Ætiological Factors in Pancreatitis

Postgastrectomy malnutrition.

“…There are several theoretical possibilities as to why postgastrectomy patients might develop pancreatitis or pancreatic atrophy, including direct trauma to the pancreas at operation, interference with the blood supply, increased tendency to duodenal reflux (McCutcheon, 1962), and disuse atrophy due to loss of the gastric stimulus to pancreatic secretion. The present study has failed to elucidate which factor or factors predominate.…”

Reflux of duodenal contents in the pathogenesis of pancreatitis

“…The emphasis on obstruction is probably a reflection of the surgical approach to pancreatitis, as most of the experimental work has been done by surgeons and most patients with pancreatitis are admitted to surgical wards. The very strong evidence against these theories was discussed recently and only the main points will be stated here (McCutcheon, 1962).…”

“…A common channel does not exist in many cases of pancreatitis (Mann and Giordano, 1923;Clark, 1942;Bartlett and Nardi, 1960;McCutcheon, 1962).…”

“…I believe that the initial site of action of the active enzymes is in small blood vessels where stasis and thromboses lead first to interstitial oedema and later to haemorrhage and infarction of pancreatic acini. The final pathological process is regarded as 'one of infarction and haemorrhage rather than autodigestion' (McCutcheon, 1962). duct may be demonstrated by the radiologist.…”

“…The biliary reflux theory also depends upon obstruction, either organic or spasm, at the termination of the pancreatic and common bile ducts with the formation of a common channel along which bile may flow. Serious objections have been raised to both these theories, however, and in a recent study (McCutcheon, 1962) it was shown that the anatomy of the ducts in fatal cases of pancreatitis favoured reflux of duodenal contents rather than reflux of bile.…”