, moderate physical education, therapeutic and relaxing baths.

Useful video about the pancreas

As the inflammatory process progresses in the pancreas in patients with chronic pancreatitis, the glandular (secretory) tissue of the organ is gradually replaced by connective, or scar tissue. As a result, the number of secretory (acinar) cells in the pancreas decreases, which, under physiological conditions, in response to food entering the duodenal lumen, secrete a secret rich in digestive enzymes and alkali (pancreatic juice) into the intestine.

It contains the entire spectrum of enzymes capable of digesting proteins, fats, carbohydrates, but only lipase, an enzyme that breaks down fat into fatty acids and soaps in the presence of bile, does not have significant “backups” in the digestive tract. Therefore, in conditions of a decrease in the number of secretory cells, a situation becomes more likely when the amount of juice released into the lumen of the duodenum is insufficient for the process of digestion and subsequent absorption, primarily fats and fat-soluble vitamins, and only then proteins, carbohydrates.

This condition is called exocrine pancreatic insufficiency. Further progression of inflammatory-cicatrical changes in the pancreas can lead to the addition of endocrine dysfunction of the organ with the development of diabetes mellitus.

Clinical manifestations

The most typical manifestation of exocrine pancreatic insufficiency is poor tolerance to fatty foods, especially fried and smoked foods. As a result, the appearance after its consumption of a feeling of heaviness in the abdomen and abundant mushy "fatty" stools, the so-called pancreatic steatorrhea (fat excretion with feces). The frequency of bowel movements usually does not exceed 3-6 times a day. A fairly simple and easily identifiable criterion for increased "fat content" of feces is its ability to leave marks on the toilet, which are poorly washed off with water.

Perhaps the appearance of bloating and colicky pain in it. Limiting the intake of fatty foods, the intake of digestive enzymes (see below) helps to reduce the severity of these symptoms and even their disappearance.

Manifestations of a deficiency of fat-soluble vitamins in the body can be pain in the bones, their increased fragility and a tendency to convulsive muscle contractions (hypovitaminosis D), disorders in the blood coagulation system in the form of bleeding (hypovitaminosis K), disorders of twilight vision, or "night blindness", increased dry skin (hypovitaminosis A), susceptibility to infections, decreased libido, potency (hypovitaminosis E).

Pallor of the skin, shortness of breath, palpitations, fatigue, decreased performance and other signs of B12-deficiency anemia can be observed due to a violation of the absorption of the corresponding vitamin from food due to a lack of pancreatic proteases (enzymes that break down proteins). Decrease in body weight, as a result of insufficient intake of nutrients, indicates a pronounced exocrine pancreatic insufficiency.

11. The concept of liver failure. Etiology, general manifestations.

ETIOLOGY : Most often it develops in the primary pore-

this organ: viruses (Botkin's disease), tumor, echinococcus, circus

rose. Quite often, liver failure develops in violation of

outflow of bile, due to compression or obstruction of the biliary tract. Maybe

poisoning with hepatotropic poisons, especially carbon tetrachloride,

chloroform, ether, benzene, mushroom poison. Often, liver damage is

due to changes outside this organ - shock of various etiologies, sepsis,

heart failure, collagenoses.

PATHOGENESIS: The pathogenesis is based on the phenomena of cytolysis of hepatic

cells. As a result of the action of all the above factors in the first

turn increases the permeability of the membranes of liver cells. Therefore, from outside

the cytoplasm of the liver cells receives sodium and water ions. Cells on-

thump. At the same time, cell organelles also increase in volume, especially

mitochondria and lysosomes. Due to swelling of mitochondria and decrease

ATP formation is aggravated by disorders of the permeability of cell membranes

bran, and edema increases, and as a result of increased membrane permeability

lysosomes and their subsequent rupture, a large amount enters the cytoplasm

the presence of enzymes, especially proteolytic ones, which, by lysing cells, form the phenomena of necrosis of hepatic cells. In connection with the violation of the functions of hepatocytes in liver failure, metabolic disorders come to the fore (see question 12)

The pancreas is one of the most important organs in the human body system. When poor absorption of nutrients or indigestion occurs, other organs cannot function properly. If it is impossible to perform its functions in the body, a failure occurs, which leads to serious consequences. First of all, the functions of the pancreas are disturbed.

This organ is one of the largest in size in the internal secretory system. The pancreas synthesizes and produces special enzymatic elements that promote digestion. Compared to other systems, it is able to work at full capacity for a long period of time, while not giving a person any signals that its performance is worn out. The factors that provoke diseases of the pancreas are very diverse. This is an improper and unbalanced diet, stressful situations, injuries of a different nature, chronic diseases.

The most dangerous syndromes for the human body are pancreatitis and inflammation of internal tissues. The disease pancreatitis develops quickly and causes serious harm to health. Such a pathology occurs without severe symptoms, which leads to the fact that a person does not know about the disease for a long time. This provokes a change in the structure of the gland and the production of enzymes does not occur in full, which means that the body cannot function normally, which affects the general well-being of the patient.

Most often, doctors diagnose exocrine insufficiency in patients. Such a diagnosis is a consequence of pancreatitis, which occurs in a chronic form. Exocrine disease leads to inflammation of the internal organs, in particular the pancreas. This disease contributes to the impairment of the patient's ability to work, and in severe cases, the patient becomes disabled.

A symptom of the disease is the poor absorption of nutrients into the soft tissues of the organ. There is a violation of the splitting process when food enters the body. The number of patients with this diagnosis is growing every year. To a greater extent, the person himself becomes the culprit of his diagnosis. Since, striving for fashion, girls begin to starve or completely refuse food. The same can be said for people who consume excessively fatty foods.

Important! All this leads to an upset pancreas.

Causes and types of exocrine insufficiency

The disease is classified depending on the factors, size, as well as the presence of other disorders in the body. There are two types of exocrine insufficiency:

• acquired - occurs in people who have chronic pancreatitis syndrome;
• congenital - peculiar anomalies are transmitted through the genetic code that block the normal production of nutritional enzymes.

Exocrine insufficiency of pancreatic disease has its own qualification, depending on the condition and its spread to neighboring organs of the system. Allocate a secondary form of the disease, in which the production of enzyme elements occurs. But the peculiarity of the disease is not the synthesis of substances in the small intestine and duodenum. In the pancreas, a process of inactivation occurs, which complicates the state of health. There is also such a classification as an aerfic form of the disease, in which disorders occur in the pancreas itself, provoked by improper synthesis of enzyme substances.

The functions of the pancreas are external and internal secretion. This is the only organ that occupies a central place in two different systems of the body - endocrine and digestive, ensuring the normal process of digestion and a full-fledged metabolism.

Violation of any function of the pancreas in the human body leads to disorders and diseases that can be complicated and end fatally.

Anatomy and morphology of the organ

How does the exocrine gland work?

The excretory function of the pancreas is provided by acini cells that produce pancreatic juice containing enzymes. About 1.5 liters of pancreatic juice is normally secreted per day. All enzymes are synthesized in the pancreas in the form of inactive compounds (such as trypsinogen) and are activated in the small intestine. They begin to be released as soon as food enters the duodenum. This process continues for 12 hours. The qualitative and quantitative composition of enzymes depends on the food consumed. Carbohydrate food causes more active secretion. In men, the secretory work of the pancreas is more pronounced than in women.

The gland produces digestive juice containing more than 20 enzymes, grouped into 3 groups:

• lipase - breaks down fats;
• protease - proteins;
• - carbohydrates.

Proteases include several more enzymes, the main ones are:

• trypsin - breaks down protein into peptides;
• carboxypeptidase - converts peptides into amino acids;
• elastase - digests proteins and elastin.

Enzymes in pancreatic juice are inactive. Under the influence of enterokinase (an enzyme of the small intestine), which becomes active in the presence of bile, they are activated in the intestinal lumen: trypsinogen is converted to trypsin. After that, it can be responsible for the activity of the remaining enzymes, changing them.

The production regulation process consists of 3 stages:

1. Brain regulation of the pancreas - begins at the time of eating due to the irritating effect on various receptors for the smell, type and taste of food. Nerve impulses are transmitted to the secretory center of the medulla oblongata, activating it.
2. Gastric regulation - the intake of food into the stomach stimulates the production of gastric juice due to the action of gastrin (prostate hormone).
3. The intestinal stage - stimulation occurs due to the action of the secreted vasoactive intestinal peptide (VIP) - the hormone of the pancreas and cholecystokinin (pancreozymin) - the hormone of the duodenum.

How does the endocrine part of the gland work?

The intrasecretory part of the gland, represented by the islets of Langerhans, produces hormones. They provide metabolism in the body, control not only the processes of digestion, but also human growth.

Insulin is the main hormone produced by the pancreas and is involved in the metabolism of carbohydrates. The only substance in the body that can lower blood sugar. With its deficiency, diabetes mellitus develops.

Glucagon - an insulin antagonist, is responsible for the process of splitting fats, increases blood glucose levels, affects the level of calcium and phosphorus.

Somatostatin regulates the functions of the hypothalamus and pituitary gland, controls the level of growth hormone - somatotropin.

Functions of the pancreas

The pancreas is a multifunctional organ. The main functions that it performs are classified as follows:

• humoral;
• endocrine;
• digestive;
• secretory.

humoral function

Humoral function - the ability of the body to obtain all the necessary substances from the food entering the body. Due to hormonal regulation, the required amount of pancreatic secretion with the currently needed enzymes is produced. Thus, the pancreas adapts to any type of food (fatty, protein or carbohydrate), highlighting specific enzymes in sufficient quantities.

Digestive function

The digestive function of the pancreas characterizes it as one of the central organs of the gastrointestinal tract. The enzymes that make up the pancreatic juice play a major role in the digestion of the constituent components of the food entering the body. Entering the lumen of the small intestine, together with pepsin produced by duodenal cells and bile acids, they break down proteins, fats and carbohydrates into their constituents. Then they are carried by the blood throughout the body.

endocrine function

Endocrine function is associated with the formation of hormones. The main ones are:

• insulin;
• glucagon;
• somatostatin.

Without them, carbohydrate metabolism is disrupted, normal human growth processes suffer, and serious diseases occur that require lifelong treatment.

secretory function

The exocrine function is based on the production of a special secret - digestive juice, which, in addition to enzymes, also includes other organic substances. Thanks to secretion, the process of digestion occurs, since under the influence of only gastric juice with hydrochloric acid, the organs in contact with them would collapse.

Relationship of functions with the structure and location of the gland

The organs of each system in the body are located in such a way that their interaction takes the shortest period of time, and all functions are performed in full. The process of digestion occurs normally when pancreatic enzymes enter the duodenum, where the food bolus initially treated with gastric juice moves. Therefore, the common duct of the pancreas (wirsungov), previously connected with the duct of the gallbladder into a common ampulla, enters the lumen of the duodenum due to the sphincter of Oddi. The head of the pancreas, which has the final part of the Wirsung duct, is located in close proximity to the small intestine - it is covered by the duodenum in the form of a shackle. This facilitates the rapid entry of pancreatic secretions into the intestinal lumen.

With the existing cholecystitis, it turns out what is the role of bile: the digestion of fats is disturbed due to a lack of bile acids. In short: their role is to emulsify (crush) large fat molecules into small fragments. A large surface is created for the action of lipase, digestion improves.

The location of the pancreas contributes to the successful implementation of the endocrine function: hormones that are produced in response to the intake of carbohydrates (insulin, glucagon) enter the general circulation.

How to support the function of the gland?

To minimize the risk of repeated exacerbations and relapses, it is necessary to follow a certain lifestyle, which includes:

• balanced diet;
• giving up other bad habits;
• active lifestyle;
• lack of stress, overwork, lack of sleep.

If the functions of the pancreas are already impaired, efforts are required to restore them. To do this, you need to consult a doctor in a timely manner when new complaints or symptoms appear, take prescribed medications, follow the prescribed regimen, and perform special exercises - exercises for the pancreas.

In all cases - both during the period of deep remission and during exacerbation - it is important to observe. Special nutrition can play a decisive role in maintaining the function of the gland. It occupies an important place in complex treatment, at the same time it is the main preventive measure.

External secretory function

Features of nutrition depend on the underlying pathology of the pancreas. Violations of exocrine functions associated with the process of digestion correlate with the development of an inflammatory process in the tissues of the gland - pancreatitis. Compliance with the diet is mandatory in any phase of the disease. It is prescribed and corrected by a therapist or gastroenterologist and corresponds to table number 5 according to Pevzner. There are some differences in allowed products, volume, calories at different stages of the disease. But always among the prohibited for use include:

• alcoholic (including low alcohol) drinks;
• fatty, fried, smoked, spicy and salty dishes;
• sausages, canned food, packaged juices, any drinks with gases;
• sour and unripe fruits and berries;
• eggs (especially the yolk) and whole milk;
• , strong tea and coffee, especially if drinks are consumed on an empty stomach;
• sweet baked goods.

When compiling a diet, it is necessary to know products that are harmful in pancreatitis, as well as those whose use is allowed in limited quantities during the period of remission of the disease. You can use a table that contains a detailed list and includes the calorie content of each product and the content of fat, protein and carbohydrates in it.

It is important to prepare food properly and follow a diet. With pancreatitis, even if the disease is not exacerbated, it is required to observe the frequency and fragmentation of nutrition: you need to eat often (5-6 times a day) and in small portions. Food should be mushy or semi-liquid, warm, steamed, in the oven, stewed or boiled. This protects the pancreas from excessive functional load, since a single meal in large quantities in large pieces requires the production of a large amount of pancreatic juice. Small portions of grated food reduce the tension of the pancreas.

The basis of nutrition for pancreatitis for the normal functioning of the pancreas should be:

• (oatmeal, buckwheat, rice);
• lean meat of fish, poultry, beef, veal;
• boiled and stewed vegetables;
• peeled, pureed or finely chopped ripe fruits;
• homemade compotes, fruit drinks.

Alcohol has a toxic effect on the cells of the liver and pancreas, causing their death. In addition, it increases the pressure in the vessels, changes the structure of their walls, and reduces their strength. Poorly metabolized, creating an additional burden on the body.

Nicotine and tar, which enter the body during smoking, lead to stenosis of the veins and arteries, contribute to the development of secondary atherosclerosis, thereby grossly disrupting the blood supply not only to the pancreas, but also to other organs. The load on the pancreas sharply increases, functional abilities decrease.

Physical inactivity is harmful to the pancreas as well as to the heart and blood vessels. Walking with a calm step, regular exercises from the complex of physiotherapy exercises, swimming improve blood circulation in the organ and its general condition.

Hyperdynamia with high loads negatively affects the state of the pancreas, so all physical activity should be moderate.

To control the functional state of the pancreas, and also if it starts to hurt in the left hypochondrium, it is necessary to undergo a regular examination, including laboratory methods:

• coprogram (fecal analysis);
• diastasis of blood and urine;
• associated with the cellular state of the liver (bilirubin and its fractions, protein, transaminases).

It is shown to carry out EFGDS - this is a technique that allows you to evaluate the motor function of the stomach and duodenum, the properties of the mucous membranes of these organs, which are closely related to the pancreas.

And the abdominal cavity allows you to observe in the dynamics of age-related and pathological transformation of the tissue structure, which can be manifested by diffuse and focal changes. It is necessary to look at the pancreas on ultrasound, depending on the condition, 1 or 2 times a year. The method is harmless, it is prescribed not only for an adult, a child can also be examined.

Intrasecretory function

Pathology of the pancreas can lead to endocrine insufficiency: insulin production is sharply reduced, diabetes mellitus develops, which is studied in detail by endocrinology. The main laboratory sign of it is high blood sugar and urine. The disease requires lifelong therapy with hypoglycemic drugs and a diet that restricts easily digestible carbohydrates. An insulin resistance index is pre-calculated to determine the type of diabetes mellitus and prescribe the correct treatment. Assigned, which provides for permitted and prohibited products. The patient should have regular blood and urine tests. These indicators are important for evaluating insulin therapy or other drugs to normalize blood glucose. They are also used to study the function of the pancreas, to check how the body reacts to the prescribed complex treatment.

The pancreas is an organ that is sensitive to various influences. Regular exposure to adverse factors leads to negative consequences. In order to avoid the development of its pathology, it is necessary to adhere to the recommendations of specialists.

Bibliography

1. Human physiology. In 3 volumes, edited by R. Schmidt and G. Tevs. M. Mir 1996
2. Human Physiology: textbook edited by A.A. Semenovich. Minsk: Higher School 2007
3. Mikhailov V.V. Fundamentals of pathological physiology. Guide for doctors. M. Medicine 2001
4. Joseph M. Henderson. Pathophysiology of the digestive system. Binom Publishers 1997
5. Almazov V.A. Clinical pathophysiology: textbook for university students. 3rd edition, revised and enlarged. SPb. Peter 1999
6. Starkova N.T. Clinical endocrinology. Edition 3, revised and supplemented - St. Petersburg. Peter 2002
7. Poltyrev S.S., Kurtsin I.T. Physiology of digestion. M. Higher school. 1980