This paper examines the current professional literature on major exo- and endopathogenic factors and mechanisms of structural changes of the pancreas. The cited data proves the diagnostic importance of functional and laboratory methods of examination as the endo- and exocrine parts of the pancreas. Up-to-date ultrasound investigation devices make it possible to identify the major pancreatic duct in 85 % cases. There are cases of pancreatic duct ectasia and pancreatic gland expansion and hypoechogenicity.

A long lasting inflammatory process causes heterogeneity of pancreas tissue with evident hyperechogenicity. Cyst encapsulations, local inflammatory infiltrates, calculi and calcificates looking like heavy hyperechogenic elaborations with acoustic shadow can be detected during the investigation. Computerized tomography with radiographic opacification enables the disclosure of false cyst, duct ectasia, thrombosis, pseudoaneurysm, necrosis and parenchymatous atrophy of pancreatic gland. Magnetic resonance cholangiopancreatography and endoscopic ultrasonography are applied for the investigation of pancreatic parenchyma.

Sonographic densitometry (the assessment of tissue density applying ultrasonic scanning) is offered by some researchers for the investigation of pancreas structural organization of different body types. The results of sonography and ultrasonic histography investigation in cases of pancreatitis having been caused by tuberculosis services and alcohol can be found in professional literature. ALOKA SSD-630 (Japan) was applied for the sonographic investigation of pancreatic gland estimating the dimensions of pancreas and its parts (head, body and terminal), edges, structural homogeneity, tissue echogenicity, diameter of a pancreatic duct, the presence of false cysts and calcificates. A lot of scientific works describe pancreas structural changes in cases of metabolic syndrome being one of the most challenging issues of modern medicine. Sensometric density is used for revealing pancreas steatosis or fibrosis. Lobular structure with explicit fat layers is considered steatosis. Fibrosis means the increase in sensitometric tissue density accompanied by the decrease of dimensions and the absence of lobular structure with fat-free layers. In the first case pancreatic gland has rough edges, heterogeneous echo-structure with the inhomogeneous distribution of echosignals and the sequence of increased and decreased echogenicity areas, as well as the evidence of calcificates, cysts and duct ectasia. In the second case the probable increase of all pancreas divisions, structural changes of pancreatic gland caused by fibrosis and the symptoms of pancreatitis are observed.

Severe chronic pancreatitis brings about the progressive advance of periductal, perilobular and inner lobular fibrosis being accompanied by the increase in smooth muscle actin expression and indicating glandular parenchyma cirrhosis. Collagen synthesis derangement caused by pancreas supportive cells results in secretory myofibroblast producing of collagen leading to irreversible sclerotic changes of pancreatic gland. Thus, the problem of pancreatic morpho-functional properties of human beings and experimental animals under physiological norms and under the influence of exopathogenic and endopathogenic factors is topical for both morphologists and clinicists. A lot of these issues are discussible and require immediate solution by conducting experimental and clinical studies.

Keywords: pancreas, structure and pathogenic factors

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