Acute necrotizing pancreatitis: pathogenesis

1. initial insult may be dietary, toxic, hormonal
2. enzymes are stopped from being secreted!
3. "colocalization" of lysosomes and secretory zymogen granules
4. lysosomal hydrolases act on trypsinogen to form trypsin
5. once typsin is activated...
6. other zymogens are activated
7. leads to activation of lipase, amylase, elastase, protease, etc.
8. autodigestion (necrosis) of pancreas and surrounding tissues

• blood vessels --> thrombosis, hemorrhage, edema --> further necrosis b/c of ischemia
• fat necrosis + calcium --> fat saponification
• inflammation (secondary event) --> neutrophil enzymes can cause further necrosis --> fibrosis