Chapter 14 The Pancreas
1 List the most important diseases of the enzymes produced by the exocrine 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:
2 Describe annular pancreas
In this anomaly, the head of the pancreas encircles the duodenum. An abnormally shaped pancreas may narrow the duodenum and interfere with the passage of food.
3 What is pancreas divisum?
In this anomaly, there are two separate pancreases, each of which is attached to the duodenum by a separate duct. This anomaly results from incomplete fusion of the two fetal pancreatic anlagen.
4 Where is aberrant pancreatic tissue most often found?
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.
5 What is acute pancreatitis?
Acute pancreatitis is in most instances a sterile (noninfectious) chemically mediated inflammation of the pancreas resulting from injury of the exocrine pancreas. It occurs in two forms:
6 Describe the pathogenesis of acute hemorrhagic pancreatitis
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.
7 Describe the sequence of a hypothetical event leading to acute pancreatitis
The inappropriate activation of enzymes inside the pancreas leading to autodigestion is thought to occur in the following sequence (Fig. 14-1):
8 List the most common causes of acute pancreatitis
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.