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The pathology of chronic pancreatitis

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Abstract

We describe the current concepts of the pathology of alcoholic and obstructive chronic pancreatitis (CP). These 2 types of CP possess distinct pathological features. Alcoholic CP is associated with a lobular distribution of the lesions, with both obstruction (from protein plugs) and dilatation of the canalicular and intercalated ducts. In alcoholics, the concentration of protein in the pancreatic juice is increased, making the precipitation of proteinaceous plugs likely. Obstructive CP, on the other hand, is rarely associated with intraductal precipitates; the small ducts are often normal in appearance, but exocrine damage is much more widespread.

The complications of CP are varied. Jaundice, while usually transient, may occasionally be permanent. This results from the compression of the distal common bile duct by fibrotic changes in the pancreatic head. Transient or permanent obstruction of the duodenum and/or colon may also occur. Nearby vessels may be involved, leading to thrombosis and/or hemorrhage from veins or arteries. Electron microscopic changes recently described in the pancreatic nerves may play a role in the etiopathogenesis of the severe pain so common in patients with CP.

Résumé

Nous exposons les dernières idées sur la pathologie de la pancréatite chronique (PC) alcoolique et obstructive. L'anatomie pathologique de ces 2 types de PC diffère. La PC alcoolique comporte une distribution lobulaire des lésions, avec obstruction (par bouchon protéique) et dilatation des canalicules et canaux intercalaires. Chez l'alcoolique, la concentration en protéines dans le jus pancréatique augmente et rend ainsi probable la précipitation de bouchons protéinaceux. Dans la PC obstructive, on voit rarement des précipitations intracanalaires; les canalicules les plus petits sont le plus souvent normaux alors que les lésions exocrines sont en général plus répandues.

Les complications de la PC sont variées. L'ictère normalement transitoire peut parfois être permanent. Il provient de la compression du cholédoque intrapancréatique par des lésions de fibrose de la tête pancréatique. On peut également voir l'obstruction transitoire ou permanente du duodénum et/ou du côlon. En cas d'atteinte des vaisseaux avoisinants, on peut voir thrombose et/ou hémorragie d'origine veineuse ou artérielle. Au microscope électronique, on a décrit dernièrement des altérations des nerfs pancréatiques susceptibles d'expliquer l'étiopathogenèse de la douleur sévère et fréquente de la PC.

Resumen

En este artículo se describen los conceptos actuales sobre la patología de las pancreatitis crónicas de tipo alcohólico y de tipo obstructivo, las cuales poseen características anatomopatológicas definidas. La pancreatitis crónica alcohólica aparece asociada con una distribución lobular de las lesionses y exhibe tanto obstrucción (por precipitados de proteína) como dilatación de los canalículos y de los canales intermedios. En los alcohólicos la concentración de proteína en el jugo pancreático se encuentra aumentada, lo cual hace posible la precipitación proteinácea. Por el contrario, la pancreatitis crónica de tipo obstructivo muy rara vez aparece asociada con precipitados intraductales, y los canalículos con frequencia son de apariencia normal, pero la lesión exocrina es bastante más generalizada.

Las complicaciones de las pancreatitis crónicas son variadas. La ictericia, aunque generalmente transitoria en ocasiones se hace permanente, como resultado de la compresión de la portion distal del colédoco por el proceso fibrótico que ocurre en la cabeza del páncreas. También puede presentarse obstrucción transitoria o permanente del duodeno y/o del colon. Los vasos vecinos pueden resultar afectados y desarrollar trombosis y/o hemorragia a partir de venas o arterias. Los cambios electromicroscópicos en la estructura de los nervios recientemente descritos pueden jugar un papel significativo en cuanto a la etiopatogénesis del severo dolor que es tan común en pacientes con pancreatitis crónica.

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Authors and Affiliations

  1. Norfolk and Norwich Hospitals, England, UK

    Surjait M. Singh M.D., F.R.C.S. & Howard A. Reber M.D.

  2. Department of Surgery, University of California at Los Angeles, Los Angeles, California, USA

    Surjait M. Singh M.D., F.R.C.S. & Howard A. Reber M.D.

  3. Surgical Service, Sepulveda Veterans Administration Medical Center, Building 3, #606 (112), 16,111 Plummer Street, 91343, Sepulveda, California, USA

    Surjait M. Singh M.D., F.R.C.S. & Howard A. Reber M.D.

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  2. Howard A. Reber M.D.
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Singh, S.M., Reber, H.A. The pathology of chronic pancreatitis. World J. Surg. 14, 2–10 (1990). https://doi.org/10.1007/BF01670538

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