Blood supply to the pancreas. How is the blood supply to the pancreas? Anatomy and functions of the organ

Pancreas(pancreas)- the second largest gland of the digestive system. Its mass is 60-100 g, length 15-22 cm. The gland has a grayish-red color, lobular structure, located retroperitoneally, extending in the transverse direction from the duodenum to the spleen. Wide head of the pancreas located inside the horseshoe formed by the duodenum, and passes into the body, crossing across the 1st lumbar vertebra and ending with a narrowed tail at the gate of the spleen. The gland is covered with a thin connective tissue capsule Pancreas and duodenum, back view. Part of the wall of the duodenum and the final part of the common bile duct were opened: 1 - body of the pancreas; 2 - splenic vein; 3 - portal vein; 4 - common hepatic duct; 5 - cystic duct; 6 - neck of the gallbladder; 7 - common bile duct; 8 - body of the gallbladder; 9 - the bottom of the gallbladder; 10 - duodenum; 11 - sphincter of the hepato-pancreatic ampulla (sphincter of the ampulla, sphincter of Oddi); 12 - peritoneum; 13 - pancreatic duct and its sphincter; 14 - sphykter of the common bile duct; 15 - head of the pancreas; 16 - superior mesenteric artery; 17 - superior mesenteric vein; 18 - tail of the pancreas

The pancreas is essentially made up of two glands : exocrine And endocrine . exocrine gland produces during the day 500-700 ml of pancreatic juice. Pancreatic juice contains the proteolytic enzymes trypsin and chymotrypsin and amylolytic enzymes: amylase, glycosidase, galactosidase, lipolytic substance - lipase, etc., involved in the digestion of proteins, fats and carbohydrates. The endocrine part of the pancreas produces hormones that regulate carbohydrate and fat metabolism (insulin, glucagon, somatostatin, etc.). Exocrine part of the pancreas is a complex alveolar-tubular gland, divided into lobules by very thin connective tissue interlobular septa extending from the capsule. The lobules consist of closely adjacent acini 100-150 microns in size, formed by one layer of large cells - pyramidal acinocytes, 10-12 in number. These cells are in close contact with each other and lie on the basement membrane. A round nucleus containing a large nucleolus lies in the basal part of the cell. A narrow lumen is visible in the center of the acinus. The cytoplasm around the nucleus is basophilic. The apical part of the cell contains a large number of zymogen granules, each measuring up to 80 nm. The cells contain elements of the granular endoplasmic reticulum with a high content of ribosomal RNA and free ribosomes. A well-developed Golgi complex is located above the nucleus. There are many mitochondria in cells. Intercellular contacts are similar to those of epitheliocytes of intestinal villi.

The structure of the acinus of the pancreas: 1 - insert section; 2 - centroacinous cells of the intercalated sections; 3 - secretory granules in the apical part of the cell; 4 - acinar cells; 5 - hemocapillary; 6 - lumen of the acinus; 7 - nerve fiber; 8 - intercalary duct acinus together with intercalary duct is a structural and functional unit of the exocrine part of the pancreas . The secret enters the lumen of the acinus through the apical surface of the cell (merocrine secretion). In the center of the acinus, centroacinous epithelial cells typical of the pancreas are located, which form the wall of the secretion-excreting intercalary duct. Flattened centroacinous cells have an irregular shape, an oval nucleus and a small number of organelles. The acini are densely entwined with blood capillaries and unmyelinated nerve fibers. The cells of the intercalary sections of the excretory ducts secrete bicarbonate ions, which are mixed with the secretion of the acinus. These cells also allow water to enter the lumen. In addition, in the lining of the intercalary ducts there are cambial elements capable of differentiating into acinus cells.

From the intercalary ducts, the secret enters intralobular ducts, formed by a single-layered cubic epithelium lying on the basement membrane. Surrounded by loose connective tissue, the intralobular ducts flow into interlobular, that pass through connective tissue septa. The interlobular ducts empty into the main (virsung) duct of the pancreas (ductus pancredticus). This duct begins in the region of the tail of the pancreas, passes through the body and head from left to right and, having connected with the common bile duct, flows into the lumen of the descending part of the duodenum at the top of its major papilla. At the end of the duct there is sphincter of the pancreatic duct (m. sphincter ductus pancreaticae). Formed in the head of the gland accessory pancreatic duct (ductus pancreaticus accessorius), opening into the lumen of the duodenum on its minor papilla. Sometimes both ducts anastomose with each other. The walls of the ducts are lined with columnar epithelium; in the epithelium of the main duct there are also goblet glandulocytes. The secretion of acinocytes is under the control of the vagus nerves and is stimulated by the hormone cholecystokinin. Secretin affects the centroacinous cells and epithelial cells lining the walls of the intralobular ducts, thereby stimulating the secretion of a large amount of liquid pancreatic juice with a small amount of enzymes and a large amount of bicarbonates. However, the effect of cholecystokinin is most effective with the simultaneous action of secretin and the normal functioning of the vagus nerves. Endocrine part of the pancreas made up of groups of cells pancreatic islets (Langerhans) (insulae pancredticae), which in the form of rounded, irregularly shaped formations with a diameter of 0.1-0.3 mm are located in the thickness of the glandular lobules. The number of pancreatic islets in an adult ranges from 200,000 to 1,800,000. Blood supply to the pancreas . The pancreas is supplied by the anterior and posterior superior pancreaticoduodenal arteries (from the gastroduodenal artery), the inferior pancreaticoduodenal artery (from the superior mesenteric artery), and the pancreatic branches (from the splenic artery). The branches of these arteries anastomose with each other in the pancreatic tissue and branch out in the interlobular and intralobular connective tissue up to the capillaries densely braiding the acini and cells of the pancreatic islets. Capillaries are collected in venules, which flow into the veins adjacent to the arteries. The pancreatic veins flow into the splenic vein, which is adjacent to the upper edge of the posterior surface of the pancreas, into the superior mesenteric vein and other tributaries of the portal vein (inferior mesenteric, left gastric). Lymph capillaries flow into the lymphatic vessels, which flow into the pancreas, pancreas-duodenal, pyloric and lumbar lymph nodes. Pancreas innervated branches of the vagus nerves (mainly the right) and sympathetic nerves from the celiac plexus. Sympathetic nerve fibers (vasomotor) follow the course of the vessels. The intramural ganglia contain cholinergic and pectodergic neurons, whose axons innervate acinar and islet cells. Age features of the pancreas. The pancreas of a newborn is very small, weighing about 2-3 g. By 3-4 months of life, the mass of the gland doubles, by 3 years it reaches 20 g, and at 10-12 years it is 30 g. The pancreas of a newborn is relatively mobile. By the age of 5-6, the gland takes on the form characteristic of the gland of an adult. In newborns and young children, the gland is characterized by a very abundant blood supply, as well as a large absolute and relative number of pancreatic islets. So, at 6 months there are about 120,000 of them, and in an adult about 800,000 with a gland mass of 70-100 g.

Peritoneum Peritoneum(peritoneum) is a serous membrane lining the abdominal cavity and covering the internal organs located in this cavity. The peritoneum that lines the walls of the abdominal cavity is called parietal peritoneum(peritoneum parietale). The peritoneum that covers the organs is called visceral peritoneum(peritoneum visceral). The total surface of the entire peritoneum in an adult occupies an area, on average, 1.75 m 2. limiting closed peritoneal cavity(cavitas peritonealis), the peritoneum is a continuous sheet passing from the walls of the abdominal cavity to the organs and from the organs to its walls. In women, the peritoneal cavity communicates with the external environment through the abdominal openings of the fallopian tubes, the uterine cavity and the vagina. The ratio of the peritoneum to the internal organs is not the same. Some organs are covered with peritoneum only on one side (pancreas, most of the duodenum, kidneys, adrenal glands), these organs lie outside the peritoneum, retroperitoneally (retro or extraperitoneally). Other organs are covered with peritoneum only on three sides and are located mesoperitoneally (ascending and descending colon). Some organs are covered with peritoneum on all sides and occupy an intraperitoneal (intraperitoneal) position (stomach, small intestine, transverse colon and sigmoid colon, spleen, liver). When moving to some intraperitoneally lying organs, the peritoneum forms ligaments and doublings (duplications) of the peritoneum - the mesentery

Abdominal cavity and organs located in the abdominal cavity. Horizontal (transverse) cut of the torso between the bodies of II and III lumbar vertebrae: 1 - retroperitoneal space; 2 - kidney; 3 - descending colon; 4 - peritoneal cavity; 5 - parietal peritoneum; 6 - rectus abdominis; 7 - mesentery of the small intestine; 8 - small intestine; 9 - visceral peritoneum; 10 - aorta; 11 - inferior vena cava; 12 - duodenum; 13 - psoas muscle

On the posterior wall of the abdominal cavity, the peritoneum covers the organs lying retroperitoneally, and also passes to the organs located mesoperitoneally and intraperitoneally. On the border of the upper and lower parts of the abdominal cavity in the transverse direction is located mesentery of the transverse colon(mesocolon transversum), formed by two sheets of peritoneum, running from the posterior wall of the abdominal cavity to the transverse colon. Below the mesentery of the transverse colon, from the posterior abdominal wall mesentery of the small intestine(mesenterium). Root of the mesentery of the small intestine(radix mesenterii) is located obliquely, from top to bottom and from left to right, from the body of the II lumbar vertebra to the level of the right sacroiliac joint. The edge of the mesentery, opposite to the root, approaches the small intestine and envelops it from all sides (intraperitoneal position of the intestine). Between the two sheets of this mesentery pass the superior mesenteric artery with its branches and nerves, which go to the small intestine, as well as the veins and lymphatic vessels emerging from the walls of the intestine. The superior mesenteric lymph nodes are also located there.

In the upper floor of the peritoneal cavity, above the transverse colon and its mesentery, the peritoneum passes from the lower surface of the diaphragm to the diaphragmatic surface of the liver, forming the ligaments of the liver: falciform, coronal, right and left triangular ligaments. Having rounded the sharp edge of the liver in front and the back of the liver, the peritoneum from the gates of the liver goes in two sheets to the lesser curvature of the stomach and the upper part of the duodenum. Thus, between the gates of the liver at the top and the lesser curvature of the stomach and the upper part of the duodenum below, a duplication of the peritoneum is formed, called lesser omentum(omentum minus). Left side of small omentum represents the hepatogastric ligament(lig. hepatogastricum), and the right - hepatoduodenal ligament(lig. hepatoduodenale).

Approaching the lesser curvature of the stomach, two sheets of the peritoneum of the hepatogastric ligament diverge and cover the posterior and anterior surfaces of the stomach. At the greater curvature of the stomach, these two sheets of peritoneum converge and go down in front of the transverse colon and small intestine, then bend sharply backwards and rise upwards. Above the mesentery of the transverse colon, these sheets pass into the parietal peritoneum, covering the posterior abdominal wall. A long fold of the peritoneum, hanging in the form of an apron in front of the transverse colon and loops of the small intestine and formed by four layers of the peritoneum, is called greater omentum(omentum majus).

The course of the peritoneum in men. Trunk section in the mid-sagittal plane. Scheme. 1 - diaphragm; 2 - coronary ligament; 3 - liver; 10 - jejunum, 11 - cape, 12 - rectum, 13 - rectal-vesical cavity, 14 - anus, 15 - testicle, 16 - serosa of the testicle, 17 - urethra, 18 - prostate, 19 - pubic symphysis, 20 - bladder, 21 - retropubic space, 22 - ileum, 23 - greater omentum, 24 - transverse colon, 25 - mesentery of the transverse colon, 26 - peritoneal cavity, 27 - omental bag, 28 - stomach, 29 pleural cavity , 30 - easy.

The course of the peritoneum in women. Trunk section in the mid-sagittal plane. Scheme. 1 - diaphragm, 2 - coronary ligament, 3 - coronogastric ligament, 4 - probe inserted into the omental opening, 5 - pancreas, 6 - retroperitoneal space, 7 - duodenum, 8 - root of the mesentery of the small intestine, 9 - jejunum , 10 - cape, 11 - body of the uterus, 12 - uterine cavity, 13 - cervix, 14 - recto-uterine cavity, 15 - rectum, 16 - anus, 17 - vagina, 18 - vaginal opening, 19 - large genital lip, 20 - female urethra, 21 - pubic symphysis, 22 - bladder, 23 - retropubic space, 24 - vesicouterine cavity, 25 - ileum, 26 - parietal peritoneum, 27 - greater omentum, 28 - peritoneal cavity, 29 - transverse colon, 30 - mesentery of the transverse colon, 31 - stuffing bag, 32 - stomach, 33 - liver, 34 - pleural cavity, 35 - lung.

Part of the greater omentum (anterior plate), stretched between the greater curvature of the stomach and the transverse colon, is called gastrocolic ligament(lig. gastrocolicum). Two sheets of peritoneum, running from the greater curvature of the stomach to the left to the hilum of the spleen, form gastro-splenic ligament. The sheets of peritoneum, going from the cardial part of the stomach to the diaphragm, form gastro-phrenic ligament(lig. gastrophrenicum).

Above the mesentery of the transverse colon, there are three bags delimited from each other: hepatic, pregastric and omental. The liver bag is located in the right hypochondrium, to the right of the falciform ligament of the liver. This bag contains the right lobe of the liver. The pancreatic sac is located in the frontal plane, to the left of the falciform ligament of the liver and anterior to the stomach. The pancreatic sac contains the left lobe of the liver and spleen. Stuffing bag(bursa omentalis) is located in the frontal plane behind the stomach and lesser omentum. This bag is bounded at the top by the caudate lobe of the liver, at the bottom by the posterior plate of the greater omentum, fused with the mesentery of the transverse colon, in front by the posterior surface of the stomach, lesser omentum and gastrocolic ligament, and at the back by the sheet of peritoneum covering the aorta on the posterior wall of the abdominal cavity, inferior vena cava, upper pole of the left kidney, left adrenal gland and pancreas. The stuffing bag communicates with the liver bag through the stuffing hole.

Below the transverse colon and its mesentery, between the right lateral wall of the abdominal cavity on the lateral side, the blind and ascending colon - with the medial there is a narrow gap, called right paracolic sulcus(sulcus paracolicus dexter), which is also called the right lateral canal. Left paracolic sulcus(sulcus paracolicus sinister), or the left lateral canal, is located between the left wall of the abdominal cavity on the left, the descending colon and the sigmoid colon on the right.

The middle part of the peritoneal cavity, limited to the right, top and left by the colon, is divided by the mesentery of the small intestine into two extensive pits - the right and left mesenteric sinuses.

In the cavity of the small pelvis, the peritoneum covers the upper and (partially) middle sections of the rectum and the organs of the urogenital apparatus. In men, the peritoneum from the anterior surface of the rectum passes to the bladder, then continues into the parietal peritoneum of the anterior abdominal wall. Between the bladder and rectum is formed rectovesical cavity(excavatio rectovesicalis). In women, the peritoneum from the anterior surface of the rectum passes to the back wall of the upper part of the vagina, to the uterus and to the bladder. Between the uterus and the rectum in women is formed recto-uterine cavity(excavatiorectouterina). Between uterus and bladder vesicouterine cavity(excavatio vesicouterina).

The human body is a complex system that carries out independent regulation. The ability of a person to resist the negative factor that is associated with the environment depends on her level of work. Problems with the normal level of blood supply to any internal organ lead to the formation of a pathology caused by an acute nutritional deficiency. Deficiency is due to the fact that useful substances do not come with the blood in the amount that is required.

The blood supply in the pancreas has a significant impact on the functioning of the intestines and the general condition of a person.

The pancreas is the second largest gland in the human body. Its place is immediately behind the stomach. The internal organ consists of three main parts: the body, head and tail.

The length of the pancreas is 250 millimeters in adults, the weight reaches 160 grams.

Thanks to the body, the appearance of enzymes involved in the normal functioning of digestion is produced. Also, due to the formation of lipase and maltase, the duodenum is activated.

Important. In addition, insulin is released into our blood. Fat metabolism depends on the level of insulin in the blood.

The blood supply to the gland includes arteries, veins, and lymph vessels.

Blood supply

The internal organ has no arterial vessels. The direct process of blood supply is carried out with the help of branches of the hepatic and splenic vessels. The entire gland is permeated with a large number of lymphatic vessels and ducts for output. The main duct of the body is called the pancreatic duct. It comes out of the head of the gland. During the exit, it merges with the bile.

Many small and large vessels attach directly to the head of the pancreas. The hepatic aorta helps maintain a person's blood supply.

Different people have a varied number of branches that supply the circulatory system. At least 3 branches are brought to the tail of the internal organ. Their maximum number is 6 branches. They are part of a single trunk of the splenic vessel. Thanks to this, the body is fed without interruptions.

thrombosis and perform active recanalization. Local thrombolytic therapy is a highly effective and non-invasive method of restoring the patency of the port systems.

Key words: port system, thrombolysis, venous thromboembolic complications.

Key words: port-system, thrombolysis, venous thromboembolism.

A.I. Shugaev

PARASYMPATIC INNERVATION OF THE PANCREAS

North-Western State Medical University named after N.N. I.I. Mechnikov" of the Ministry of Health of the Russian Federation

Introduction. Information about the supraorgan topographic features of the parasympathetic nervous system (PNS) of the pancreas (PZ) in the literature is contradictory. EAT. Melman (1970) believes that the parasympathetic innervation of the pancreas is provided only by the posterior vagus nerve (ZVN). According to V.Yu. Pervushin (1967), parasympathetic conductors follow to the pancreas mainly as part of the ZBN, and some of the conductors pass in the anterior trunk. Along with this, there are publications indicating that the pancreas receives parasympathetic innervation from the anterior vagus nerve (Saveliev V.S. et al., 1983).

Purpose of the study. Specify the parasympathetic innervation of the pancreas in humans.

Materials and methods. The study of parasympathetic innervation was carried out on 25 human organocomplexes. We used the technique of anatomical preparation, supplemented by chemical treatment of tissues with acetic acid. For this purpose, the preparation of small branches was carried out with a tupfer moistened with 10% acetic acid. After such treatment, the branches of the vagus nerves acquired a pearly color and were clearly differentiated against the background of the surrounding tissues. The branches of the vagus nerves isolated in this way were redrawn on glass and then transferred to paper.

Results. It has been established that the main source of parasympathetic in-

Nervation of the pancreas is ZBN, the branches of which have four main variants of the structure: two main ones, with clearly defined two branches to the stomach and pancreas, and the second - with three branches to the stomach, pancreas and spleen; two loose types with division of the posterior vagus nerve in the upper third into multiple branches to the stomach, pancreas and spleen, the second type is characterized by division of the posterior vagus nerve in the lower third into branches to the stomach and pancreas. Regardless of the variants of the structure of the branches of the vagus nerve, most of them on the way to the pancreas end in the ganglia of the solar plexus, from where the gland receives postganglionic mixed innervation. With great constancy (100%), postganglionic branches entering the pancreas at the border of the head and body, as well as along the splenic artery to the body and tail of the pancreas, were determined. Along with the indicated permanent postganglionic branches, in 7 out of 25 organocomplexes (28%), branches of the posterior vagus nerve were found, directly going to the tail of the pancreas, bypassing the solar plexus. In 9 out of 25 cases (36%), branches of the posterior vagus nerve were identified, leading to the spleen and from it to the tail of the pancreas.

The branches of the anterior trunk of the BN predominantly carry out parasympathetic innervation of the liver and stomach. With regard to the topic under consideration, it should be noted the presence of branches of the anterior nerve of Latarjet, directly going to the head of the pancreas, which were noted in 4 cases (16%). Conclusions. Thus, an analysis of variants of pancreatic innervation in humans showed that the main source of parasympathetic innervation is the branches of the posterior vagus nerve, and only in 16% of cases are the branches of the anterior vagus nerve leading to the head involved.

Literature

1. Melman E.P. Functional morphology of the innervation of the digestive organs. M.: Medicine. - 1970. - 327 p.

2. Pervushin V.Yu. Innervation of the pancreas: Abstract of the thesis. dis. ... Dr. med. Sciences. - M. - 1967. - 28 p.

3. Saveliev V.S., Buyanov V.M., Ognev Yu.V. Acute pancreatitis.- M.: Medicine, 1983.- 270 p.

Key words: parasympathetic nervous system, pancreas. Keywords: parasympathetic nerve system, pancreas.

The pancreas is an extremely important structure. After all, this organ is not only involved in the processes of digestion, but is also part of the endocrine system, ensuring the regulation and utilization of glucose in the blood. Of course, such a structure needs an appropriate blood supply. The pancreas is fed by many blood vessels. As you know, any violation of blood flow adversely affects the functioning of the body and can lead to tissue necrosis.

That is why many people are interested in additional information. What is the blood supply to the pancreas? The scheme, the main arteries and veins, the features of innervation and lymph flow are important points. It is worth studying these data in more detail.

Blood supply to the pancreas. Anatomy and general information

Before considering the main vessels, it is worth familiarizing yourself with the structure of the organ itself. The pancreas is located behind the stomach, directly above the solar plexus. They consist of a head, body and tail. By the way, the gland is the second largest in the body and has a lobed structure. The tail of the organ rests on the spleen, and the head lies on the loop of the duodenum.

Specific cells of this gland synthesize enzymes, in particular trypsin, lipase, lactase, which ensure the digestion of protein, carbohydrate and fat molecules. In addition, important hormones are produced in the tissues of the organ, in particular insulin and glucagon.

Arterial blood supply to the pancreas

We have already dealt with the structure and features of the functioning of the body. How is the blood supply to the pancreas?

In fact, this organ does not have its own vessels. Blood is delivered to the tissues through branches of the splenic, hepatic, and superior mesenteric arteries. The head of the organ is powered by the superior mesenteric and hepatic arteries, which originate from the inferior and superior pancreatoduodenal vessels.

In turn, the pancreatoduodenal arteries connect the blood vessels into an arc, which ensures a constant circular movement of blood.

Gastroduodenal artery: features of blood flow

Some people are interested in questions about how the blood supply to the stomach and pancreas is carried out. A significant role here is played by the gastroduodenal artery, which departs from the common renal artery. This vessel, as a rule, reaches a length of 20-40 mm, and its diameter is 2.5-5.0 mm.

This vessel is located behind the part of the stomach that controls the processes of food intake. Also, the vessel crosses the initial sections of the intestine. It is partly responsible for the blood supply to the pancreas and duodenum, stomach and nearby tissues.

By the way, any surgical intervention on the pancreas (for example, removal of part of the head) can lead to displacement, circulatory disorders and further necrosis of this vessel.

Venous outflow

We must not lose sight of the venous vessels, considering the blood supply. The pancreas has a highly developed arterial network. The outflow of blood is also carried out by a mass of small vessels that merge into multiple branches and eventually flow into the portal vein system.

From the head of the gland, the uncinate process and the duodenum, blood is collected through vessels that run parallel to the pancreas-duodenal arteries. The most functional are the inferior pancreaticoduodenal veins, which one, less often two trunks are included in the superior mesenteric vein. Additionally, blood from the head of the gland and parts of the duodenum is collected in the right gastroepiploic vein.

As for the tail and body of the gland, the outflow of blood in this case is carried out through the pancreatic branches of the splenic vein. Also, the blood is collected by a large inferior vein, which subsequently flows into the inferior or superior mesenteric vein.

Lymphatic vessels of the pancreas

Considering the blood supply to the pancreas, do not forget about the lymph flow, because this biological fluid is no less important.

Which collect lymph from the pancreas, are inextricably linked with the general lymphatic system of other organs. Small capillaries collect fluid from and acini, after which they combine into small vessels that run parallel to the blood vessels.

Subsequently, the lymph flows into the pancreatic and pancreatoduodenal lymph nodes, which spread near the upper edge of the pancreas, as well as at its anterior and posterior surfaces. Further, the fluid is collected in the larger splenic and celiac lymph nodes (they belong to the collectors of the second order).

Innervation of the pancreas

Innervation (or rather, nervous regulation) of the pancreas is provided by the branches of the right vagus nerve. In addition, the sympathetic nerves of the solar plexus (in particular, celiac) also affect the tissues of the organ.

It is worth noting that the sympathetic nerves regulate the tone of the venous walls, through which the outflow of blood from the gland is carried out. At the same time, parasympathetic nerve fibers are involved in the production and secretion of digestive enzymes.

Damage to the aforementioned nerves leads to the development of hemodynamic and neurovegetative disorders. Also, with injuries, motor-evacuation disorders from the gastrointestinal tract are observed.

Secretory activity of the organ and nerve impulses

Many people are interested in questions about how the pancreas works. Blood supply and innervation are important issues to consider.

As already mentioned, the activity of the organ is regulated by the parasympathetic fibers of the vagus nerve. Nerve impulses received from these nerve endings activate the processes of production and release of digestive enzymes.

Sympathetic nerves act differently. Short-term irritation of the celiac nerve leads to a stop in the secretion of pancreatic juice. However, prolonged stimulation is also accompanied by an intense release of enzymes.

It should be noted that even with damage to the above nerves, pancreatic secretion does not stop, as it is supported by humoral regulatory mechanisms.

Alcohol abuse and circulatory disorders of the pancreas

Alcohol negatively affects the work of the whole organism, in particular the pancreas. The fact is that alcoholic beverages cause narrowing of the small vessels of the body. In this regard, the tissues of the gland do not receive the nutrients and oxygen they need so much. In chronic alcoholism, cells begin to die, which threatens with more massive necrosis.

In addition, the abuse of strong drinks often contributes to the deposition of salts in the tail of the organ, which also negatively affects the functioning of the gland. According to statistics, in women, such processes proceed faster than in men.

Violation of blood circulation in the tissues of the gland: causes, symptoms and treatment

Impaired blood circulation is very dangerous. The pancreas consumes a lot of oxygen and nutrients that it needs for synthetic processes.

This pathology is rarely independent. In most cases, circulatory disorders are associated with other diseases, in particular atherosclerosis and heart failure. These pathologies lead to a violation of the venous outflow from the tissues of the gland.

It should be noted right away that diagnosing this disease is not easy. The fact is that the clinical picture is blurred, since the symptoms of the primary disease come to the fore. Violation of the venous outflow negatively affects the work of the pancreas - it swells and increases in size, but the processes of synthesis of enzymes and hormones are deactivated.

The lack of enzymes primarily affects digestion. Some patients note the occurrence of dyspepsia. There are pains in the abdomen, heaviness in the stomach, rumbling, bloating, increased gas formation, which is often accompanied by severe pain.

It is possible to diagnose a violation of the outflow of blood in the tissues of the pancreas using tests. For example, against the background of a similar pathology, the activity of trypsin and amylase increases in the blood serum. At the same time, amylase activity in urine samples is moderately elevated.

Ultrasound is also informative, since during the procedure the doctor can detect swelling and changes in the size of the pancreas. In a laboratory study of feces, it is possible to detect the presence of a large amount of undigested substances, which are completely absorbed during the normal functioning of the digestive system.

In the absence of treatment, as well as in the case of serious circulatory disorders in the tissues of the gland, the development of diabetes mellitus is possible (the body stops synthesizing insulin, which is so necessary for the body).

There is no specific therapy in this case, since first you need to eliminate the underlying disease. Nevertheless, patients are prescribed a special sparing diet and recommend fractional meals (often, but in small portions). In the presence of serious digestive disorders, patients take medicines that contain pancreatic enzymes.

Proper blood supply to the pancreas ensures its normal operation - the secretion of pancreatic secretions and the synthesis of hormones. Thanks to the arterial blood flow, iron receives nutrients and oxygen. The output of waste products is carried out by veins and lymphatic vessels. The nerve fibers innervating the gland regulate its activity and blood supply. Nervous and vascular disorders cause pancreatic pathologies.

Anatomy and functions of the organ

The pancreas is a large organ in the abdominal cavity. Its widest part (head) lies next to the liver, and its narrow curved (tail) is in contact with the spleen. The middle section, called the body of the gland, is completely covered by the stomach. Large blood vessels and nerve plexuses adjoin the pancreas.

On average, the length of the pancreas is 18-25 cm, the maximum width is 7 cm, and the weight does not exceed 80 g.

The internal structure of the gland is represented by the parenchyma and stroma. Parenchymal tissue is formed by glandular cells, stroma - by connective tissue. Glandular cells form endocrine and exocrine elements that perform certain functions:

• Endocrine cells produce hormones insulin, glucagon, somatostatin, which enter directly into the blood. Cells form structures (islands of Langerhans) located mainly in the tail (endocrine) part of the organ.
• Exocrine cells (pancreocytes) perform an exocrine function, producing pancreatic juice. It consists of water, mineral salts, digestive enzymes. Groups of cells form acini, combined into lobules. All lobules have their own small excretory ducts. The produced juice enters these ducts. Small ducts merge into large ones. From the common pancreatic duct, the secret through the major papilla enters the cavity of the duodenum 12.

Connective tissue cells form layers between individual structures, creating a kind of organ skeleton. It contains the pancreatic ducts, blood vessels, and nerves.

The anatomical structure of the gland determines its uniqueness - the pancreas simultaneously performs endocrine and exocrine functions, participates in digestion and carbohydrate metabolism.

external secretion

The pancreas takes an active part in digestion. It produces pancreatic juice, consisting of enzymes. In the duodenum, they break down semi-digested products from the stomach:

• amylase and lactase break down starch and other sugars into glucose, fructose, galactose;
• proteases (trypsin, chymotrypsin) break down proteins and polypeptides to amino acids;
• lipase converts complex fats into fatty acids and glycerol.

In the pancreas, they are produced in an inactive form so as not to destroy the tissues of the gland itself. Activation occurs already in the intestine, in an alkaline environment. The contents of the duodenum are alkalized with pancreatic secretion salts.

internal secretion

The endocrine function of the pancreas is carried out by hormones:

• insulin converts glucose into glycogen, lowers blood glucose, regulates fat metabolism;
• glucagon converts glycogen into glucose, when energy is needed, breaks down fats in tissues;
• functions of the hormone somatostatin - regulation of internal and external secretion of the pancreas.

The amount of substances secreted by the gland is regulated by the nervous system, hormones of the digestive system, adrenal glands and pituitary gland.

Blood supply to the pancreas

For the normal functioning of the gland, its cells need nutrients and oxygen, which come from the arterial blood. Therefore, the pancreas is permeated by a huge number of blood vessels.

The complex circulatory network of the pancreas begins from the abdominal aorta, which divides into several branches. Among them are the arteries:

• gastroduodenal (gastroduodenal);
• splenic;
• superior mesenteric.

Branching out, they create many smaller arteries for blood supply to different parts of the gland:

1. Branches of the gastroduodenal artery create the superior pancreaticoduodenal artery, which divides into anterior and posterior branches. They are involved in the blood supply to the head of the gland.
2. A branch of the superior mesenteric artery - the inferior pancreatoduodenal artery with anterior and posterior branches - feeds the head and body.
3. The splenic artery has several pancreatic branches that feed the body, caudal region, and partly the head of the pancreas.

Between the branches of the pancreatic-duodenal upper and lower arteries, "bridges" (anastomoses) are formed. Sometimes branches of the splenic artery also participate in the blood supply. Anastomoses form the anterior and posterior arterial arches. These two arcs are combined into a ring. Due to this, a complex arterial network arises, constantly providing the cells of the gland with nutrients.

Venous outflow

The products formed in the course of metabolism enter the capillaries, then into the venous vessels, through which the outflow of blood occurs. From the head of the gland, blood is carried out:

• Posterior superior pancreaticoduodenal vein. It carries blood directly into the portal vein.
• From the anterior superior blood enters the superior mesenteric vein.
• The inferior anterior and posterior pancreatoduodenal veins also carry blood to the superior mesenteric vein.

Between these vessels, anastomoses develop, which form the anterior and posterior venous arches.

A significant part of the veins is located in the caudal region, from where blood enters the splenic and inferior mesenteric veins through the vessels of the body of the pancreas. The inferior and superior mesenteric veins, together with the splenic vein, carry blood into the portal vein. From it, the blood goes to the liver.

Lymphatic drainage

Removal from the tissues of the products of cell decay, microorganisms, viral particles is carried out by the lymphatic system.

These vessels pass through the lymph nodes, where the lymph is cleared of harmful substances. The nodes are located along the course of the blood vessels, which contributes to the outflow of lymph from all parts of the body:

1. From the body of the pancreas, lymph is discharged through chains of nodes that flow into large splenic and celiac lymph nodes.
2. Outflow from the head is carried out by nodes located along the upper mesenteric and pancreatoduodenal blood vessels. Next, the lymph enters the lymph nodes located near the aorta, mesentery, celiac artery.
3. Lymph from the caudal region flows into the nodes of the spleen and the greater omentum.
4. A large accumulation of nodes is located in the zone of confluence of the pancreatic and bile ducts, from there the lymph flows to the celiac nodes and the accumulation of nodes of the mesentery.

Anastomoses are formed between the lymphatic vessels of the pancreas and the lymphatic system of other digestive organs, which provides high protection of the gastrointestinal tract from harmful particles, rapid transfer of substances between organs, and the entry of necessary proteins into the blood.

Scheme of innervation of the organ

The work of the pancreas is regulated by the divisions of the autonomic nervous system: sympathetic and parasympathetic. Under the action of nerve impulses, the production of pancreatic secretion begins:

• The taste and smell of food excite the activity of the main parasympathetic nerve (vagus), in the nerve endings of which substances are produced that stimulate pancreatocytes.
• Digestion of food in the stomach also activates the vagus nerve neurons, which increases the secretion of juice.

The sympathetic innervation of the pancreas is carried out by the nerves of the solar (celiac) plexus. Fibers depart from it, creating the mesenteric and splenic plexuses. Together they form a smaller pancreatic plexus in the gland.

The work of the sympathetic department regulates the tone of the muscle walls of blood vessels, inhibits the secretion of juice.

Signs of impaired blood supply and innervation

In case of violation of the blood supply, the pancreas receives less oxygen and nutrients, ceases to function normally.

In 70% of cases, the main causes of poor blood flow are atherosclerosis and hypertension. At an early stage, the pathology is compensated by an extensive network of arteries. Then dystrophic changes occur, pancreatic cells are destroyed.

Violation of blood circulation in the veins, leading to edema and an increase in the size of the gland, cause:

• blockage of veins as a result of their inflammation or atherosclerosis;
• valvular insufficiency;
• increased arterial blood flow;
• heart or lung failure.

At the same time, the production of enzymes and hormones decreases, the activity of all digestive organs worsens. Symptoms appear:

• belching and vomiting;
• heaviness, and then pain in the upper abdomen after eating;
• stool disorders;
• weight loss.

Symptoms are similar to chronic pancreatitis, but there are differences that make it possible to diagnose venous insufficiency:

• the manifestation of pain syndrome does not depend on the quality of food;
• pains appear after each meal;
• they pass at the end of digestion;
• there are no appetite disturbances;
• stools do not normalize after taking pancreatic enzymes.

Provoke circulatory pathologies in the pancreas:

• smoking - contributes to the development of varicose veins;
• alcohol abuse - worsens the tone of blood vessels;
• frequent stress - lead to vasospasm.

Causes of vagus nerve dysfunction:

• brain pathology (encephalitis, meningitis, tumors, injuries);
• autonomic failure;
• damage to the nerve plexuses;
• inflammatory processes (bronchitis, sinusitis);
• infectious diseases (tuberculosis);
• metabolic disorders (diabetes).

At the same time, the secretion of the gland is suppressed, the production of pancreatic juice is inhibited. It is shown, as a rule, in violation of defecation.

Damage to the sympathetic nerves has practically no effect on the secretion process, their work is compensated by humoral mechanisms.

How to treat disorders of blood flow and innervation of the organ

The treatment strategy is determined after the diagnosis is made. In most cases, the diagnosis of blood supply is carried out with long-term ineffective therapy for diseases of the gastrointestinal tract.

Therapy for violations of venous circulation is carried out by prescribing:

• venotonics (Detralex, Venarus);
• anticoagulants (Aspirin, Xarelto);
• complexes with vitamins A, C, E;
• polyunsaturated fatty acids (Omega 3, 6).

At the same time, treatment with enzyme preparations is carried out, a diet is prescribed, fractional meals are recommended, and smoking and alcohol cessation is given.

To reduce the negative impact of innervation disorders on the pancreas, drugs that increase the level of the neurotransmitter acetylcholine: Piracetam, Phosphatidylcholine, Lecithin. Surgical intervention is resorted to in rare cases, for example, with thrombosis of large vessels.