Pathogenesis of pancreatitis: a unified concept.

The primary pathophysiology of acute pancreatitis is due to a low flow state mediated through the neurohumoral mechanisms. Ischemia of the microcirculation, combined with hormonal and other biochemical factors, produces destruction of cellular elements of the pancreas. These changes can be triggered by one or more stressors, including the psychic factor. Emotional stress may not only be responsible for an initial attack of pancreatitis (idiopathic) but must be considered, like any other stressor, to be responsible for exacerbations, relapses or chronicity of pancreatic disease.