13. Pathophysiology of chronic pancreatitis

Last updated on April 3, 2019 at 21:07

Chronic pancreatitis is the slow, progressive and irreversible destruction of the pancreas. People suffering from it occasionally have exacerbations.

It rarely evolves from an acute pancreatitis. The common causes include:

  • Chronic alcoholism – more viscous juice, less antitrypsin, increased sphincter tone
  • Idiopathic, especially in elderly
  • Cystic fibrosis – mucoviscidosis. more viscous juice
  • Chronic protein deficiency
  • Chronic hypercalcaemia – due to crystal precipitating in the ducts

No matter the cause does the pathogenesis involve a gradual fibrosis of the pancreatic parenchyme.

The three common consequences are:

  • Epigastric belt-like pain
  • Complex malabsorption syndrome
  • Secondary diabetes mellitus

It appears that the pathomechanism of chronic pancreatitis is similar to that of the acute type except to a less severe degree. The more viscous juice partly obstructs the duct, causing some enzymes to be forced into the parenchyme where they cause damage. The damage is healed by fibrosis, which further narrows the ducts. This process will eventually reduce the number of functioning acini, causing pancreatic juice deficiency and resulting complex malabsorption.

The pain comes from the fact that the fibrosis compresses nerve endings in the pancreas.

The process also damages the Langerhans islets, eventually causing “secondary” pancreoprivic diabetes. In this case is also glucagon deficient.

The progression of the disease can be slowed. This is accomplished by preventing unnecessary pancreatic secretion, meaning that the patient should consume small, frequent meals of easily digestible food. If necessary should insulin be administered. Alcohol-abstinence is essential.

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12. Acute pancreatitis. Pathophysiology and consequences

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14. Disorders of intermediary metabolism in general liver cell damage

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