By Waldemar Uhl, Peter Malfertheiner, Michael G. Sarr
Read or Download Diseases of the Pancreas: Acute Pancreatitis, Chronic Pancreatitis, Tumours of the Pancreas PDF
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Extra resources for Diseases of the Pancreas: Acute Pancreatitis, Chronic Pancreatitis, Tumours of the Pancreas
Sample text
4. Focal necrosis of pancreatic parenchyma and peripancreatic fatty tissue reaction suggestive of infected necrosis. 5. Diffuse/extensive necrosis of the pancreatic parenchyma and massive peripancreatic/fatty tissue reaction or objective signs of infected necrosis (gas bubbles in the necrotic lesions). 48 The disadvantages of CT for diagnostic purposes are that the procedure is both expensive and not universally available and unlike ultrasonography cannot be performed at the bedside. These findings were made in a rat model of necrotizing pancreatitis and may be attribued to contrast medium-induced impairment of the microcirculation.
Most of the fluid loss is third-spacing in the retroperitoneum, but there may also be involvement of the peritoneal cavity (ascites). In addition, part of the fluid sequestration is interstitial fluid accumulation in various organs as a result of the generalized increase in vascular permeability. Further fluid losses may occur secondary to vomiting or nasogastric aspiration. It is unlikely that acute pancreatitis has a direct effect on cardiac contractility. The original description of a specific myocardial depressant factor has not been confirmed in recent studies.
Subsequent clinical studies on biliary pancreatitis supported this concept of gallstones as the triggering factor. However, unlike the original case history reported by Opie with an impacted stone, as a rule, in 80–95% of patients, the stones pass the papilla spontaneously. This observation suggests that the cause of the illness is unlikely to be related to a persistent obstruction of bile flow, but rather to transient obstruction with temporary impairment of the sphincter mechanism. Even transient obstruction of the papilla is evidently sufficient to induce pancreatitis.