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Flashcards in Pancreas Deck (12):
1

What is the pathogenesis for acute pancreatitis?

Zymogen granules fuse with lysosomes --> lysosomal protease activates trypsinogen to trypsin --> pancreatic secretory trypsin inhibitor overwhelmed --> trypsin activates digestive enzymes in the pancreas --> autodigestion --> inflammation

2

What are the initiating events of an acute pancreatitis?

Diet (high in fat)

Trauma

Ischemia

Drug use

Metabolic (diabetes)

Infection

Toxin

3

Pathogenesis of actue pancreatitis:

Intra-pancreatic activation of typsin --> acinar cell damage with activation of additional digestive enzymes -->

  1. Kallikrein-kinin activation --> ?
  2. Chymotrypsin activation --> ?
  3. Elastase activation --> ?
  4. Lipase activation --> ?
  5. Phospholipase A2 activation --> ?

 

  1. Kallikrein-kinin --> inflammation & edema
  2. Chymotrypsin --> edema, vascular damage
  3. Elastase --> vascular damage, hemrrohage
  4. Lipase --> fat necrosis
  5. Phospholipase A2 --> coagulation necrosis

4

What are the gross lesions of an acute pancreatitis?

Hyperemia

Hemorrhage

Necrosis

Fibrinopurulent exudate

Peripancreatic fat necrosis

Fibrinous adhesions to adjacent structures

5

Is this acute or chronic pancreatitis?

Q image thumb

Acute 

NOTE: hyperemia

6

What is your morphologic diagnosis?

Q image thumb

Acute, diffuse necrotizing and fibrinous pancreatitis

7

What causes the peripancreatic fat necrosis present?

Q image thumb

Release of activated enzymes into adjacent fat results in peripancreatic fat necrosis (arrows)

8

Q image thumb

Peripancreatic fat necrosis

9

Pathogenesis of acute pancreatitis:

Initiating event --> intra-pancreatic trypsin activation --> trypsin activate additional proenzymes (like what??)

Phospholipase A2

Lipase

Chymotrypsin

Elastase

10

What happens with repeated bouts of pancreatitis?

Repeated bouts of pancreatitis  --> partial digestion of the pancreas --> replacement with fibrous tissue --> repeat

 

Chronic relapsing pancreatitis --> fibrosis & atrophy --> exocrine pancreatic insufficiency (diabetes mellitus)

11

What happens with severe pancreatitis?

Severe disease --> systemic release of inflammatory mediators (kallikrein-kinins) and activated digestive enzymes --> shock, respiratory distess, DIC, & death

12