PancreatitisPancreatitisisa commonnonbacterialinflammatorydiseasecaused by activation,interstitialliberation,and autodigestionofthepancreas by its own enzymes.Theprocess may or may not beaccompanied by permanentmorphologic and functional changesin the gland.Much is known aboutthe causes of pancreatitis, butdespite the accumulation of muchexperimental data, understanding ofthe pathogenesis of this disorder isstillincomplete
Pancreatitis is a common nonbacterial inflammatory disease caused by activation, interstitial liberation, and autodigestion of the pancreas by its own enzymes. The process may or may not be accompanied by permanent morphologic and functional changes in the gland. Much is known about the causes of pancreatitis, but despite the accumulation of much experimental data, understanding of the pathogenesis of this disorder is still incomplete. Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis—EtiologyMostpancreatitisiscausedbybiliarydiseasesand excessivealcoholconsumption,afewarecausedbyhypercalcemia,trauma,hyperlipidemia,andgeneticsusceptibility;therestareidiopathic.Thereareimportant differencesbetweenthemanifestationsandnaturalhistoryofdiseasescausedbythesedifferentfactors.AcutePancreatitis Clinical Associations and Proposed EtiologiesClinical SrttingaednlAlcobolinnHlypeneumetic.dieshoyperlipidemiaudenet soucity.hared maryfiatcoreemaical prodocticmprutzis phngCholelithiasia CinctsceledochalcystcartObstructiescoalfhuidreflux.pucrmaticdoctwbstruetioe,freeraficalpruductfoneigmhodiebHereditaryDefectefmmenthtaaes and'et mrtaboluHhaLavperwgyoctLrtinMecibalieMatmaritiorTeatnacemechaciesToxinmethytalcobol.scoiondeepheandpostoperathretrnLarugeniryand ahered secretonlirnctticHemodybcbmiafheraficalpooductiee,CyokincellacokiomeealovirsihacteriaeMvcoplldectiocicaideClepardhissihethEAlobanuctn1idiopattic
Acute Pancreatitis—Etiology Most pancreatitis is caused by biliary diseases and excessive alcohol consumption; a few are caused by hypercalcemia, trauma, hyperlipidemia, and genetic susceptibility; the rest are idiopathic. There are important differences between the manifestations and natural history of diseases caused by these different factors
Acute Pancreatitis-PathogenesisThepathogenesisof acutepancreatitisiscomplicatedandhasnotyetbeenfullyelucidatedMostresearchersbelievethat acutepancreatitis isthe resultofabnormal activationof acinarendometriumenzymes.Theactivationofmembraneenzymesintheacinusinducestheself-digestionoftheglandularparenchyma.Onthisbasis,acinarcellsreleaseinflammatorycytokines,which can causea cascade of inflammation.Lipase breaks downfats intofatty acids.Thecombinationoffattyacidsand calciumions is calledfattyacid calcium.Therefore,bloodcalciumislowered inacutepancreatitis.Damagedblood+DissolvevascularelasticfibersElastasevesselsFatnecrosisandLipaseNeutral lipolysisliquefactionPancreaticedema,PancreaticnecrosisPhospholipaseA,→DestroycellmembranesTrypsinogenTrypsinhemolysishemorrhage,necrosisDiastolicbloodKininogenasechangedtoKallikreinbradykininandpancreatickininvesselsVasodilationandincreasedAngiotensinpermeability
Acute Pancreatitis—Pathogenesis The pathogenesis of acute pancreatitis is complicated and has not yet been fully elucidated. Most researchers believe that acute pancreatitis is the result of abnormal activation of acinar endometrium enzymes. The activation of membrane enzymes in the acinus induces the selfdigestion of the glandular parenchyma. On this basis, acinar cells release inflammatory cytokines, which can cause a cascade of inflammation. Lipase breaks down fats into fatty acids. The combination of fatty acids and calcium ions is called fatty acid calcium. Therefore, blood calcium is lowered in acute pancreatitis. Trypsinogen Trypsin Elastase Lipase Phospholipase A2 Kallikrein Angiotensin Dissolve vascular elastic fibers Neutral lipolysis Destroy cell membranes Kininogenase changed to bradykinin and pancreatic kinin Damaged blood vessels Fat necrosis and liquefaction Pancreatic necrosis, hemolysis Diastolic blood vessels Vasodilation and increased permeability Pancreatic edema, hemorrhage, necrosis
Acute PancreatitisPathology-mild·Acuteedematouspancreatitis[7]: Acute necrotizing pancreatitis-severe[6]Acutepancreatitis.NecroticadiposetissueanddamagedGrossmorphologyofacutepancreatitis.Extensivepancreaticparenchymacontaininflammatorycells.Intactnecrosisofthepancreasandaccumulationofpancreasliesinthelowerpartofthefiguresurroundingmesenterycanbeseen(above);MassivefatnecrosisofpancreaticandmesentericfatSthed./senioreditor,StaceyEMills;editorsDamylCarter...Jetal.JP1437lStemberg'sdiagnosticsurgical pathologycanbeseen (below)I7)Posai&Ackeman外科病理学：第10版/（意）罗塞（Rosai.）原著：郑杰主逢，北京大学医学出版社2014.1，P1008
Acute Pancreatitis—Pathology · Acute edematous pancreatitis——mild · Acute necrotizing pancreatitis——severe Acute pancreatitis. Necrotic adipose tissue and damaged pancreatic parenchyma contain inflammatory cells. Intact pancreas lies in the lower part of the figure Gross morphology of acute pancreatitis. Extensive necrosis of the pancreas and accumulation of surrounding mesentery can be seen (above); Massive fat necrosis of pancreatic and mesenteric fat can be seen (below). [6] Sternberg’s diagnostic surgical pathology. — 5th ed. / senior editor, Stacey E. Mills ; editors Darryl Carter . [et al.].P1437 [7] Posai & Ackerman 外科病理学：第10版/（意）罗塞（Rosai,J.）原著；郑杰主译，北京大学医学出版社，2014.1，P1008 [6] [7]