Pathology of the pancreas Flashcards
What is pancreatitis
Inflammation of the pancrease which can be acute or chronic - overlap between the two
Describe acute pancreatitis
- Adults - acute onset of severe abdominal pain
- Patients may be severly shocked
- Elavated amalyase levels
What are the causes of acute pancreatitis
- Alcohol
- Cholelithiasis
- Shock
- Mumps
- Hypothermia
- Hyperparathyroidism
- Trauma or iatrogenic
What is the pathogenesis of acute pancreatits
Bile, reflux, stone blockage or damage to the sphincter of oddi all can lead to pancreatic duct epithelial injury - loss of the protective barrier leads to autodigestion of pancreatic tissue
How do the released enzymmes cause damage to the pancreas
Proteases and lipases
- Intra and peripancreatic fat necrosis - lipases
- Tissue distruction and haemorrhage - proteases
What is the gross appearance of mild acute pancreatits
What is the appearance of moderate acute pancreatitis
What is the gross appearance of severe acute pancreatitis
What is a pancreatis pseudocyst
- Painful, localised collection of pancreatic secretions that develop after pancreatitis
- Not a true cyst because no epithelial lining
- No epithelial lining, cyst arises from drainage of pancreatic secretions from damaged ducts into interstitial tissue, which becomes walled off by fibrous tissue
What is the histological appearance of Acute pancreatits
- Fat necrosis and pancreatis necrosis
What are the complications of acute pancreatitis
- Death, shock
- Psuedocyts formation
- Abcess formation
- Hypocalcaemia
- Hyperglycaemia
Describe chronic pancreatitis
- May me insidious onset or due to repeated episodes of acute pancreatitis
- Replacement of of pancreatis tissue by chronic inflammation or scar tissue
- Desctruction of exocrine acini and islets
What are the causes of chronic pancreatitis
- Acohol
- Cholelithiasis
- Cystic fibrosis
- Hypoparathyroidism
- Familial
What is the gross appearance of chronic pancreatitis
- Inflammation and necrosis mimics a tumour in head of pancreas
What is the histological appearance of CP
- Loss of acini and ductal tissue with relative sparing of islets, irregularly distributed bland periductal fibrosis, variable obstruction of pancreatic ducts of all sizes
- Chronic inflammation (including mast cells) around lobules and ducts; perineural and intraneural inflammation with hyperplasia of the nerves
- Dilated ducts with concretions
- Ductal epithelium is atrophic, hyperplastic or undergoes squamous metaplasia
- Islets may become sclerotic and disappear
What are the invasions of the carcinoma of head to pancreas
- Doudenum
- Constriciton of common bile duct
- Direct invasion of spleen - Carcinoma in tail of pancreas
What is the microscopic appearance of Adenocarcinoma of pancreas
Where does adinocarcinoma of pancreas spread to
- Direct invasion - doudenum, stomach spleen
- local lymphnode spread
- Haematogenous spread - Liver
