Lethal Factors and Response to Therapy in Experimental Bile-Reflux Pancreatitis

Abstract

Bile-reflux pancreatitis is produced in 18 dogs by establishing an obstructed common biliary-pancreatic system; the mortality rate was about 90%. The lethal factors that appear to have played a role were identified and selectively treated 1) obstruction of the common biliary-pancreatic system, 2) infection in the system, 3) plasma and systemic fluid losses and 4) systemic absorption of active proteolytic enzymes (trypsin) or other vasoactive substances. The response to selective therapy, in each case begun 24 hours after instigation of pancreatis, has been assessed. Most other studies have demonstrated maximum effectiveness of trypsin inhibitor therapy when given before or during creation of the disease; systemic proteolytic enzyme inhibitors were effective, although less so when given 24 hours after the onset of pancreatitis. Since factors of fluid loss and infection are also important, the use of systemic trypsin inhibitors in the therapy of severe, acute pancreatitis appears to be most valuable when used in addition to fluid and plasma replacement and antibiotics.