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KMID : 0359119750070010001
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Korean Journal of Gastroenterology
1975 Volume.7 No. 1 p.1 ~ p.23
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Experimental Studies on the Pathogenesis of Acute Pancreatitis
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Hong,S.S/洪思奭
Kim, K.H/Kim, W.J/Kim, S.H/Kim, C.S/Lee, Y.b/金景煥/金源進/金世煥/金貞淑/李有福
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Abstract
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To elucidate pathogenesis of acute hemorrhagic pancreatitis, particularly the role of ductal obstruction versus the specific factors in the initiation of tissue injuries in the pancreas, changes following the instillation of saline, trypsin, phospholipase A, lysolecithin, alcohol and cholate into the pancreatic duct with or without ligation were studied.
Occlusion of pancreatic ductal flow alone, either permanent or temporary, brought about only an elevation of serum amylase and lipase levels and edematous changes without actual tissue necrosis in the pancreas. However the instillation of trypsin, phospholipase A, lysolecithin, alcohol or cholate at lower pressure, even into the unobstructed pancreatic duct induced tissue necrosis in the pancreas. When the instillation of these agents into the pancreatic duct is coupled with either permanent or temporal ductal obstruction, intensive tissue necrosis was induced. Also, the elevation of serum amylase or lipase level after the instillation of the agents was roughly paralleled with the severity of pancreatic lesion induced. The elevation of the serum enzymes was more marked in animals which had longer ductal occlusion of the pancreas. Therefore, it is concluded that the initiation of tissue injury is dependent upon the nature of the specific agents introduced. Furthermore, the obstruction of pancreatic ductal flow merely intensifies and is responsible for the progress of the tissue damage already initiated. Among the tested injurious agents, phospholipase A is most potent and responsible for the parenchymatous necrosis which is a central part of acute pancreatitis, while trypsin is less potent and mainly responsible for vascular injury which brings about hemorrhage. Thus, phospholipase A, or its split product lysolecithin, appears to stand out as the most potent and important factor for the initiation of acute hemorrhagic pancreatitis. The ultrastructural changes of acinar cells following instillation of trypsin or phospholipase A into pancreatic duct revealed a lytic pattern of endoplasmic reticulum and other organelles of the cell. However, the pattern of changes induced by alcohol or cholate instillation were more of a toxic nature.
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