pancreas Flashcards
microvascular leakage causing edema, (2) necrosis of fat by lipases, (3) an acute inflammatory reaction, (4) proteolytic destruction of pancreatic parenchyma, and (5) destruction of blood vessels leading to interstitial h
interstitial edema and focal areas of fat necrosis in the pancreas and peripancreatic fat
acute necrotizing pancreatitis, the damage also involves acinar and ductal cells, the islets of Langerhans, and blood vessels. Macroscopically, the pancreas exhibits red-black hemorrhagic areas interspersed with foci of yellow-white, chalky fat necrosis (Fig. 17.2B). Fat necrosis also can occur in extrapancreatic fat, including the omentum and bowel mesentery, and even outside the abdominal cavity (e.g., in subcutaneous fat). In most cases, the peritoneum contains a serous, slightly turbid, brown-tinged fluid with globules of fat (derived from enzymatically digested adipose tissue). In the most severe form, hemorrhagic pancreatitis, extensive parenchymal necrosis is accompanied by diffuse hemorrhage within the substance of the gland.
abdominal pain
elevated levels of amylase lipase
acute abdomen w pain, guarding no bowel sounds
Laboratory findings include markedly elevated serum amylase during the first 24 hours, followed (within 72–96 hours) by rising serum lipase levels. Hypocalcemia can result from precipitation of calcium in areas of fat necrosis; if persistent, it is a poor prognostic sign. The enlarged inflamed pancreas can be visualized by computed tomography (CT) or magnetic resonance imaging (MRI).
supportive therapy (e.g., maintaining blood pressure and alleviating pain) and “resting” the pancreas by total restriction of oral food and fluids. In 40% to 60% of cases of acute necrotizing pancreatitis, the necrotic debris becomes infected, usually by gram-negative organisms from the alimentary tract,
acute pancreatitis (and in particular, alcoholic pancreatitis) is a pancreatic pseudocyst. Liquefied areas of necrotic pancreatic tissue become walled off by f ibrous tissue to form a cystic space, lacking an epithelial lining
