PATHOPHYSIOLOGY

Pathophysiology
Causes
Biliary tract disease
Alcohol

Hyperlipedemia
Hypercalcemia
Trauma
ERCP
Ischemia

Pancreatic neoplasia
Pancreas divisum
Ampullary lesions
Duodenal lesions
Infections
Venom
Drugs
idiopathic

Pathophysiology
Theories behind mechanism of biliary
pancreatitis
Common channel theory
Incompetent sphincter theory
Co-localization theory

PATHOPHYSIOLOGY
Common channel theory
Opie 1901
Detergent effect of bile

Pathophysiology
Critique of common channel theory
Higher hydrostatic pressure in PD
Introduction of bile into PD in animal
models failed to cause AP

Pathophysiology
Incompetent sphincter theory
Incompetent sphincter of Oddi due to
stone passage reflux AP
Critique
How come papillotomy doesnt routinely
cause AP??

Pathophysiology
Co-localization theory Steer & Saluja 1998
Most acceptable
Stones PD ductal hypertension ducutle
rupture
Ductal pH = 9 parynchemal pH = 7
trypsinogen + cathepsin B trypsin
autodigestion cascade

Pathophysiology

Pathophysiology

10

Pathophysiology

Source
Granger J, Remick D. Acute pancreatitis: models,
markers, and mediators. Shock. Dec 2005;24 Suppl
1:45-51
Banks PA. Epidemiology, natural history, and
predictors of disease outcome in acute and chronic
pancreatitis. Gastrointest Endosc. Dec 2002;56(6
Suppl):S226-30.
Imrie CW. Prognostic indicators in acute
pancreatitis. Can J Gastroenterol. May
2003;17(5):325-8