PATHOPHYSIOLOGY

PATHOPHYSIOLOGY1

12PathophysiologyCausesBiliary tract disease AlcoholHyperlipedemiaHypercalcemiaTraumaERCPIschemia

Pancreatic neoplasiaPancreas divisumAmpullary lesionsDuodenal lesionsInfectionsVenomDrugsidiopathic2PathophysiologyTheories behind mechanism of biliary pancreatitisCommon channel theoryIncompetent sphincter theoryCo-localization theory33PATHOPHYSIOLOGYCommon channel theory Opie 1901Detergent effect of bile4

4PathophysiologyCritique of common channel theoryHigher hydrostatic pressure in PDIntroduction of bile into PD in animal models failed to cause AP55PathophysiologyIncompetent sphincter theoryIncompetent sphincter of Oddi due to stone passage reflux APCritiqueHow come papillotomy doesnt routinely cause AP??66PathophysiologyCo-localization theory Steer & Saluja 1998Most acceptableStones PD ductal hypertension ducutle ruptureDuctal pH = 9 parynchemal pH = 7 trypsinogen + cathepsin B trypsin autodigestion cascade

77Pathophysiology8

8Pathophysiology9

9Pathophysiology10

10SourceGranger J, Remick D. Acute pancreatitis: models, markers, and mediators.Shock. Dec 2005;24 Suppl 1:45-51Banks 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