The pathogenesis of acute pancreatitis

The leading role in the pathological process in severe acute pancreatitis plays the enzymatic digestion of the tissues of the body and the overall impact on the body coming into the blood enzymes.
When the obstruction of the ducts and the increase in pressure-containing enzymes pancreatic juice seeping out of the small moves in and interstitial lung tissue cancer; soaked in blood, enzymes influence the organism of General toxic effect and affect various organs.
In connection with the possible activation of trypsinogen enterokinase duodenal juice products of normal and pathologically changed tissues and a decrease in the resistance of glandular cells developing process of enzymatic destruction Acinonyx cells and additional exemption contained in them enzymes. This mechanism is the primary effect in the development of the pathological process in severe acute pancreatitis.
Resulting in the development of first aseptic inflammation of the body with subsequent infection and education vnepankreaticalkie foci enzymatic destruction. The last is caused by the penetration of the enzymes through the serous membrane into the abdominal cavity, where they form a focal fatty and hemorrhagic necrosis in nearby tissues with the development serosanguineous peritonitis (ascitic fluid contains pancreatic enzymes). Through lymphatic system and portal system enzymes invade neighboring organs and the liver, and through the aperture in the left pleural cavity. Getting into the General circulation, enzymes can cause degenerative necrotic processes in distant organs and cause General intoxication, which is one of the reasons for developing a shock. Severe the condition of patients with this burden intense pain, dehydration, mineral metabolism disorders, disorders, cardiovascular, kidney, liver, and adrenal insufficiency.
In milder forms of acute pancreatitis enzymatic destruction of the body is less pronounced or absent.
In General toxic action on the organism, the role of individual enzymes pancreatic juice is not the same. Hyperamylasemia not entail any serious violations. This enzyme, apparently, does not destroy vital complexes, and the body from him quickly released. Mostly toxic effects caused by hyperlipidemia and hyperlipasemia, although the precise mechanism of their action on the whole organism still insufficiently studied.
The question of the role of enzymes is still not completely clear. Doubts about two facts: 1) could not find active tropicheskie enzymes in necrotic tissue or in the experiment on animals or humans; 2) active inhibitors of trypsin and chymotrypsin are not completely inactivate the enzymes in vitro, keeping residual activity, able to digest casein.
In the digestion of cancer does not exclude the participation of other enzymes, in addition to the digestive, such as elastase, collagenase, phospholipase A. an Important task at present is to explain the mechanism of activation of enzymes and finding effective inhibitors.
In the pathogenesis of acute pancreatitis great value may also have primary local disorder of blood circulation in the pancreas, occurring due to General diseases of arterial and venous vessels. A significant role in the process of dehydration plays swelling retroperitoneal space.
It is possible that in some cases of acute severe injury of the pancreas is the mechanism of auto-aggression, associated with the formation of autoantibodies against cells of the body.
Despite the large number of factors, which are given a certain role in the emergence and development of the disease, the question about the etiology and pathogenesis of acute pancreatitis remains not quite clear.