REMODELING PECULIARITIES OF DUODENAL SUBMUCOSAL GLANDS IN CONDITIONS AT POSTRESECTION PORTAL HYPERTENSION

Abstract

It is known that the removal of large volumes of the liver leads to postresection portal hypertension, which is complicated by bleeding from varicose veins of the esophagus, stomach, rectum, ascites, splenomegaly, secondary hypersplenism, parenchymal jaundice and portosystemic encephalopathy. Postresection portal hypertension leads to structural rearrangement of the organs of the basilar portal hepatic vein, as well as the remodeling of their structures. Hemodynamic disorders with hypertension in the portal hepatic vein are complicated by pronounced morphological changes in the duodenum, under which the features of remodeling of its submucosal glands are insufficiently studied.

The aim of the study – to learn the features of remodeling of submucosal glands of the duodenum in conditions of postresection portal hypertension.

Materials and Methods. The research was conducted on 45 laboratory-sexually mature white male rats, which were divided into 3 groups. The group 1 consisted of 15 intact virtually healthy animals, 2–15 rats after resection of the left lateral part – 31.5 % of liver parenchyma, 3–15 animals after removal of the right and left lateral parts of the liver (58.1%). Euthanasia of experimental animals was carried out by bloodletting in conditions of thiopental anesthesia 1 month after the beginning of the experiment. From the duodenum, histological micropreparations were made. Morphometrically the diameter of the submucosal glands of the duodenum was determined, the height of the mucocytes cells of the submucous glands, the diameter of their nuclei, the nuclear-cytoplasmic ratio in the mucocytes, and the relative volume of the damaged mucocytes. Quantitative indicators were processed statistically.

Results and Discussion. The analysis of the data obtained found that, after a month after resection of 31.5 % of the liver parenchyma, most of the structures of the duodenal submucosal glands did not change. The relative volume of damaged mucocytes of the submucous glands of the duodenum with a statistically significant increase (p <0.001) by 1.5 times. In experimental animals, in the removal of 58.1 % of liver parenchyma at the intersection of the peritoneal cavity, there was an enlargement of the hepatic portal vein, enlargement of the erythematous mesenterium veins and the visible veins of the small and large intestines, ascites, splenomegaly, which confirmed the presence of postresection portal hypertension. One month after resection of 58.1 % of liver parenchyma, the morphometric parameters studied significantly changed. Thus, the diameter of the submucosal glands of the duodenum statistically significantly
(p <0.001) increased by 25.9 %. The height of the mucocytes of the duodenal submucosal glands in the experimental conditions with a high degree of significant difference (p <0.001) decreased by 12.1 % compared with the similar control quantitative morphological index, and the diameter of their nuclei – by 7.3 %. Nonuniform disproportionate changes in spatial characteristics of the nucleus and cytoplasm of mucocytes resulted in marked violations of nuclear-cytoplasmic relations in these cells. In this case, the indicated morphometric parameter is statistically significant (p <0.01) increased by 11.1 %. The detected changes in the nuclear-cytoplasmic relationships showed an alteration in structural cellular homeostasis. The relative volume of damaged mucocytes of the duodenal submucosal glands one month after the removal of 58.1 % of liver parenchyma with a pronounced statistically significant difference (p <0.001) increased by 9.7 times.

Conclusions. Resection of large volumes of liver parenchyma leads to postresection portal hypertension and severe structural rearrangement of the duodenal submucosal glands, which is confirmed by changes in their topography, a violation of cellular structural homeostasis of mucocytes and a marked increase in the relative volume of their damage, infiltrative and sclerotic processes, which significantly impairs functional morphology of glands and increases the dysfunction of the investigated organ.