Basic Factors in the Pathogenesis of Pancreatitis
IN the last fifty years many studies and observations, both clinical and experimental, have contributed to the knowledge of the pathogenesis of pancreatitis. From this work, it has become apparent that no single etiologic factor can explain all types of pancreatitis. This paper reviews the basic factors that have been shown to be pathogenic, and some of the clinical or experimental studies in which they have been observed.
Those basic pathogenic factors, which have been enumerated over the years, are: (l) obstruction of the pancreatic ductal system with a stimulus to secrete against the obstruction; (2) reflux of bile into the pancreatic ductal system via a “common channel”; (3) infection, secondary to the reflux of infected material into the pancreatic duct, or from systemic infection elsewhere; (4) trauma to the pancreas; (5) vascular ischemia of the pancreas; (6) circulating proteolytic enzymes; and (7) an allergic response to previous sensitization. An eighth potential factor is that of the effect of direct toxins on the pancreas, a factor that has been the subject of much speculation, but at the present time has no clinical or experimental support.
In dealing with the problems of pancreatitis, it should be recalled that the disease, in approximately 80 per cent of patients, is a secondary or associated condition. The primary problems with which pancreatitis is most often associated are those of biliary tract disease, alcoholism, the postoperative state, trauma, mumps or other infections, and metabolic disorders such as hyperparathyroidism or hyperlipemia. In 20 per cent of . . .