Etiology and pathophysiology of acute pancreatitis

摘要: The pathophysiology of acute pancreatitis can be divided into four different pathogenetic principles. 1. Ductular: ductular pathogenesis is characterized by the frequent association between migrating gallstones and pancreatitis. causative mechanism consists an intraductal pressure permeability increase with consecutive premature enzyme activation. 2. Acinar: acinar based on autoactivation pancreatic enzymes after misdirected basolateral secretion interstitium pancreas and/or colocalization lysosomes proenzyme-rich zymogen granules inside cell. 3. Mixed ductular-acinar: main entity this pathophysiological concept alcohol An pressure, duct a possible direct toxic effect seem to responsible. 4. Microcirculation disturbance: impairment microcirculation appears play key role in progression edematous necrotizing was demonstrated all models examined so far. Causative factors are poor blood fluidity hemoconcentration, intravascular hypercoagulability, arteriolar inflow vasospasms, capillary flow endothelial injury edema, venous outflow thrombosis, leukocyteendothelium interaction activated enzymes, kinins other mediators. A specific therapeutically successful approach represents administration dextran which antagonizes both systemic local causes microcirculatory impairment.