Acute pancreatitis results in
enzymic necrosis of tissues
Acute pancreatitis is an
important cause of severe abdominal pain and enters the differential diagnosis
of the acute abdomen.
Severe acute inflammation and necrosis of the pancreas leads to liberation of
the powerful digestive enzymes, resulting in extensive enzyme-mediated local
tissue necrosis, particularly fat necrosis.
A complication of the
development of acute pancreatitis is the conversion of the necrotic pancreas
into a cyst filled with serosanguinous fluid (pancreatic pseudocyst).
Clinically most patients with
acute pancreatitis recover.
In severe disease chemical peritonitis and shock may develop. This may
predispose to ARDS.
In acute pancreatitis
The pancreas appears oedematous and is commonly haemorrhagic.
Pancreatic tissue becomes necrotic and may become semi-liquid.
Lipase released from the pancreatic acini causes the development of foci of fat
Severe pancreatic atrophy
occurs with cystic fibrosis
Chronic pancreatitis is mainly
caused by chronic alcohol abuse
Chronic pancreatitis results
from chronic inflammation and fibrosis in the gland.
The four pathological features of chronic pancreatitis are continued chronic
inflammation, fibrous scarring, loss of pancreatic parenchymal elements, and
duct strictures and ectasia with formation of intrapancreatic calculi.
Gallstones are not felt to
play an important role in chronic pancreatitis, in contrast to their importance
in acute pancreatitis.
Patients have recurrent bouts
of severe abdominal pain, with eventual development of malabsorption, and
diabetes mellitus as pancreatic parenchyma is destroyed.
Episodes of acute pancreatitis may complicate chronic pancreatitis.
In chronic pancreatitis the
pancreas is atrophic and replaced by rubbery, fibrous tissue, in which dilated
ducts are seen.
In many cases calculi are present in the dilated ducts.