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Flashcards in Pathology of the pancreas Deck (19):

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


Describe carcinoma of the pancreas

  • Adenocarcinoma
  • Smoking, diabetes, familial pancreatitis
  • Poor prognosis 


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 

  1. Direct invasion - doudenum, stomach spleen 
  2. local lymphnode spread 
  3. Haematogenous spread  - Liver