Basic and Clinical Approach for Acute Pancreatitis

Yoichi Saitoh

First Department of Surgery, Kobe University School of Medicine

In our past experience with 251 cases of acute pancreatits, several problems have emerged. We have conducted basic analysis in hope of solving them. The results of our investigation are presented in this paper. First, the pathogenesis in initial stages of the disease is illustrated whereas disarray of pancreatic acinar microtubules is suggested to be involved in this process. In case of biliary pancreatitis, the promoting effect on pancreatic secretion by bile acids may trigger the disorder. In addition, intraductal hypertension within the pancreas in suggested to play an important role in its exacerbation. We have also studied possible pathogenesis involved in organ failures, and found the presence of hepatotoxic factor (s) in ascitic fluid as well as the involvement of macrophages in pulmonary dysfunction. In circulatory failure in both kidney and pancreas, there is an impairment of cytochrome oxydase system due to mitochondrail damage, for which perfluorocarbons may offer a useful treatment. Our results further indicate that immunosupression may play a role in excerbating the condition, which may effectively be prevented by transintestinal nourishment. It is also found that the serum level of trypsin protein eaterase activity is a useful indicator for both prognosis and severity of the disease. For the treatmnet of acute pancreatitis, significance of peritoneal lavage as well as of plasma excahnge is revealed. Hence, it is conducted that only aggressive approaches combining surgical resection of necrotic tissue with open drainage and the above modalities would be linked to better results, especially in severe cases.

Key words
cell biology of cuute pancreatitis, organ failure in acute pancreatitis, peritoneal lavage, plasma exchange, surgical treatment of acute pancreatitis

Reprint requests
Yoichi Saitoh First Department of Surgery, Kobe University School of Medicine
7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650 JAPAN

Accepted
May 13, 1992

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