Modern ideas on the role of hemodynamic disorders in the pathogenesis of acute pancreatitis

Acute pancreatitis remains one of the most common abdominal diseases, causing a large number of both local and systemic complications. Acute pancreatitis has a high death rate. The pathogenesis of acute pancreatitis is complex and needs careful examination. Many authors suppose, that hemodynamic disorders lead to the development of complications, often fatal. Thus, such disorders need be studied separately. The review is based on the analysis of articles included in such databases as elihrary.ru, cyberleninka.ru, and e-versions of specialized open access journals. All the articles outline modern views on the role of hemodynamic disorders in the pathogenesis of acute pancreatitis. The causes and mechanisms of development of hemodynamic disorders are considered in terms of central and regional hemodynamics, and microcirculation. The authors describe their mutual influence and role in the development of both local and systemic complications of acute pancreatitis. Contractility disorders can be observed in the pathogenesis of central hemodynamics. They can be caused by a highly active myocardial depressant factor. These disorders are supported and aggravated by other organs and systems with the development of multiple organ failure. Violations of regional hemodynamics are associated mainly with an increase in intra-abdominal pressure. A direct dependence of intestinal wall perfusion on intra-abdominal pressure is established. Intestinal barrier dysfunction contributes to the infection of necrosis foci. Microcirculation disorders are the most important element in the pathogenesis of acute pancreatitis, often defining its outcome. Microcirculation disorders include angiospasm, venous stasis, microthrombi formation, and interstitial edema. A decrease in local perfusion due to impaired gland microcirculation can cause tissue ischemia and pancreonecrosis.