Pancreatitis

Chapter 50 Pancreatitis




Questions


image Why does pancreatitis occur?

image What are the complications of pancreatitis?

image What is the difference between acute and chronic pancreatitis?

Inflammation of the pancreas may be acute or chronic. Acute pancreatitis implies the sudden onset of inflammation with, in severe cases, haemorrhagic necrosis. In chronic pancreatitis, the inflammation causes fibrosis and atrophy of acinar tissue with irreversible impairment of pancreatic function.




Acute pancreatitis



Aetiology and pathogenesis


There are a number of causes of acute pancreatitis;


image toxins: ethanol, drugs (e.g. diuretics such as thiazides and furosemide), venoms (e.g. certain scorpion stings)

image obstruction of the pancreatic ducts: gallstones, tumours of the ampulla of Vater, parasites (e.g. ascariasis and liver flukes)

image infections: mumps, coxsackievirus

image metabolic disorders: hypercalcaemia, hypothermia, hyperlipidaemia

image mechanical injury: trauma, endoscopic procedures involving cannulation or injection of the pancreatic ducts

image ischaemia: shock, obstruction of blood supply (e.g. arterial embolism)

image genetic: inherited abnormalities in genes encoding pancreatic enzymes and their inhibitors.

The commonest causes in industrialized countries are gallstones and alcohol abuse, which together account for approximately three-quarters of all cases. There is no known cause in approximately 10%


The pathogenesis of acute pancreatitis is poorly understood. Recent research has suggested that toxic damage promotes free radical production together with activation of mast cells. It is also believed that autodigestion of the pancreatic tissue by pancreatic enzymes is involved. Normally, pancreatic enzymes do not attack the pancreatic tissues because:


image the enzymes are physically isolated from other cellular components within the endoplasmic reticulum, Golgi apparatus and secretory granules
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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Pancreatitis

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