Pathology Flashcards
What is chronic pancreatitis
Chronic inflammation with fibrosis and irreversible loss of pancreatic parenchyma
Commonest cause of chronic pancreatitis
Alcohol abuse
Clinical presentations of chronic pancreatitis
Recurrent severe abdominal pain Malabsorption Jaundice Abdo pain following food, alcohol or opiates Symptomless Diabetes
How to diagnose chronic pancreatitis
Abdo xray or
ERCP or MRCP of ducts
Aetiology of chronic pancreatitis
repeated episodes of acute pancreatitis Chronic alcohol abuse causing toxic damage to acini Chronic pancreatic duct pbstruction Cystic fibrosis HAemochromatosis Hyperlipidaemia Tropical pancreatitis Autoimmune pancreatitis Idiopathic
Morphology of pancreatitis
Fibrosis
Chronic inflammation
Destruction and atrophy of pancreatic acini
Islets of Langerhans initially spared
Duct strictures and dilatations
Hard shrunken pancreas containing plugged dilated ducts
May mimic cancer
Complications of chronic pancreatitis
Malabsorption Diabetes Pseudocysts Episodes of acute pancreatitis Pancreatic cancer if hereditary chronic pancreatitis Death
Commonest cause of acute pancreatitis
Gallstones
Presentation of acute pancreatitis
Severe abdo pain
N&V
Shock
It’s complication
Blood of acute pancreatitis
elevated serum amylase and lipase Hyperglycaemia in severe cases Mild elevation of ALP and bilirubin decreased serum albumin and calcium Neutrophilia
Causes of acute pancreatitis
Pancreatic duct obstruction
Metabolic
Vascular (under perfusion of pancreas)
Infections
What can cause obstruction of pancreatic ducts
Stones Alcoholism Traume e.g. ERCP Tumours Parasites
Metabolic conditions that cause acute pancreatitis
Alcohol Hyperlipidaemia Hypercalcaemia Drugs e.g. thiazide diuretics, morphine, steroids Idiopathic
Which conditions can cause under perfusion of the pancreas which can cause ischaemic damage and acute pancreatitis
SHock Vasculitis Atherosclerosis Embolism of atheroma Hypothermia
Infectious causes of acute pancreatitis
Mumps EBV CMV Coxsackie virus Mycoplasma pneumonia
What is the mechanism of damage in acute pancreatitis
Pancreatic enzymes released from damaged acinar cells
- Enzymes include proteases, amylase, lipase and phospholipase.
- Leads to necrosis of pancreatic tissue which leads to inflammation and haemorrhage
Morphology of acute pancreatitis
Inflammation OEdema NEcrosis HAemorrhage Fat necrosis from action of liberated lipase (make soaps due to fatty acids binding to calcium)
Local complications of acute pancreatitis
Abscess formation
Pancreatic pseudocyst
Systemic complications of acute pancreatitis
Diabetes HYpocalcaemia Adult respiratory distress syndrome Disseminated intravascular coagulation Multiorgan failure Death
What is Meckel’s diverticulum
Incomplete regression of Vitelli-intestinal duct
Complications of mockers diverticulum
MOst asymptomatic
May become inflamed resembling acute appendicitis
Heterotopic gastric mucosa may ulcerate, bleed and perforate
Intussusception
