Pathophysiology

Ethanol abuse may cause precipitation of pancreatic enzymes in the ducts of the pancreas, leading to chronic inflammation and fibrosis resulting in loss of exocrine function. Ethanol itself may be directly toxic to the pancreatic cells, compounding this effect. Gallstones may obstruct the ampulla of Vater causing pancreatic enzymes or bile to move in a retrograde fashion into the pancreas. This retrograde movement maybe responsible for pancreatic autolysis.1

Table 23-1 Selected Medications Associated With Acute Pancreatitis

Definite Association

Probable Association

5-Aminosalicylic acid

Angiotensin-converting enzyme

Asparaginase

inhibitors

Azathioprin

Burnctamide

Didanosine

HMG-CoA reductase inhibitors

Estrogens

Clmetldlne

Furosemide

Gisplatin

6-Mercaptopuiine

Clozapine

Methyldopa

Corticosteroids

Metronidazole

Cytarabine

Pentamidine

Ethacrynic acid

Sulfonamides

ifosfamide

Suiirtdac

Interferon a-2b

Tigecydine

Losartan

Thiazide diuretics

Procainamide

Valproic acid/salts

Salicylates

Adapted from ESerardi RR, Montgomery PA. Pancreatitis. In: DiPiro JX Taibert RL, Yee GC/et al, eds,Pharmacotherapy: A Pathophysiologic Approach, 7th ed Now York: McGraw-Hill, 200S; Table41-2, p. 661, with permission.

Autolysis of the pancreas can occur when zymogens are activated in the pancreas before being released into the duodenum. Acute pancreatitis can result from the initial injury to the zymogen-producing cells, which is followed by neutrophil invasion of the pancreas and further activation of enzymes within the pancreas. This cascade of events is destructive to the pancreas and harmful to the patient.

Acute pancreatitis can progress to several distinct consequences. A pancreatic fluid collection (or pancreatic pseudocyst) is a collection of tissue, pancreatic enzymes, and blood that forms weeks after acute pancreatitis. Many pancreatic pseudocysts resolve spontaneously, but some require surgical drainage.2 Rupture of a pancreatic pseudo-cyst with associated erosion and hemorrhage of major abdominal blood vessels can have a mortality approaching 60%; thus, continued monitoring of a pseudocyst is prudent.3

Pancreatic necrosis is a diffuse inflammation of the pancreas with infectious etiology. Pancreatic necrosis occurs within the first 2 weeks of acute pancreatitis and develops in 10% to 30% of patients with acute pancreatitis. The necrotic pancreas can become secondarily infected with enteric gram-negative bacteria (such as Escherichia coli), and disseminated infection may result from pancreatic necrosis.4,5

Pancreatic abscess is a collection of pus that forms in the pancreas 4 to 6 weeks after acute pancreatitis. Pancreatic abscess is usually less life-threatening than pancreatic necrosis or pancreatic pseudocyst and can be managed with percutaneous drainage.2 Pancreatic fluid collections and pancreatic abscesses can form during the course of acute pancreatitis. Pancreatic necrosis can occur when pancreatic enzymes damage the pancreatic tissue or when pancreatic abscesses become secondarily infected. This infection is usually due to bacteria that are normally found in the GI tract, including E. coli, Enterobacteriaceae, Staphylococcus aureus, viridans group streptococci, and anaerobes.

Get Rid of Gallstones Naturally

Get Rid of Gallstones Naturally

One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.

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