[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Pancreas](https://durgical.com/en/general-pathology/areas/pancreas/) › Chronic pancreatitis: fibrosis, ductal stones and lost acini

# 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.

Updated Nov 12, 2026

## Key points

- Morphology: parenchymal fibrosis, fewer and smaller acini, dilated ducts with protein plugs and calcified stones; islets relatively spared until late.
- Calcifications on imaging are nearly diagnostic.
- Pancreatic stellate cells, activated by TGF-β and other cytokines, make the collagen.
- Consequences: chronic pain, steatorrhea and fat-soluble vitamin deficiency, diabetes (pancreatogenic), pseudocysts, biliary or duodenal stricture.
- Raised risk of pancreatic adenocarcinoma.
- Tropical pancreatitis occurs in young people in some tropical countries with large ductal stones.

## 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 |

## Memory aid

Chronic pancreatitis leaves stones, scar and steatorrhea, and at the end sugar (diabetes).

## 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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## Elsewhere in DurgiPedia

- [Exocrine pancreatic secretion](https://durgical.com/en/physiology/exocrine-pancreatic-secretion/)
- [Pancreas: acini and islets](https://durgical.com/en/histology/pancreas-acini-and-islets/)

## Connections

## Related 7

- [Acute pancreatitis: causes, and how trypsin starts self-digestion](https://durgical.com/en/general-pathology/acute-pancreatitis-causes-and-how-trypsin-starts-self-digestion/)
- [Genetic pancreatitis: PRSS1, SPINK1, CFTR and CTRC](https://durgical.com/en/general-pathology/genetic-pancreatitis-prss1-spink1-cftr-and-ctrc/)
- [Autoimmune pancreatitis: type 1 (IgG4-related) vs type 2](https://durgical.com/en/general-pathology/autoimmune-pancreatitis-type-1-vs-type-2/)
- [Pancreatic ductal adenocarcinoma](https://durgical.com/en/general-pathology/pancreatic-ductal-adenocarcinoma/)
- [Fibrosis in organs: TGF-β and the myofibroblast](https://durgical.com/en/general-pathology/fibrosis-in-organs-tgf-and-the-myofibroblast/)
- [Pathologic calcification: dystrophic vs metastatic](https://durgical.com/en/general-pathology/pathologic-calcification-dystrophic-vs-metastatic/)
- [Atrophy](https://durgical.com/en/general-pathology/atrophy/)

## Related conditions 5

- [Chronic pancreatitis](https://durgical.com/en/conditions/chronic-pancreatitis/)
- [Alcohol use disorder](https://durgical.com/en/conditions/alcohol-use-disorder/)
- [Cystic fibrosis](https://durgical.com/en/conditions/cystic-fibrosis/)
- [Pancreatic cancer](https://durgical.com/en/conditions/pancreatic-cancer/)
- [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

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](https://www.ncbi.nlm.nih.gov/books/NBK482325/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/chronic-pancreatitis-fibrosis-ductal-stones-and-lost-acini/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/chronic-pancreatitis-fibrosis-ductal-stones-and-lost-acini/