Model of functional disorders in the sphincter of Oddi in ... 2015/02/01 ¢  Duodenum...

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  • Functional disorders in the sphincter of Oddi Dr. Turumin JL, MD, PhD, DMSci.

    Web-site: http://www.drturumin.com E-mail: drjacobturumin@yahoo.com

    Model of functional disorders in the sphincter of Oddi in patients with biliary diseases and pancreatic diseases

    Biliary type III

    of sphincter of Oddi dysfunction Fig. 2. Passage of hepatic bile and pancre- atic juice into the duodenum lumen in pa- tients with biliary diseases and hypertonus (spasm) of the sphincter of common bile duct (biliary type III of sphincter of Oddi dys- function). The increase of COX-2 activity in the smooth muscle cells of the sphincter of common bile duct may be accompanied by hypertonus (spasm) formation. Associated diseases: Chronic (spastic aseptic) cholecystitis. Cholesterol gallstone disease. Chronic calculous cholecystitis. Metaplasia.

    Common bile duct (CBD)

    Hepatopancreatic ampulla (HPA)

    Sphincter of HPA

    Pancreatic duct (PD)

    Sphincter of PD

    Pressure in HPA – (++)

    Pressure in CBD – (+++)

    Hypertonus or spasm of the sphincter of CBD

    Pressure in PD - (++)

    Pressure in Duodenum – (-)

    Duodenum

    Common bile duct (CBD)

    Hepatopancreatic ampulla (HPA)

    Sphincter of HPA

    Pancreatic duct (PD)

    Sphincter of PD

    Pressure in HPA – (++)

    Pressure in CBD – (+++)

    Hypertonus or spasm of the sphincter of CBD

    Pressure in PD - (++)

    Pressure in Duodenum – (-)

    Duodenum

    Common bile duct (CBD)

    Hepatopancreatic ampulla (HPA)

    Sphincter of HPA

    Pancreatic duct (PD)

    Sphincter of PD

    Pressure in HPA – (++)

    Pressure in CBD – (+++)

    Hypertonus or spasm of the sphincter of CBD

    Pressure in PD - (++)

    Pressure in Duodenum – (-)

    Duodenum

    Pancreatic type III

    of sphincter of Oddi dysfunction Fig. 3. Passage of hepatic bile and pancre- atic juice into the duodenum lumen in pa- tients with biliary diseases and hypertonus (spasm) of the sphincter of pancreatic duct (pancreatic type III 0f sphincter of Oddi dys- function). The increase of COX-2 activity in the smooth muscle cells of the sphincter of pancreatic duct may be accompanied by hypertonus (spasm) formation. Associated diseases: Chronic (spastic aseptic) pancreatitis.

    Common bile duct (CBD)

    Hepatopancreatic ampulla (HPA)

    Pressure in CBD – (++)

    Sphincter of CBD

    Pressure in Duodenum – (-)

    Duodenum

    Sphincter of HPA Pressure inHPA – (++)

    Hypertonus or spasm of the sphincter of PD

    Pancreatic duct (PD)

    Pressure in PD - (+++)

    Common bile duct (CBD)

    Hepatopancreatic ampulla (HPA)

    Pressure in CBD – (++)

    Sphincter of CBD

    Pressure in Duodenum – (-)

    Duodenum

    Sphincter of HPA Pressure inHPA – (++)

    Hypertonus or spasm of the sphincter of PD

    Pancreatic duct (PD)

    Pressure in PD - (+++)

    Common bile duct (CBD)

    Hepatopancreatic ampulla (HPA)

    Pressure in CBD – (++)

    Sphincter of CBD

    Pressure in Duodenum – (-)

    Duodenum

    Sphincter of HPA Pressure inHPA – (++)

    Hypertonus or spasm of the sphincter of PD

    Pancreatic duct (PD)

    Pressure in PD - (+++)

    Sphincter of Oddi hypomotility and duodenogastric reflux

    Fig. 1. Passage of hepatic bile and pancre- atic juice into the duodenum lumen in pa- tients with biliary diseases, sphincter of Oddi hypomotility (hypomotility of the sphincter of common bile duct, sphincter of pancreatic duct and sphincter of hepato- pancreatic ampulla) and duodenogastric reflux (duodenal juice) or duodenogastroe- sophageal reflux (duodenal juice and gas- tric juice). Associated diseases: Bile reflux gastritis. Atrophic antral gastritis. Intestinal metapla- sia. Duodenogastroesophageal reflux dis- ease. Chronic esophagitis. Gastric meta- plasia. Dysplasia. Esophageal cancer.

    Common bile duct (CBD)

    Pancreati c

    duct (PD)

    Hepatopancreatic ampulla (HPA)

    Pressure in PD - (++)

    Pressure in Duodenum – (-)

    Hypotonus of the sphincter of CBD

    Pressure in CBD – (++)

    Hypotonus of the sphincter of HPA

    Hypotonus of the sphincter of PD

    Pressure in HPA – (++)

    Duodeno- gastric reflux

    Duodenum

    Common bile duct (CBD)

    Pancreati c

    duct (PD)

    Hepatopancreatic ampulla (HPA)

    Pressure in PD - (++)

    Pressure in Duodenum – (-)

    Hypotonus of the sphincter of CBD

    Pressure in CBD – (++)

    Hypotonus of the sphincter of HPA

    Hypotonus of the sphincter of PD

    Pressure in HPA – (++)

    Duodeno- gastric reflux

    Duodenum

    Common bile duct (CBD)

    Pancreati c

    duct (PD)

    Hepatopancreatic ampulla (HPA)

    Pressure in PD - (++)

    Pressure in Duodenum – (-)

    Hypotonus of the sphincter of CBD

    Pressure in CBD – (++)

    Hypotonus of the sphincter of HPA

    Hypotonus of the sphincter of PD

    Pressure in HPA – (++)

    Duodeno- gastric reflux

    Duodenum

  • Functional disorders in the sphincter of Oddi Dr. Turumin JL, MD, PhD, DMSci.

    Web-site: http://www.drturumin.com E-mail: drjacobturumin@yahoo.com

    2

    Mixed type of sphincter of Oddi dysfunction

    Fig. 4. Passage of hepatic bile and pancre- atic juice into the duodenum lumen in pa- tients with biliary diseases and и hyperto- nus (spasm) of the sphincter of hepatopan- creatic ampulla (mixed type of sphincter of Oddi dysfunction). The increase of COX-2 activity in the smooth muscle cells of the sphincter of hepatopancreatic ampulla may be accompanied by hypertonus (spasm) formation. Associated diseases: Chronic (aseptic) cholecystitis. Cholesterol gallstone disease. Chronic calculous cholecystitis. Metaplasia. Chronic (aseptic) pancreatitis. Pressure in

    Duodenum – (-)

    Duodenum

    Common bile duct (CBD)

    Pressure in CBD – (+++)

    Sphincter of CBD

    Hepatopancreatic ampulla (HPA)

    Hypertonus or spasm of the sphincter of HPA

    Pressure in HPA – (+++)

    Pancreatic duct (PD)

    Sphincter of PD

    Pressure in PD - (+++)

    Pressure in Duodenum – (-)

    Duodenum

    Common bile duct (CBD)

    Pressure in CBD – (+++)

    Sphincter of CBD

    Hepatopancreatic ampulla (HPA)

    Hypertonus or spasm of the sphincter of HPA

    Pressure in HPA – (+++)

    Pancreatic duct (PD)

    Sphincter of PD

    Pressure in PD - (+++)

    Pressure in Duodenum – (-)

    Duodenum

    Common bile duct (CBD)

    Pressure in CBD – (+++)

    Sphincter of CBD

    Hepatopancreatic ampulla (HPA)

    Hypertonus or spasm of the sphincter of HPA

    Pressure in HPA – (+++)

    Pancreatic duct (PD)

    Sphincter of PD

    Pressure in PD - (+++)

    Biliopancreatic reflux (lithogenic bile)

    Fig. 5. Passage of hepatic bile and pancre- atic juice into the duodenum lumen in pa- tients with biliary diseases, hypertonus (spasm) of the sphincter of hepatopan- creatic ampulla, hypotonus of the sphincter of pancreatic duct and biliopancreatic reflux of hepatic bile into the pancreatic duct. The increase of COX-2 activity in the smooth muscle cells of the sphincter of hepa- topancreatic ampulla may be accompanied by hypertonus (spasm) formation. Associated diseases: Chronic biliary pan- creatitis. Biliary metaplasia. Dysplasia. Pan- creatic cancer.

    Common bile duct (CBD)

    Hepatopancreatic ampulla (HPA)

    Pressure in CBD – (+++)

    Sphincter of CBD

    Hypertonus or spasm of the sphincter of HPA

    Pressure in Duodenum – (-)

    Duodenum

    Pressure in HPA – (+++)

    Pancreatic duct (PD)

    Pressure in PD - (+)

    Hypotonus of the sphincter of PD

    Common bile duct (CBD)

    Hepatopancreatic ampulla (HPA)

    Pressure in CBD – (+++)

    Sphincter of CBD

    Hypertonus or spasm of the sphincter of HPA

    Pressure in Duodenum – (-)

    Duodenum

    Pressure in HPA – (+++)

    Pancreatic duct (PD)

    Pressure in PD - (+)

    Hypotonus of the sphincter of PD

    Common bile duct (CBD)

    Hepatopancreatic ampulla (HPA)

    Pressure in CBD – (+++)

    Sphincter of CBD

    Hypertonus or spasm of the sphincter of HPA

    Pressure in Duodenum – (-)

    Duodenum

    Pressure in HPA – (+++)

    Pancreatic duct (PD)

    Pressure in PD - (+)

    Hypotonus of the sphincter of PD

    Pancreaticobiliary reflux (pancreatic juice)

    Fig. 6. Passage of hepatic bile and pancre- atic juice into the duodenum lumen in pa- tients with biliary diseases, hypertonus (spasm) of the sphincter of hepatopan- creatic ampulla, hypotonus of the sphincter of common bile duct and pancreaticobiliary reflux of pancreatic juice into the common bile duct. The increase of COX-2 activity in the smooth muscle cells of the sphincter of hepatopancreatic ampulla may be accom- panied by hypertonus (spasm) formation. Associated diseases: Chronic (enzymatic) cholecystitis. Chronic calculous cholecysti- tis. Intestinal metaplasia. Dysplasia. Gall- bladder cancer.

    Common bile duct (CBD)

    Hepatopancreatic ampulla (HPA)

    Hypertonus or spasm of the sphincter of HPA