Chronic pancreatitis

Chronic pancreatitis is a progressive inflammation of the pancreas, accompanied by severe violations of its functions with occasional outbreaks on the background of incomplete remission. Outcome of chronic pancreatitis can be fibrosis and calcification of the authority with complete loss of the functional activity. Much less often, the disease does not progress, but full recovery is unlikely.

The etiology and pathogenesis
Chronic pancreatitis is more common than acute. This finds its explanation in the fact that he can be as a result of acute pancreatitis, and the result of other pathological processes. In addition to acute pancreatitis, which, as we know, can give relapses, the cause of chronic pancreatitis are different infections and intoxications, disorders in metabolism, malnutrition, venous stagnation of the heart and liver of origin and many other pathological processes. Such an acute infection of the abdominal and typhus fever, scarlet fever, mumps, Botkin's disease, sore throat, influenza and other in which a complication of acute pancreatitis is often unrecognized, may often be the cause of chronic pancreatitis. Among chronic infections should indicate on tuberculosis, malaria, syphilis, and from chronic exogenous intoxications most important etiologic role of alcoholism; the disease is observed also in case of poisoning by lead, cobalt, mercury, phosphorus, arsenic, dichloroethane and other poisons. Baggenstoss (1947) found frequent destruction of the pancreas, with uremia. Infringements of exchange processes in the form of stone formation, hemochromatosis can also be a cause of chronic pancreatitis and fibrous changes gland. Such diseases malnutrition, as pellagra, kwashiorkor, usually accompanied chronic pancreatitis. A common cause of this disease, and acute pancreatitis, are diseases of liver and biliary tract diseases, in particular hepatitis and cirrhosis of the liver, cholecystitis and cholangitis and especially cholelithiasis. 3. A. Cooper (1971) indicates a decline of the exocrine function of the pancreas diseases of the biliary tract.
The possibility of developing chronic pancreatitis after cholecystectomy in connection with change of the anatomical and physiological conditions biliary excretion marked Mallet-Guy and Laskowski (1957), Was Mazhdrakova (1961) and other data, Mazhdrakova, lesions of the pancreas are found in almost 30% of patients after the operation.
One of the causes of chronic pancreatitis can be duodenitis and peptic ulcer disease, in particular ulcers, penetrating into the pancreas. Great material provided on this issue in the monograph by A. A. Shelagurova "Pancreatitis" (1967).
Pathogenesis of chronic pancreatitis has much in common with the pathogenesis of acute pancreatitis. In the development of the pathological process, a significant role belongs intraorganic the activation of enzymes (proteases and lipases), damaging tissues of the body. The destruction of the parenchyma gland, replacing it with connective tissue leads to a progressive weakening of the external, and with the defeat of insulyarnogo apparatus and internal secretion. The latter is often with the defeat of the tail gland and with full hardening. Perhaps in the development of pancreatitis play a significant role autoimmune processes (A. K. Sidorov and A. N. Mitropolsky, 1968).
Predisposing to the development of chronic pancreatitis is the stagnation of the secret, is caused by a mechanical obstacle, complicating secondary infection ductless.
The infection can penetrate rising by which contributes to the penetration of bile or duodenal contents (biliopancreatic and duodenoplasty refluxes) or hematogenous or lymphogenous way.
McCutcheon (1962) attached great importance to the penetration into the ducts of the pancreas, intestinal enterokinase, which, in his opinion, and developing pancreatitis. P. D. Tarnopolsky and S. A. Tuzhilin (1964) found in 80% of patients they studied duodenitis and the sphincter of Oddi. The authors give these factors pathogenetic significance.
The inflammatory process may be diffuse and may affect the entire gland or just part of it, such as head or tail. When inflammation of the head sometimes significantly increased, squeezes the common bile duct and causes a mechanical jaundice. In this case, chronic pancreatitis, even during laparotomy may be mistaken for cancer of the head cancer.