 Gallstones  Alcohol  Post-ERCP  Drugs  Hypertriglyceridemia

intrapancreatic enzyme activation acinar cell injury intrapancreatic inflammatory reaction effects of activated proteolytic enzymes and cytokines on distant organs

Endotoxins, exotoxins, viral infections, ischemia, anoxia and direct trauma activate the zymogens. Activation is mediated by lysosomal hydrolases, such as Cathepsin B. Acinar cell injury

activation, chemoattraction, and sequestration of neutrophils intrapancreatic inflammatory reaction

Activated proteolytic enzymes digest pancreatic & peripancreatic tissues. Activation of other enzymesEnzymes digest cellular membranes. Proteolysis, edema, interstitial edema, vascular damage, coagulation & fat necrosis, and parenchymal cell necrosis

Bradykinin peptides, vasoactive substances and histamine vasodilation, increased vascular permeability and edema cellular injury and death