Pancreatic and Gall Bladder Pathology Flashcards
What is acute pancreatitis loosely described as?
Inflammation of the pancreas, associated with acinar cell injury ( dilated vessels, dark necrotic tissue, hemorrhage)
What are the four main categories of pancreatitis? (etiology)
Metabolic- alcohol (mc)
Mechanical- Gallstones (mc), trauma
Vascular- shock, vasculitis
Infection- mumps
What is the pathology of pancreatitis, and what are the consequences?
Autodigestion by pancreatic enzymes, cell injury repsonse mediated by inflammatory cytokines.
Proteases break down cells, ducts and islets; Lipases cause fat necrosis; elastases break down bv’s; cell injry response causes inflammation, oedema, ischaemia and impaired blood flow
What appear to be the key events in triggering acute pancreatitis?
Obstruction- increases intrapancreatic pressure, more enzymes, lipase causes fat destruction, promotes edema, this can compromise blood flow
Acinar cell injury- by alcohol etc, release of enzymes
What are some clinical features of acute pancreatitis?
Acute epigastric pain; nausea and vomiting; fever and tachycardia
How can acute pancreatitis be diagnosed?
- High white cell count
- elevated serum amylase or lipase
- CT scan for edema, nerosis or pseudocysts
How can acute pancreatitis be managed?
Iv fluids; NG suction; analgesia; close monitoring (avoid pancreatic activity, ie eating)
What is chronic pancreatitis?
Repeated bouts of pancreatic inflammation, loss of pancreatic tissue and more fibrous tissue (late stages of inflammation) (NB 60-70% heavy alcohol intake)
What is the pathology of chronic pancreatitis?
Fibrous/rock hard pancreas with atrophy of the exocrine component.
What are clinical features of chronic pancreatitis?
epigastric pain repeatedly, often after alcohol consumption
Can appear on scans with pseudocysts, and also loss of exocrine function.
How is chronic pancreatitis diagnosed?
Clinical suspicion mostly, serum amylase is not always elevated as potential loss of exocrine function.
CT imaging
Where does pancreatic adenocarcinoma present?
Males more than females, aged above 50 with late presentation
What is the pathology of pancreatic adenocarcinoma?
60-70% in pancreas head- invade the ampulla and cause biliary obstruction (jaundice, pale stool and dark urine)
less in body and tail- often slient and can spread.
What are clinical features of PA?
Jaundice, pain, weight loss, pancreatitis, thrombophlebitis.
usually diagnosed on imaging.
** Are there islet cell tumours?
They are rare, and mostly benign.
eg and insulinoma will cause hypoglycaemia
