Chapter 14 The Pancreas
Pancreatic acini secrete more than 20 digestive enzymes. These enzymes are released in response to stimulation, which may be neurogenic or hormonal with polypeptide hormones such as cholecystokinin. The most important enzyme disorders are:
Pancreatic acini and islets may be found anywhere in the other parts of the gastrointestinal tract in 2% of normal people. Most often, such choristomas are found in the duodenum and the stomach. These lesions are usually accidentally discovered during histologic examination of gastrointestinal organs resected or biopsied for an unrelated reason. Larger masses may be mistaken for tumors.
Acute hemorrhagic pancreatitis is an acute inflammatory process caused by enzyme-mediated destruction of pancreatic and peripancreatic tissue. The key event is the inappropriate activation of pancreatic digestive enzymes inside the ducts and acini of the exocrine pancreas. Activated enzymes act on the pancreatic cells, which leads to additional release of digestive enzymes into the interstitial and peripancreatic tissues and blood vessels.
Most cases of acute hemorrhagic pancreatitis (>80%) are related to biliary tract disease and alcohol abuse. Bile stones are known to obstruct the common choledochopancreatic duct and thus cause reflux of bile into the pancreas. Alcohol is thought to cause a spasm of the sphincter of Oddi that may also lead to reflux.