What is acinar cell injury?

• Acinar cells are the excretory cells of the pancreas. When functioning properly, these cells synthesize digestive enzymes, store them and secrete them when needed. These enzymes are normally inactive while in the pancreas, only becoming activated when they reach the intestine. Acinar cell injury is any damage to these cells, leading to improper functioning.
  
  

Causes

• Many chemicals can cause damage to these important cells of the pancreas. Alcohol, some medications and smoking all introduce chemicals into the body that may damage acinar cells. Gallstones may block the common bile duct, trapping digestive enzymes in the pancreas. Hypercalcemia (excess calcium), hyperparathyroidism (excess parathyroid hormone) and hypertriglyceridemia (excess triglycerides) can all interfere with the proper function of the acinar cells. Abdominal injury or surgery can also lead to acinar cell damage. Rarely, cancers of the pancreas can cause a malfunction of the acinar cells.
  
  

Pancreatitis

• Pancreatitis, the most common presentation of acinar cell injury, is caused when the digestive enzymes produced by the acinar cells are somehow activated in the pancreas. These enzymes damage the pancreas cells. (References 2) Pancreatitis can be acute, presenting suddenly and disappearing within a few days. It may also be chronic, with symptoms presenting over many years. The symptoms of pancreatitis include both abdominal and back pain, nausea and vomiting. Symptoms are often made worse by eating. Occasionally, type II diabetes may develop, if the insulin producing cells (islet cells) are damaged by the enzymes.
  
  

Acinar Cell Cancer

• Very rarely, acinar cells may develop cancer. These cancers make up 1 percent of the pancreatic tumors in the US, or about 400 cases a year. Acinar cell tumors are more common in older individuals (age 60 or over) and among smokers. The average survival for acinar cell tumors is about 19 months, as they are often diagnosed at a late stage. Leung et al describe a rare case of a man presenting with acute pancreatitis. Hospital treatment resolved the pancreatitis, but diagnostic tests continued to show a mass in the pancreas. The mass was determined to be a carcinoma of the acinar cells.
  
  

Treatment

• Treatment for pancreatitis usually requires hospitalization until inflammation of the pancreas is under control. The pancreas is rested, with the patient not consuming any food or drink. IV fluids are usually required to combat dehydration. Pain medication may be administered as needed. Depending on the underlying cause of the disease, treatment may also include surgery to remove bile duct obstructions or tumors. The gallbladder or portions of the pancreas may also need to be removed. Treatment for alcohol dependence may also be necessary. In the case of acinar cell cancer, surgery may remove the tumor. Other treatment is usually palliative, to reduce the symptoms. After surgery, there is no standard chemotherapy treatment.