Chronic pancreatitis: fibrosis, ductal stones and lost acini
- Lesion
Chronic pancreatitis is long-term scarring of the pancreas; it causes pain, poor digestion of fat and eventually diabetes.
What it is
Chronic pancreatitis is long-standing inflammation with irreversible destruction of exocrine parenchyma, fibrosis and, late, loss of islets. Alcohol is the commonest cause in adults; others are genetic variants, duct obstruction, hypercalcemia, hypertriglyceridemia, autoimmune disease, tropical pancreatitis and smoking, which is an independent risk factor. Repeated acute episodes (necrosis-fibrosis sequence) and activated pancreatic stellate cells drive the scar.
Structure
- Gross: hard, shrunken gland with dilated ducts and visible calcified stones.
- Micro: dense fibrosis, atrophic or absent acini, chronic inflammatory cells, dilated ducts with eosinophilic plugs; clusters of surviving islets in scar.
Step by step
- Alcohol, genes or obstruction cause repeated acinar injury or small episodes of acute pancreatitis.
- Protein-rich secretions precipitate in ducts as plugs that calcify into stones.
- Ducts are obstructed and dilated; acini atrophy.
- Macrophages release TGF-β and PDGF that activate pancreatic stellate cells.
- Stellate cells deposit collagen: fibrosis replaces the exocrine gland.
- Late, islets are trapped in scar and lost: diabetes.
Acute vs chronic pancreatitis
| Feature | Acute pancreatitis | Chronic pancreatitis |
|---|---|---|
| Nature | Reversible inflammation | Irreversible destruction and fibrosis |
| Main lesions | Edema, fat necrosis, hemorrhage | Fibrosis, acinar loss, ductal stones |
| Enzymes in blood | High lipase and amylase | Often normal or mildly raised |
| Function | Usually recovers | Exocrine and endocrine insufficiency |
| Imaging | Swelling, necrosis | Calcifications, dilated irregular ducts, atrophy |
Test yourself
Think of the answer, then tap the question to see it.
Which cell is responsible for fibrosis in chronic pancreatitis?
The activated pancreatic stellate cell.
What imaging finding strongly supports chronic pancreatitis?
Pancreatic calcifications within dilated, irregular ducts.
Why does diabetes appear late in chronic pancreatitis?
Islets are relatively resistant and survive in the scar until fibrosis finally destroys them.
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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Chronic Pancreatitis (StatPearls (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.