Biliary acute pancreatitis: A review

Figure 6 Disruption of the entero-pancreatic feedback loop. A: Normal condition: Brake of CCK release. Direct brake (trypsin, chymotripsin) of the CCK-releasing peptide and of the monitor peptide (a). Indirect brake (bilis). Stabilization of trypsin and chymot rypsin (b). Bile-pancreatic secretion activation of a negative duodeno-pancre atic reflex (c). B: Bile-pancreatic duct obstruction condition-Loss of the normal bile-pancreatic secretion-evoked brake of CCK release. Stone impactation in the Vaterian papilla (a). CCK-induced paracrine-neural duode no-pancreatic reflex (b). CCK-elicited hormonal activation of pancreon units (c). Neural (b) and hormonal (c) mechanisms. Neural (b) and hormonal (c) pathway to the CCK-evoked supramaximal stimulation of the acinar component of the panc reon units.