Acute Pancreatitis

Acute Pancreatitis: causes, pathogenesis, symptoms and course

Acute pancreatitis is a serious illness that results from inflammation of the pancreas and can be fatal. In acute pancreatitis, enzymes are activated in the pancreatic ducts, which leads to its autolysis (self-digestion).

The etiology of the disease is not fully understood. In 60% of cases, acute pancreatitis is associated with diseases of the biliary tract, but the theory of the common channel of Oddi is confirmed only in 1-2% of cases. More often, such an etiological dependence is explained by the close connections of the lymphatic collectors and the transition of inflammation through the lymphatic vessels.

Among the main causes of acute pancreatitis are alcohol intake, excessive consumption of foods rich in fat, cholecystitis and choledocholithiasis, duodenal diverticulitis, etc.

The pathogenesis of acute pancreatitis is associated with increased pressure in the pancreatic ducts, which leads to cell damage and activation of cytokines. Cytokinase in turn activates trypsinogen, which turns into trypsin. Trypsin is an activator of most proenzymes, such as chymotrypsin, elastase, collagenase and phospholipase A.

Phospholipase A releases lysolecithin and lysokephalin, which have a strong cytotoxic effect, from cell membrane phospholipids. Trypsin also releases polypeptides and kinins from tissue and blood kininogen. Activated kinins cause pain and generalized vasodilation, which is one of the causes of hypovolemic shock. Active lipases, breaking down cellular fats into glycerol and bile acids, lead to the development of severe degenerative changes in tissues, promote the formation of areas of fat necrosis (steatonecrosis) in the tissue of the gland, the fiber surrounding the gland, distant tissues and organs.

In acute pancreatitis, death within the first few days is usually due to cardiovascular dysfunction, respiratory failure, and renal failure. In 10% of cases, acute edematous pancreatitis progresses to hemorrhagic or fatty necrosis of the pancreas. Symptoms of acute pancreatitis include acute pain in the upper abdomen that may radiate to the back, nausea and vomiting, elevated body temperature, rapid pulse, increased blood pressure and loss of appetite. With a severe course of the disease, signs of jaundice, multiple organ failure syndrome and other dangerous complications may appear.

In the treatment of acute pancreatitis, important points are early detection of the disease, provision of emergency medical care, intensive care and surgical interventions if necessary. With optimal treatment, most patients have a good chance of recovery, but if complications develop or seek medical help too late, the prognosis may be poor.