Etiopathogenesis of acute pancreatitis

Acute pancreatitis (AP) is characterized by abdominal pain and elevations in the serum levels of amylase and lipase. Although there are many causes of AP, the most common are alcohol and gallstones. Regardless of the cause, AP results from a cascade of events that begins with aberrant zymogen activation that leads to pancreatic acinar cell damage, and culminates with the elaboration of an inflammatory response that leads to local and system effects. This article describes the early events and known cellular mechanisms responsible for zymogen activation and acinar cell injury; summarizes the mechanisms by which alcohol is believed to lead to pancreatitis; and reviews the role of inflammation in the pathogenesis of AP, the therapeutic strategies that may be used to limit the effects of the inflammatory response, and complications.