Cd che benh sinh cua viem tuy cap cho den nay, con ngiidi van chiia hoan toan hieu ro, da co nhieu thuyet diidc diia ra.
4.1. Thuyet t ic nghen va trao ngifdc
Nam 1882 Prince da diia ra gia thuyet ve sii tac ong tuy bdi soi mat, lam bung phat viem tuy cap, gia thuyet nay cung diidc Opie khang dinh lai vao nan 1901, sau khi giai phau t i thi mot triidng hdp viem tuy cap thay co soi ket d bong Vater. Theo Fagnier, trong da so' cac triidng hdp viem tuy cap do soi mat ngiidi ta thay co hdn 80% so" benh nhan co soi trong phan, va 2/3 trong so" do co mot ong chung de dan ong mat chu va ong Wirsung. Ben canh do, nhiem doc riidu diidc coi la yeu to" lam tang triidng liic cd that Oddi cung nhii co that ta trang, v ia gay tang ap hie, v ia gay tang hoi liiu dich mat trong ong Wirsung. Nhii vay theo thuyet nay, cac yeu to" lam tac nghen diidng mat nhii soi, giun, u chen vao ong m at-tuy va nhiem doc riidu da gay ra tang ap l i e ong tuy, gay viem tuy cap, dong thdi stf tSc nghen nay thiidng kem theo trao ngiidc dich ruot, dich tuy va dich mat da diidc hoat hoa d ta trang, la n h in g yeu to" gay hoat hoa cac men tuy. Ngiidi ta da gay difdc viem tuy cap t h ic nghiem d s ic vat, khi tron lan dich mat, dich ta trang roi tiem vao ong tuy vdi ap l i e thap < 20 cm H20 thi 70% cac triidng hdp gay viem tuy cap hoai t i xuat huyet va hoai t i md,
cac ton thiidng nay chu yeu xay ra d khoang ke, vdi stf tham nhilm te bao viem, trong 24 gid dau cac nang tuyen con nguyen ven, ve sau cac nang tuyen se bi ton thiidng. Schmit va Lan Kisch da thuc nghiem d chuot bang cach tiem dau oliu hoac acid oleic vao ong tuy da gay viem tuy cap hoai t i.
4.2. Thuyet tirtieu
Diidc de xuat bdi Chiari 1896, theo thuyet nay thi: Cac men thuy phan protid nhii trypsinogen, chymotrypsinogen, proelastase, phospholipase A diidc hoat hoa ngay ben trong tuyen tuy, trong do cac yeu to" nhii noi doc to', ngoai doc to, nhiem virus, thieu mau, thieu oxy, chan thiidng, diidc nghi den nhii la yeu to' hoat hoa men, dau tien cac men thuy phan protein, nhat la trypsin khong nhiing tieu huy mo tuy va cac mo xung quanh, ma con hoat hoa cac men khac nhu elastase, phospholipase. Cac men nay diidc hoat hoa gay tieu huy mang te bao, tieu huy protein gay phu, chay mau mo ke, ton thiidng hoai tii mach mau, hoai tii md, hoai t i nhu mo tuy, cac san pham cua sii ton thiidng va hoai t i te bao lam hoat hoa, phong thich cac bradykinin, kalikrein va cac chat hoat mach gay gian mach, tang tinh tha'm, phu, do do lam thoat dich, gay giam the tich tuan hoan nang ne, gay Shock, lai lam nang them tinh trang thieu khi, thieu mau, thuc day sii hoai t i tuy.
4.3. Thuyet ong dan
Binh thiidng niem mac ong tuy khong tham qua nhiing phan t i co kich thiidc > 3000 DA, s i gia tang tinh tham xay ra khi d in g liidng acid acetyl salisylic, histamin, calci, prostaglandin E2, khi do hang rao bieu mo co the tham qua cac phan t i t i 20.000- 25.000 DA, dieu nay cho phep hoai hoa cac men phospholipase ma dac biet la phospholipase A 2 trypsin, elastase xam nhap vao mo ke tuy gay viem tuy cap hoai t i, tii do lai phong thich cac lysosom va cac hydrolase lam hoat hoa men va lam tieu huy ben trong te bao.
4.4. Thuyet oxy hoa qua mure
Nam 1993 Lery dda ra thuyet oxy hoa qua m ic: Theo thuyet nay thi viem tuy cap dddc khoi phat la do sd san xuat qua m ic cac goc oxy hoa td do va cac peroxyt dddc hoat hoa bdi sd cam i n g men cua he thong Microsom P 450. Do rddu, hoac mot sd cdng cap qua nhieu cd chat ma sd chuyen hoa oxy la quan trong.Cac hydrocarbon, halogen va mot sd giam cd che td ve chong lai sd oxy hoa qua m ic nay do sd giam glutathion, dieu nay giai thich vai tro cua yeu to' t h ic an trong viem tuy cap.
Gan day ngddi ta dda ra vai tro c ia mien dich va cac cytokin, interleukin, cung nhd y e i to" hoai td U.TNF (Tumor necrotizing factor) nhat la trong viem tuy cap hoai td cung dddc de cap nhieu.
5. BENH HOC VA SINH LY BENH CUA VIEM TUY CAP5.1. Roi loan tai cho - sir urtre djch