Pancreas and Gallbladder Pathology Flashcards
What is this?
Exocrine component of pancreas
What is this?
Endocrine component of pancreas
What is acute pancreatitis?
Acute inflammation of the pancreas caused by aberrant release of pancreatic enzymes.
What are general categories of causes of acute pancreatitis?
Duct obstruction
Metabolic/toxic
Poor blood supply
Infection/Inflammation
Autoimmune
Idiopathic (15%)
What are examples of duct obstruction which may lead to acute pancreatitis?
Gall stones (50%)
Trauma
Tumours
What are examples of metabolic/toxic which may cause acute pancreatitis?
Alcohol (33%) - 5% of alcoholics develop acute pancreatitis
Drugs (e.g. thiazides)
Hypercalcaemia
Hyperlipidaemia
What are examples of poor blood supply which may cause acute pancreatitis?
Shock
Hypothermia
What are examples of infection/inflammation which may cause acute pancreatitis?
Viruses (e.g. mumps)
How can duct obstruction lead to acute pancreatitis?
Gallstone stuck distal to where the common bile duct and pancreatic ducts join leads to: reflux of bile up the pancreatic duct followed by damage to acini and release of proenzymes which then become activated.
Alcohol leads to spasm/oedema of Sphincter of Oddi and the formation of a protein rich pancreatic fluid which obstructs the pancreatic ducts.
What are patterns of injury for acute pancreatitis?
Periductal: Necrosis of acinar cells near ducts (usually secondary to obstruction).
Perilobular: Necrosis at the edges of the lobules (usually due to poor blood supply).
Panlobular: Develops from periductal and perilobular.
What is the pathophysiology of acute pancreatitis?
Activated enzymes > acinar necrosis > enzyme release etc.
Ranges from stromal oedema, to haemorrhagic necrosis.
e.g. Lipases > fat necrosis (calcium ions bind to free fatty acids forming soaps which are seen as yellow-white foci)
What are pancreatitic complications of acute pancreatitis?
Pseudocyst
Abscess
What are systemic complications of acute pancreatitis?
Shock
Hypoglycaemia
Hypocalcaemia
What is the prognosis of acute pancreatitis?
Overall mortality up to 50% for haemorrhagic pancreatitis
What is this?
Acute pancreatitis
What is this?
Acute pancreatitis
What is chronic pancreatitis?
Relapsing or persistent, associated with acute pancreatitis in half of cases.
Relatively uncommon.
Mortality 3% per year.
What are causes of chronic pancreatitis?
Metabolic/toxic:
- Alcohol (80%)
- Haemochromatosis
Duct obstruction:
- Gallstones
- Abnormal pancreatic duct anatomy
- Cystic fibrosis (“mucoviscoidosis”)
Tumours
Idiopathic: Autoimmune
What is the pattern of injury of chronic pancreatitis?
Chronic inflammation with parenchymal fibrosis and loss of parenchyma.
Duct strictures with calcified stones with secondary dilatations.
What are complications associated with chronic pancreatitis?
Malabsorption
Diabetes mellitus
Pseudocyts
Carcinoma of the pancreas
What is this?
Chronic pancreatitis
What is this?
Chronic pancreatitis