Type:
Educational Exhibit
Keywords:
Abdomen, Pancreas, Oncology, CT, Diagnostic procedure, Image compression, Acute, Inflammation, Neoplasia
Authors:
M. J. Regaña Feijoó, T. Díaz Antonio, L. Dominguez Gomez, A. Ruiz Salas, A. Dominguez Igual, C. Leiva Vera; Malaga/ES
DOI:
10.1594/ecr2018/C-0737
Background
In the pathophysiology of acute pancreatitis the release of pancreatic enzymes that are responsible for provoking a secondary systemic response occurs.
These include lipolytic enzymes that "self-digest" pancreatic tissue and peripancreatic fat and activate a series of mediating factors of inflammation,
mainly macrophages,
resulting in an exaggerated inflammatory response.
The lysis of the fat cells will cause the release of fatty acids that precipitate with the serum calcium in the form of soap.
This is the phenomenon known as fatty saponification and is thought to be responsible for the hypocalcemia that is typically associated with severe acute pancreatitis.
These concepts are important because the severity of acute pancreatitis is related not only to the initial magnitude of pancreatic acinar damage,
but also to the activation of the inflammatory and endothelial response that this damage generates.
In addition,
two types of acute pancreatitis,
the interstitial-edematous and necrotizing pancreatitis,
were established in the review of the Atlanta criteria in 2008,
the distinctive parameter being the presence or absence of necrosis,
either of the pancreatic gland or not,
peripancreatic fat or both (the most common).
From all this it is deduced that the phenomenon of fatty saponification is not only useful in the diagnosis of acute pancreatitis,
but it is also related to a greater severity of the process by predisposing to peripancreatic fat necrosis,
although at present this concept is not collected explicitly in the CT.