Review
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World J Gastroenterol. Nov 28, 2006; 12(44): 7087-7096
Published online Nov 28, 2006. doi: 10.3748/wjg.v12.i44.7087
Pathophysiology of pulmonary complications of acute pancreatitis
George W Browne, CS Pitchumoni
George W Browne, Saint Peter’s University Hospital, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, United States
CS Pitchumoni, Robert Wood Johnson School of Medicine, Saint Peter’s University Hospital, New Brunswick, NJ 08903, United States
Correspondence to: CS Pitchumoni, MD, CARES Building, Saint Peter’s University Hospital, New Brunswick, NJ 08903, United States. pitchumoni@hotmail.com
Telephone: +1-732-9910110 Fax: +1-732-4229061
Received: March 1, 2005
Revised: March 28, 2005
Accepted: April 2, 2005
Published online: November 28, 2006
Abstract

Acute pancreatitis in its severe form is complicated by multiple organ system dysfunction, most importantly by pulmonary complications which include hypoxia, acute respiratory distress syndrome, atelectasis, and pleural effusion. The pathogenesis of some of the above complications is attributed to the production of noxious cytokines. Clinically significant is the early onset of pleural effusion, which heralds a poor outcome of acute pancreatitis. The role of circulating trypsin, phospholipase A2, platelet activating factor, release of free fatty acids, chemoattractants such as tumor necrsosis factor (TNF)-alpha, interleukin (IL)-1, IL-6, IL-8, fMet-leu-phe (a bacterial wall product), nitric oxide, substance P, and macrophage inhibitor factor is currently studied. The hope is that future management of acute pancreatitis with a better understanding of the pathogenesis of lung injury will be directed against the production of noxious cytokines.

Keywords: Acute pancreatitis; Cytokines; Acute respi-ratory distress syndrome; Complications of pancreatitis; Pleural effusion; Interleukins