ISSN:
2181-3906
2024
International scientific journal
«MODERN
SCIENCE
АND RESEARCH»
VOLUME 3 / ISSUE 5 / UIF:8.2 / MODERNSCIENCE.UZ
1276
MORPHOLOGICAL BASIS OF THE "GAME" OF THE PHATERNAL PAPILLA
Zafarjon Mamadievich Rakhmanov
Assistant teacher Department of “Human anatomy”, Samarkand State Medical University,
Samarkand, Uzbekistan.
https://doi.org/10.5281/zenodo.11356191
Abstract. This article provides information on the morphological basis of the "game" of
the paternal papilla.
Keywords: phater papilla, phater papilla ampulla, hepatic-pancreatic ampulla, large
duodenal papilla ampulla
МОРФОЛОГИЧЕСКАЯ ОСНОВА «ИГРЫ» ОТЦОВСКОГО СОСОЧКА
Аннотация. В статье представлены сведения о морфологической основе «игры»
отцовского сосочка.
Ключевые слова: фатерный сосочек, ампула фатерного сосочка, печеночно-
поджелудочная ампула, ампула большого сосочка двенадцатиперстной кишки.
Purpose of the study.
Morphological substantiation of the "game" of the phaternal papilla
and the role of its muscular sheath in the secretion of pancreatic juice and bile into the duodenal
cavity depending on the digestive activity of the latter.
Material and methods of research.
The organocomplex of the area of the large papilla of
the duodenum of 7 dogs and 11 rabbits was studied by serial histotopographic sections stained by
the methods of haematoxylin-eosin, Van-Gizon and Mallory.
Results.
It has been established that the muscular membranes of the duodenum and ampulla
of the phaternal papilla are represented by a single morphofunctional system. The intrinsic
sphincters of common bile and pancreatic ducts are formed by a longitudinal layer, and the mouth
sphincters by a circular layer of duodenal muscular tissue. Separate bundles of smooth muscle
tissue of the longitudinal layer pass into the wall of the ampulla of the phaternal papilla in a
cosocircular direction.
Conclusion.
"Play" of the phaternal papilla is represented by rhythmic contractions of the
muscular membrane of the duodenal wall and the ampulla of the phaternal papilla in complex at
the moment of digestion. It allows bile and pancreatic juice to be secreted into the duodenal cavity
in portions and rhythmically, depending on the periodic activity of the latter, at the moment of
digestion.
The functional significance of the rhythmic contraction of the muscle of the phater papilla
(the large papilla of the duodenum), which is called by radiologists and surgeons as the "game" or
dance of the phater papilla is important (1), for the evacuation of bile and pancreatic juice into the
duodenal cavity, depending on the digestive activity of the latter.
According to the physiological literature, the release of these digestive juices into the
duodenal cavity is a thousandth of a second ahead of the arrival of chyme (3). This process is
highly regulated, and strictly co-ordinated. There are many sphincters in the wall of extrahepatic
bile ducts and pancreatic duct (sphincters of Oddi, Lutkens, Boyden, Mirizzi and own sphincters
of common bile and pancreatic ducts).
ISSN:
2181-3906
2024
International scientific journal
«MODERN
SCIENCE
АND RESEARCH»
VOLUME 3 / ISSUE 5 / UIF:8.2 / MODERNSCIENCE.UZ
1277
The co-ordinated and strictly interdependent work of these sphincters and its dependence
on the digestive activity of the duodenum make the work of this part of the digestive tract very
important and complex. Literature devoted to the study of comparative and surgical morphology
of the phaternal papilla [2,4,7,9], as well as the ampulla of the phaternal papilla [4,6] is available.
Separate works are devoted to the study of the muscular sheath of the phaternal papilla [5].
However, there are questions concerning the morphology of this zone that require further
clarification. This, first of all, concerns the question of studying the morphological basis of the
mechanism of "play" of the phaternal papilla, on which the secretion of bile and pancreatic juice
into the duodenal cavity depends. Also the questions of interrelation of the muscular sheath of the
ampulla of the phaternal papilla with such sheath of the duodenal wall are not completely clarified.
There are different and sometimes opposite opinions (8-10) regarding the relationship of
the muscular sheath of the phaternal papilla with such a sheath of the duodenal wall. Clarification
of these questions is not only important for the physiology of biliary excretion, but it is of great
importance for elucidation of pathogenesis of dyskinetic disorders of biliary excretion and
dysfunction of sphincters of the terminal part of the common bile and pancreatic ducts. Taking
into account the above-mentioned, we studied the morphology of the phaternal papilla and
interrelations of its muscular sheath with such sheath of the duodenum.
Material and Methods.
We have studied the large nipple of duodenum in 7 dogs and 11
rabbits by the method of preparation of serial histotopographic sections. Eighteen organ complexes
fixed in 12% neutral formalin were studied. A flap of the duodenal wall was cut from the place of
the common bile and pancreatic ducts penetration into its wall to the lower border of the mouth of
the ampulla of the phaternal papilla. Conducting of the material and pouring into paraffin was
carried out according to the generally accepted technique. The weight of the material was "planted"
in one block and serial histotopographic sections were obtained.
The whole material was cut and through every tenth four slices in a row were mounted on
4 slides. Depending on the volume of the material under study, 300 to 400 or more slices were
obtained from each block. Slices were stained by the methods of haematoxylin-eosin, Van Gieson
and Mallory. Sequentially studying serial slices and by mounting reconstruction of their computer
printouts, the pharyngeal nipple from the place of its formation to its mouth was studied.
The consecutive study of serial histotopographic slices gave us an opportunity to trace the
course and topography, as well as the relationship of the muscular sheath of the phaternal papilla,
in particular its ampulla with such a sheath of the duodenum. We also studied the morphology of
the muscular sheath of the phaternal papilla by means of montage reconstruction of computer-
generated tomography.
printouts of these serial slices.
Results and their discussion.
As the common bile and pancreatic ducts sink into the wall
of the duodenum, the muscular sheath of the latter gradually passes into their wall and in the
intramural part of these ducts a muscular ring in the form of a figure of eight is formed around
them. Further the course of the muscular sheath is complex and several sphincters are formed (own
sphincter of the common bile duct, own sphincter of the pancreatic duct, sphincter of Oddi). These
sphincters are formed at the expense of the outer longitudinal layer of the muscular coat of
the duodenum. The bundles of smooth muscle tissue, winding the ducts, reach to the apex of the
ISSN:
2181-3906
2024
International scientific journal
«MODERN
SCIENCE
АND RESEARCH»
VOLUME 3 / ISSUE 5 / UIF:8.2 / MODERNSCIENCE.UZ
1278
phaternal papilla, that is, to the very orifice. The arrangement of muscle bundles in the wall of the
ampulla is not the same throughout its circumference. Up to the proximal border of the orifice, the
ampulla is surrounded by a complete ring of longitudinal layer of muscle tissue.
Some bundles of muscle tissue pass obliquely to the wall of the ampulla. The thickness of
this muscle layer is almost the same around the entire circumference of the ampulla. Further, the
amount of the muscle layer gradually decreases. The decrease in the thickness of the muscle layer
is more pronounced in the inner wall of the ampulla, i.e. on the side of the intestinal cavity.
At the proximal end of the orifice (the ampulla opens into the intestinal cavity with a slit-
shaped opening), the inner part of the muscular ring gradually breaks off, but this unclosed
muscular ring accompanies the ampulla to the distal border of the orifice. The free ends of the
muscular ring are wedge-shaped, which broadly adjoin the wall of the ampulla on the side of the
outer wall of the intestine.
At the same time, the muscular sheath of this wall is inseparably connected with such a
sheath of the intestinal wall. In the area of the ampulla, the circular and longitudinal layers of the
duodenal muscular wall are not clearly distinguished. Complex intertransitions of smooth muscle
bundles from the intestinal wall to the ampulla wall and vice versa often obscure this picture.
Conclusions.
Thus, the results of our studies indicate that the muscular layers of the
duodenum and the ampulla of the phaternal papilla are inseparably interconnected in the game or
gantz of the phaternal papilla. The results of our studies allow us to join the opinion of those
researchers who consider the muscular layers of the duodenal wall and the ampulla of the phaternal
papilla as a single whole (8). It can be assumed that when the longitudinal layer of the muscular
layer of the intestinal wall is relaxed, the ampulla fills with digestive juices, and when the
longitudinal layer, with which the muscular tissues of the intramural sphincters of the ducts are
connected, is contracted, their intramural part closes.
At this moment, due to relaxation of the circular layer of the muscular sheath, the mouth
sphincters open. The oblique bundles of the longitudinal layer, encircling the ampullae also
contract, as a result of which the pharyngeal nipple is tensed (raised) and the contents of the
ampullae are literally "injected" into the intestinal cavity, where at this moment comes chyme from
the stomach. This ensures a portioned and rhythmic release of pancreatic juice and bile each time
chyme from the stomach enters the duodenum. This process is rhythmically repeated and forms
the morphological basis of the "play" or "dance" of the phaternal papilla at the time of digestion.
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ISSN:
2181-3906
2024
International scientific journal
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SCIENCE
АND RESEARCH»
VOLUME 3 / ISSUE 5 / UIF:8.2 / MODERNSCIENCE.UZ
1279
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