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GEMS > Exocrine Pancreas Path > Flashcards

Exocrine Pancreas Path Flashcards

1
Q

Acute pancreatitis

A

Inflammation & hemorrhage of the pancreas that results from aberrant release of pancreatic enzymes, autodigestion of pancreatic parenchyma by pancreatic enzymes

Premature activation of trypsin –> activation of other pancreatic enzyme

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2
Q

Acute pancreatitis

Patho

A

Results in liquefactive hemorrhagic necrosis of pancreas

Fat necrosis of peripancreatic fat

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3
Q

Acute pancreatitis

Etiology – 1/2

A

Mechanical: gallstones, biliary sludge, neoplasms, duodenal stricture, obstruction

Gallstones&raquo_space;» (most common cause)

Toxic: ethanol, methanol, organophosphate poisoning

Alcohol&raquo_space; (2nd most common cause)

Trauma: blunt or penetrating abdominal injury, iatrogenic injury during a procedure

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4
Q

Acute pancreatitis

Etiology – 2/2

A

Metabolic: hyperlipidemia (type V)–> elevations of chylomicrons/VLDL

Vascular: ischemia, hemorrhagic shock, vasculitis

Genetic

Drug-induced

Infectious agents: consider in immunocompromised patients
-Acute infection of pancreas usually a secondary event
-Usually 2/2 gram-aerobic bacteria

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5
Q

Mild Acute pancreatitis

Micro

A
  1. Spotty peripancreatic or perilobular fat necrosis
  2. Interstitial acute inflammation
  3. clinical dx»> morphologic
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6
Q

Severe Acute pancreatitis

Micro

A
  1. Large areas of fat necrosis & variable pancreatic parenchymal necrosis (saponification)
    a) Necrotic areas: abundant neutrophils, can involve duct lumina
    b) Hemorrhage & venous thrombosis
    c) Fat necrosis: may extend to omentum, retroperitoneum, bone marrow, subcutaneous tissue
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7
Q

Mild acute pancreatitis

Gross

A

Enlarged & swollen w/ foci of fat necrosis (yellow-white, waxy, chalky)

Usually recover w/in 5-7 days

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8
Q

Severe acute pancreatitis

A

Larger confluent areas of fat necrosis & parenchymal necrosis, hemorrhage can encase the pancreas & stimulate hematoma

Sequelae: pancreatic abscesses & pseudocyst

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9
Q

Acute pancreatitis
Sx & complications

A

i. Epigastric abdominal pain → radiates to back
ii. Nausea, vomiting
iii. Periumbilical & flank hemorrhage signs
1) Necrosis spreads into periumbilical soft tissue / retroperitoneum

iv. Shock d/t peripancreatic hemorrhage & fluid sequestration

DIC, ARDS, AKI

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10
Q

Acute pancreatitis labs

A

Elevated lipase, amylase, hypocalcemia

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11
Q

Chronic pancreatitis

A

Progressive inflammatory disorder of the pancreas, resulting in scarring, gland destruction, functional impairment

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12
Q

Chronic pancreatitis

Epidemiology

A
  1. alcohol-related: >40 yo males >
  2. Hereditary/tropical forms: childhood
    -presents w/ recurring attacks of acute pancreatitis
    - complications like alcohol-related, only at a young age
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13
Q

Chronic pancreatitis

Etiology

A
  1. Alcohol
  2. Duct obstruction: stones, tumors
  3. Metabolic: hypercalcemia, hyperlipidemia
  4. Genetics
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14
Q

Chronic pancreatitis

Etiology – Genetics

A

Trypsinogen gene (PRSS1) –> 60-80% of hereditary CP

Cystic fibrosis (CFTR)

Serine protease inhibitor kazal type 1 (SPINK1)

Chymotrypsin C (CTRC)

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15
Q

Chronic pancreatitis

Symptoms

A

Abdominal pain, WT loss, N/V, jaundice

Steatorrhea (malabsorption 2/2 impaired pancreatic enzyme secretion)

Diabetes, pancreatic CA, portal vein thrombosis, ascites, pancreatic pseudocyst

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16
Q

Chronic pancreatitis

Labs
Micro

A

Elevated CA19-9 > 1000 (highly specific) –> pancreatic CA

M: Fibrosis & chronic inflammation – retention of normal lobular pancreatic architecture

Islets of langerhans preserves, my show pseudo hyperplasia

17
Q

Mucinous cystic neoplasms

A

Neoplasm of mucin-producing epithelial cells, assoc w/ ovarian-type stroma (precursors to invasive carcinomas)

18
Q

Mucinous cystic neoplasms

Gross

A

40-50 yo
Female»»

Body or tail of pancreas

Solitary & large

Multiloculated w/ thick walls filled w/ thick, tenacious mucoid material

19
Q

Mucinous cystic neoplasms

Micro

A

Tall, columnar, mucin- producing epithelium w/ varying degrees of cellular atypia

Ovarian-type stroma REQUIRED for dx (mimics a spindle cell stroma)

20
Q

Mucinous cystic neoplasms

Symptoms

A

Vague
Abdominal symptoms (pain, fullness)
Compression of adjacent organs/tissue

21
Q

Intraductal papillary mucinous neoplasm (IPMN)

A

Grossly visible mucin-producing epithelial neoplasm present w/in main pancreatic duct and/or branches

22
Q

Intraductal papillary mucinous neoplasm (IPMN) v. Mucinous cystic neoplasms

A
  1. Absence of dense ovarian stroma
  2. Involvement of pancreatic duct
23
Q

Intraductal papillary mucinous neoplasm (IPMN)

Epidemiology
Risk Fx
Symptoms

A

Mid-60s
Fam hx of diabetes or pancreatic ductal adenocarcinoma

Asymptomatic, nonspecific
-Abdominal, back pain, anorexia, wt loss
-Symptoms often present for month-years before dx

24
Q

Intraductal papillary mucinous neoplasm (IPMN)

Gross
Endoscopy
Micro

A

Pancreatic HEAD
Markedly dilated pancreatic duct w/ abundant mucin

Mucin extravasation from patulous ampulla of Vater

M: flat or papillary mucinous epithelium

25
Q

Serous cystic neoplasm (serous cystadenoma)

A

Benign, cystic epithelial neoplasm

Anywhere in pancreas, mainly the tail

26
Q

Serous cystic neoplasm (serous cystadenoma)

Sx

A

Abdominal mass/pain (larger – more likely to have sx)

No comunication of cyst to pancreatic ductals sys

Sponge-like or honeycomb appearance

Numerous, tightly packed cysts

27
Q

Pancreatic intraepithelial neoplasia (PanIN)

A

Noninvasive pancreatic intraductal epithelial proliferation, precursor of pancreatic ductal adenocarcinoma

28
Q

Pancreatic intraepithelial neoplasia (PanIN)

Micro

A

Enlarged hyperchromatic nuclei & slight loss of nuclear polarity

Prominent cytologic atypia, variably prominent nuclei, loss of polarity

29
Q

Pancreatic exocrine neoplasia (pancreatic adenocarcinoma, duct cell adenocarcinoma)

A

Malignant epithelial neoplasm arising in pancreatic ductal system w/ glandular differentiation

85-90% of all pancreatic adenocarcinomas

60-80 yo male
» AA

30
Q

Pancreatic exocrine neoplasia (pancreatic adenocarcinoma, duct cell adenocarcinoma)

Patho

A

Multifactorial

Precursor lesions: pancreatic intraepithelial neoplasia, intraductal papillary mucinous neoplasm, mucinous cystic neoplasm

Familial pancreatic CA (increased risk w/ inherited syndromes w/ known germline mutations)

31
Q

Pancreatic exocrine neoplasia (pancreatic adenocarcinoma, duct cell adenocarcinoma)

Gross

A

Can arise anywhere in pancreas (HEAD»>)

Solid & firm mass w/ ill-defined borders

Bile & pancreatic ducts dilated

Adjacent areas of fibrosis, secondary to chronic pancreatitis

Common bile duct & duodenum invasions common

32
Q

Pancreatic exocrine neoplasia (pancreatic adenocarcinoma, duct cell adenocarcinoma)

Micro

A

Loss of lobular configuration

Sharp angulated edges of malignant glands

Neoplastic glands in close proximity to a thick-walled vessel

33
Q

Pancreatic exocrine neoplasia (pancreatic adenocarcinoma, duct cell adenocarcinoma)

Sx

A

Painless jaundice and pruritus if common bile duct obstructed

WT loss, epigastric pain – radiates to back, anorexia, depression

CA19-9 elevated, lewis blood group antigen increased

Migratory thrombophlebitis (Trousseau syndrome)

GEMS (20 decks)

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