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.

Ключові слова: pancreas, structure and pathogenic factors

Повний текст: PDF (Ukr)

1. 1. Barkhina T Moldavskaia A, Savishchev A. Characteristics of Pancreatic Structure during Experimental Coronary-Carotid Perfusion. Medical Journal of Astrakhan city. 2010;5(4):27-29.
2. 2. Viduetskii A, Huminskii Y, Obolenskyi A. Sonographic Densitometry of Liver and Pancreatic Gland Observed in 18 Year Old Residents of Vinnytsia City of Different Body Types. Herald of Morphology. 1997;3:144-145.
3. 3. Volkov V. Some Age-Specific Properties of Functional Morphology Observed in Endocrinous Division of Pancreatic Glandе. In: Innovations in Science: Collected works based on the materials of the XXX international scientific and practical conference. Novosibirsk city: Academy of Siberia. 2014; 2(27):74-84.
4. 4. Huberhrits N, Klochkov A. Sonographic Changes of Pancreatic Gland Revealed in Patients Suffering from Drug-Induced Pancreatitis Followed Pulmonary Tuberculosis Treatment. In: Materials from scientific and practical conference "Topical Issues of Medicine". Chernivtsi city: Medical Herald of Bukovina region. 2011;15(2):199-202.
5. 5. Hurevych L, Korsakova N. Morphological Factors of Pancreas and Gastro-Intestinal Tract Neuroendocrine Tumor Prognostication. Effective Drug Therapy. Carnicology, Hematology, Radiation Oncology. 2010;2:20-23.
6. 6. Zubrytskyi M. Morphological Changes of Pancreatic Gland in Cases of Acutus Herpetic Meningoencephalitis. Journal. State Medical University of Gomel city. 2006;1:53-56.
7. 7. Chumasov E, Maistrenko N, Petrova E et al. The Change in Pancreas Nervous Apparatus under Pathological Condition. Morphology. 2012;141(3).173.
8. 8. Kalyiev A. The Clinical and Morphological Comparison of Pancreatic Changes in Cases of Acutus Destructive Pancreatitis. The Medical journal of Kazan city. 2013;XСIV(4):464-468.
9. 9. Krylova O. Visualization Methods of Pancreas Representation and Pancreatobiliary Ducts Observed in Patients Suffering from Chronic Pancreatitis. Modern Gastroenterology. 2011;4:5-53.
10. 10. Moldavskaya A, Savishchev A, Donskoi M. Sub-microscopic Organization of Pancreatic Gland under Normal Conditions and Over Exertion of Single Effect in Evolutional Aspect. Morphological Records. 2008;3:9-10.
11. 11. Tkachuk O, Pishakк V, Lenkov O et al. Morpohological Conditions of Pancreatic Islets in the Long Distance Period of Ischemia and Reperfusion Brain Injury Observed in Experimental Rats and Rats Suffering from Streptozotocin Induced Diabetes Mellitus. Clinical and Experimental Pathology. 2011;Х(35):152-155.
12. 12. Osadchuk M, Kyrychuk V, Kashkina E. Anti-Aggressive Vessel Wall Activity and Ultrasonic Image of Pancreatic Gland over Chronic Alcohol Pancreatitis Progression. Clinical Medicine. 2000;78(4):22-24.
13. 13. Ostapenko O. Morpho-Functional Changes of Pancreatic Gland Observed In Rats under the Correction of Hypotheriosis. Medical and Biological Herald of Tavrida. 2013;16(1):169-171.
14. 14. Paklina O. Morphogenesis of Chronic Pancreatitis and Pancreatic Ductal Adenocarcinoma. Russian Journal on Gastroenterology, Hepatology and Coloproctology. 2011;2:88-90.
15. 15. Savishchev A. The Effect Made by Hypoxia on the Ulstrastructure of Pancreatic Acinar Cells. Morphology. 2008;4:91-94.
16. 16. Ivashkin V, Shyfrin O, Sokolina I, Leonovych A, Ashytko M, Lemyna T. Pancreatic Steatosis and Its Clinical Effect. Russian Journal on Gastroenterology, Hepatology and Coloproctology. 2006;4:32-37.
17. 17. Tkachuk O. Morphofunctional Conditions of Pancreatic Islets Revealed in Rats Affected by Diabetes Mellitus and Ischemia Cerebral Perfusion. Medical Herald of Bukovina region. 2011;15(3):102-104.
18. 18. Filippov Y, Skyrda I. Principal Diseases of Digestive Apparatus. Distribution and Case Rate in Ukraine for the Last 10years. (1997 – 2006). In: Gastroenterology: Interdepartmental scientific collection. Dnipropetrovsk city: 2008. 3-10.
19. 19. Khrystych T, Kendzerskaia T. Vascular Factor and Circulation Disorder of Pancreatic Etiology. Modern Gastroenterology. 2005;6(26):35-40.
20. 20. Tsymmerman Y. Laboratory and Instrumental Diagnostics Applied for Revealing Pancreas. Clinical Medicine. 2011;6:13-21.
21. 21. Shamychkova A. Pancreatic Exocrinous of Patients Suffering from Viral Hepatitis B or C. Clinical Laboratory Diagnostics. 2007;2:47-49.
22. 22. Shcherbinina M, Shvets S. Pancreatic Structural Changes Under Metabolic Syndrome. Family Medicine. 2009;2:31-34.
23. 23. Yakshe P. Chronic Pancreatitis. World Medicine. 2005;2:77-87.
24. 24. Oijen M, Jose-manders D, Laheij R, Rossum L, Tan A, Jansen J. Gastrointestinal disorders and symptoms: does body mass index matter? Neth. J. Med. 2006;64:45- 49.
25. 25. Kocher H. Chronic pancreatitis. BMJ. 2008;1:417-435.
26. 26. Makary M, Duncan M, Harmon J, Magnuson T. The role of magnetic resonance cholangiography in the management of patients with gallstone pancreatitis. Ann. Surg. 2005;241:119-124.
27. 27. Trivedi C, Pitchumoni C. Drug-induced pancreatitis. An update. J. Clin. Gastroenterol. 2005;39:709-716.
28. 28. Watanabe S, Hojo M, Nagahara A. Metabolic syndrome and gastrointestinal diseases. J. Gastroenterol. 2007;42:267-274. doi.org/10.1007/s00535-007-2033-0