Acute - gland reverts to normal if underlying cause removed Chronic - irreversible loss of tissue
Acute
- Relatively common - damage to exocrine parenchyma
- Gallstones (50%), alcohol (25%), idopathic (10%)
- Hereditary pancreatitis - recurrent attacks of severe pancratitis PRSS1 a. dominant or SPINK1 a. recessive
- Emergency, severe acute abdo pain with raised serum amaylase/lipase. Persistent hypocalcaemia poor prognnostic sign
- Mild - swollen gland with fat necrosis
- Severe - swollen, necrotic gland and haemorrhage (Grey Turner’s and Cullen’s sign)
- Pseudocysts (full of pancreatic juice)
- Hypocalcaemia is bad
Chronic pancreatitis
- Irreversible destruction of exocrine tissue (replaced with fibrosis that can mimic carcinoma) followed by destruction of endocrine -
- Malnutrition and diabetes, pain
- Recurrent acute can become chronic Toxic - alcohol, drugs, infections Idiopathic Genetic CFTR, PRSS1, SPINK1 Autoimmune Recurrent acute Obstruction of main duct - stone, cancer, scarring