Overview Chronic pancreatitis is characterised by recurrent or persistent abdominal pain arising from the pancreas. The inflammatory process results in irreversible destruction and fibrosis of the pancreas. Often associated with exocrine or endocrine pancreatic insufficiency.
Definition Acute Pancreatitis: An inflammatory process in which pancreatic enzymes are activated and cause autodigestion of the gland. Chronic Pancreatitis: Irreversible damage causing fibrosis and scarring to the pancreas, resulting in exocrine and endocrine dysfunction Pancreatic pseudocyst: Cystic space within the pancreas not lined by epithelial cells, often associated with chronic pancreatitis. |
Pancreatic anatomy Pancreas extends retroperitoneally across posterior abdominal wall. It means "All (pan) Flesh (Kreas)". The pancreas consists of the following parts:
The head is encircled by duodenum and tail in contact with spleen. Pancreas has a poorly developed capsule & therefore adjacent structures (common bile duct, duodenum, splenic vein, transverse colon) are commonly involved in inflammatory process.
Blood Supply
Venous drainage
Nerve invervation
Lymphatic drainage
Embryology
Pancreatic physiology exocrine (98%) & endocrine (2%) functions
Exocrine: Pancreatic acinar cells produce digestive enzymes, which are stored in secretory granules. The Pancreatic exocrine secretion is regulated by cephalic, gastric & intestinal stimuli. Acinar cells secrete pancreatic juice made up the enzymes:
Exocrine section is stimulated by:
Endocrine: Islets of Langerhans – clusters of hormone-producing cells secreted directly into circulation. Endocrine cells of the pancreas:
Cells of the Pancreas | Secretion | Function |
Acinar cells secrete enzymes into the duodenum |
Nucleases | Breaksdown nucleotides |
Proteases | Digests Proteins | |
Lipases | Digests lipids | |
B-amylase | Digests carbohydrates | |
Islets of Lagerhan secrete hormones into the bloodstream |
Glucagon | Stimulates glucose release into the bloodstream from glucose stores |
Insulin | Increases cell uptake and storage of glucose |
Risk Factors |
Alcohol |
Smoking |
Family history |
Coeliac disease |
Pathological features
Difference between acute pancreatitis and chronic pancreatitis
Resectional surgery is associated with increasing risk of exocrine and endocrine pancreatic failure and high risk of complications
Complications
Prognosis