Pathology of the pancreas Flashcards Preview

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Flashcards in Pathology of the pancreas Deck (19):
1

What is pancreatitis 

Inflammation of the pancrease which can be acute or chronic - overlap between the two

2

Describe acute pancreatitis 

  • Adults - acute onset of severe abdominal pain
  • Patients may be severly shocked 
  • Elavated amalyase levels

3

What are the causes of acute pancreatitis 

  • Alcohol 
  • Cholelithiasis 
  • Shock 
  • Mumps
  • Hypothermia 
  • Hyperparathyroidism 
  • Trauma or iatrogenic 

4

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 

5

How do the released enzymmes cause damage to the pancreas

Proteases and lipases

  • Intra and peripancreatic fat necrosis - lipases
  • Tissue distruction and haemorrhage - proteases 

6

What is the gross appearance of mild acute pancreatits 

7

What is the appearance of moderate acute pancreatitis 

8

What is the gross appearance of severe acute pancreatitis 

9

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

10

What is the histological appearance of Acute pancreatits 

  • Fat necrosis and pancreatis necrosis

11

What are the complications of acute pancreatitis 

  • Death, shock
  • Psuedocyts formation
  • Abcess formation 
  • Hypocalcaemia
  • Hyperglycaemia 

12

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

13

What are the causes of chronic pancreatitis

  • Acohol 
  • Cholelithiasis
  • Cystic fibrosis
  • Hypoparathyroidism 
  • Familial 

14

What is the gross appearance of chronic pancreatitis

  • Inflammation and necrosis mimics a tumour in head of pancreas

15

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

16

Describe carcinoma of the pancreas

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

17

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

18

What is the microscopic appearance of Adenocarcinoma of pancreas

19

Where does adinocarcinoma of pancreas spread to 

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