PNLIP and ischemia: One theory proposed by Havel et al. suggests that pancreatic lipase hydrolyzes excess TG in pancreatic capillary beds leading to high concentration of FFAs; these FFAs aggregate causing damage to acinar and capillary endothelial cells with resulting ischemia, increased acidity, and further FFA toxicity (36, 37); additionally, chylomicrons may increase serum viscosity, further decreasing pancreatic blood flow and adding to ischemic/acidotic environment (36–38).