The Morphologic Basis for the Evolution of Acute Pancreatitis into Chronic Pancreatitis
The pathogenesis of chronic pancreatitis is still unsettled. The most commonly cited theory postulates that the deposition of protein plugs which later calcify leads to duct obstruction with subsequent fibrotic replacement of the acinar tissue upstream of the occlusion . Alternatively, we have proposed a working hypothesis that relates the pathogenesis of chronic pancreatitis with that of acute pancreatitis [8, 9]. The sequence of events that we believe may connect acute with chronic pancreatitis starts with interstitial fat necrosis and hemorrhage that induces perilobular fibrosis. Perilobular fibrosis, in turn, may also distort the interlobular ducts, creating stenoses and dilatations. The ducts, once altered, hamper the normal flow of pancreatic secretions, thereby enabling the precipitation of proteins (protein plugs) and eventually their calcification (calculi). If duct obstruction becomes more extensive, the acinar cells upstream of such a stenosis disappear, leaving dense intralobular fibrosis.
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- 5.Dürr GHK (1979) Acute pancreatitis. In: Howat HT, Sarles H (eds) The exocrine pancreas. Saunders, London, pp 352–401Google Scholar
- 6.Gullo L, Priori P, Labo G (1984) Natural history of acute pancreatitis and its relationship to chronic pancreatitis. In: Banks PA, Porro GB (eds) Acute pancreatitis. Masson, Milan, pp 87–93Google Scholar
- 7.Gyr K, Singer MV, Sarles H (eds) (1984) Pancreatitis. Concepts and classification. In: Proceedings of the second international symposium on the classification of pancreatitis. Excerpta Medica, AmsterdamGoogle Scholar
- 10.Klöppel G, von Gerkan R, Dreyer T (1984) Pathomorphology of acute pancreatitis. Analysis of 367 autopsy cases and 3 surgical specimens. In: Gyr KE, Singer MV, Sarles H (eds) Pancreatitis. Concepts and classification. Excerpta Medica, Amsterdam, pp 29–35Google Scholar
- 13.Sarles H (1986) Chronic pancreatitis: etiology and pathophysiology. In: Go VLW, Gardner JD, Brooks FP, Lebenthal E, DiMagno EP, Scheele GA (eds) The exocrine pancreas. Biology, pathobiology, and diseases. Raven, New York, pp 527–575Google Scholar