Pancreatic & Gall Bladder Pathology Flashcards
Is the pancreas usually palpable? What does this mean for symptoms?
No. It is ‘hidden’, sits deep, tucked behind duodenum. Therefore symptoms are late & nonspecific
How is the pancreas a dual function organ?
It has both exocrine (80-90%) and endocrine (10-20%) components.
Exocrine function of the pancreas…
- Acinar cells and ducts
- Acini contain Zymogen granules
- release proenzymes that are activated by trypsin
Zymogens are? what are they for?
Inactive precursor enzymes (travel in zymogen granules) for trypsin, chymotrypsin, amylase, lipase, elastase
Prevent digestion of pancreas»_space; inflammatory response
Endocrine function of pancreas?
Islets of langerhans secrete insulin, glucagon
Involved in diabetes mellitus
The main pathologies of the pancreas?
1) Acute & chronic pancreatitis (inflamm/infect)
2) Pancreatic Adenocarcinoma (malignant)
3) Cystic Fibrosis (genetic)
What is acute pancreatitis, how is it classified?
Inflammation of the pancreas
Mild: 60-70% (low mortility rates)
Severe: 30-40% (20-30% mortility) due to multiorgan failure
Etiology of Pancreatitis
Mainly (80-90% due to these)
Alcohol (metabolic)
Gallstones (mechanical)
also
shock/vasculitis
What happens in pancreatitis?
- autodigestion by pancreatic enzymes (damaged cells release enzymes > further damage)
- This lead to a 2’ inflammatory response (cytokines)
What are the consequences of inappropriate pancreatic enzyme release?
Protease: proteolysis of acini, ducts, islets
Lipase: fat necrosis in pancreas + other sites
Elastase: BV destruction»_space; haemorrhage
Cell injury response»_space; inflammation, oedema, impaird blood flow, ischaemia
Key triggers of ACUTE pancreatitis
1) Obstruction : gall stones, ductal concentrations, ampullary obstruction, alcholism.
obstruction > High intrapancreatic ductal pressure > accumulation of enzyme rich fluid > fat necrosis > oedema/ inflammation > impaired BF > ischemia > acinar cell injury
2) Direct injury to acinar cells: enzyme release
Clinical symptoms/features of ACUTE pancreatitis?
- acute abdo pain (epigastric)
- nausea & vomiting
- Fever, tachycardia (inflammatory response)
- marked abdo tenderness (ileus or shock)
How can we diagnose ACUTE pancreatitis?
- Elevated WBC count (non-specific)
- Elevated serum amylase or lipase (non-specific)
- CT scan - oedema, necrosis, pseudocysts
- Rarely laparotomy
Management and treatment of pancreatitis…
“REST THE PANCREAS” (decrease stimulation/secretions)
- IV fluids (no food = no secretions)
- NG suction (remove gastric/ duodenal )
- Anaglasia
- Monitoring
Define CHRONIC pancreatitis
“repeated bouts of pancreatic inflammation with loss of pancreatic parenchyma and replacement by fibrous tissue)
If you were looking at chronic pancreatitis in a microscopic slide, what would you see?
Macrophagal tissue, necrosis, scarring
Etiology/causes of CHRONIC pancreatitis
-60-70% due to heavy alcohol intake (damage to pancreatic tissue)
also
-previous acute pancreatitis
-severe malnutrtion
Pathology of CHRONIC pancreatitis
- Fibrotic (can be rock hard)
- Atrophy of exocrine, but endocrine relatively spared (low risk of diabetes)
- Often calcified (seen in CT scan)
Clinical symptoms/ features of CHRONIC pancreatitis
- repeated attacks of abdominal pain, brought on by ALCOHOL
- persistent pain can also occur
if its ongoing you can see
- loss of exocrine function (rarely endocrine > diabetes)
- pseudocysts (scarring > cavities formed)
Diagnose CHRONIC pancreatitis by
serum amylase (not as prominant as acute) CT imaging
Pancreatic Carcinoma is
4th most common form of cancer death M>F most 50+ years, (peak 60-80) -poor prognosis (due to late presentation) -
Risk factors of adenocarcenoma
- smoking
- rare hereditary cases
- alcohol & coffee
- High BMI
% of adenocarcinoma
60-70% head
5-10% body
10-15% tail
20% diffuse
carcinoma of the head of pancreas
- invade ampulla, bilary obstruction (jaundice, pale stool, dark urine)
- Body and tail: remain silent, spreads to nodes, adjacent organs, liver, bones, lungs
Clinical features/symptoms of pancreatic andenocarcinoma
obstructive jaundice pain weight loss pancreatitis Thrombosis (SF veins) & venous thrombosis (deep veins)
DIAGNOSIS USUALLY MADE ON IMAGING
What increases the risk of Venous thrombosis?
cancer
Can pancreatic endocrine tumors occur?
If so what are their symptoms
Occasionally. These are rare.
- elaborate pancreatic hormones
eg) insulinoma: hypoglycaemia, most are benign (10%) malignant, treated with resection
