Abstract

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Fibrosis of the pancreas is one of the representative histopathologic findings in cases of chronic pancreatitis. Pancreatic fibrosis is classified into interlobular and intralobular types. In chronic alcoholic pancreatitis cases, fibrosis is mainly found in the interlobular or perilobular areas in the form of nodular pancreatitis or cirrhosis-like pancreatitis. As for the mechanism of interlobular fibrosis, incomplete obstruction of the pancreatic duct and the appearance of cells expressing a-smooth muscle actin, which is a marker for myofibroblasts, play an important role. On the other hand, intralobular fibrosis should be considered or designated as so-called pancreatic fibrosis, but not as chronic pancreatitis. In cases of chronic alcohol abuse, alcohol intake is shown to have an effect in the initial stage of periacinar collagenization through the activation of myofibroblasts and severe damage to acinar cells. Progression of fibrosis occurs due to both pancreatic duct obstruction and interlobular fibrosis admixed with myofibroblast proliferation. Therefore, myofibroblasts play an important role in both the mechanism and progression of pancreatic fibrosis.

Copyright © 2007 S. Karger AG, Basel

Fibrosis of the pancreas is one of the representative histopathologic findings in cases of chronic pancreatitis. Pancreatic fibrosis is attributable to various causes, such as alcohol abuse [1], pancreatic duct obstruction [2], biliary diseases [3], acute pancreatitis [4], liver cirrhosis [5], hemochromatosis [6], ischemia [7] and unknown etiology, and presents in various degrees and distribution patterns.

In this chapter, the distribution of pancreatic fibrosis and its pathogenesis and progression are described.

Table 1. Distribution of pancreatic fibrosis corresponds with individual causes

Cause

Distribution of pancreatic fibrosis

Disease

Alcohol

interlobular or perilobular area

CAP

intralobular or periacinar area

PS, ADS

Duct obstruction

inter- and intralobular area

COP, AIP, DP

Biliary disease

interlobular and periductal areas

BP

Acute pancreatitis

surrounding area of necrosis and interlobular area

Acute pancreatitis

Hemosiderin

intralobular and periinsular areas

Hemochromatosis

Ischemia

focal intralobular area

DIC

ADS = Alcoholic dependence syndrome; AIP = autoimmune pancreatitis; BP = biliary pancreatitis; CAP = chronic alcoholic pancreatitis; COP = chronic obstructive pancreatitis; DIC = disseminated intravascular coagulation; DP = dorsal pancreatitis in patients with pancreas divisum; PS = so-called pancreatic fibrosis.

ADS = Alcoholic dependence syndrome; AIP = autoimmune pancreatitis; BP = biliary pancreatitis; CAP = chronic alcoholic pancreatitis; COP = chronic obstructive pancreatitis; DIC = disseminated intravascular coagulation; DP = dorsal pancreatitis in patients with pancreas divisum; PS = so-called pancreatic fibrosis.

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Alcohol No More

Alcohol No More

Do you love a drink from time to time? A lot of us do, often when socializing with acquaintances and loved ones. Drinking may be beneficial or harmful, depending upon your age and health status, and, naturally, how much you drink.

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