Pathology of the Pancreas Flashcards
Pancreatitis
Pancreatitis is inflammation of the pancreas … ‘itis’ meaning inflammation
Classifications:
Acute or chronic; mild, moderate, or severe
Causes: Biliary disease Alcohol abuse Trauma Ulcers Idiopathic
S&S: Abdominal pain Nausea and vomiting History of gallstones Alcoholism Fever Increased enzymes Increased leukocytes Abdominal distension Jaundice Malabsorption
Ultrasound presentation – acute pancreatitis : Hyperechoic parenchyma Homogeneous pancreas Enlarged pancreas Oedema through parenchyma Irregular pancreatic outline Peripancreatic fluid
Chronic Pancreatitis
- Results from recurrent attacks of acute pancreatitis
- Continued prolonged inflammatory and fibrosing process
- Causes destruction of the pancreatic parenchyma – may be localised
- Most often associated with chronic alcoholism or biliary disease
Patient may also have:
- Pseudocysts (25% to 40%)
- Ascites
- Dilated common bile duct
- Thrombosis of the splenic vein with extension into the portal vein
- Increases risk of patient developing pancreatic cancer
Ultrasound presentation – chronic pancreatitis:
- Hyperechoic gland (often diffuse) indicative of fibrotic changes
- Heterogeneous pancreas
- Atrophied pancreatic tissue
- Irregular pancreatic outline
- Double duct sign – dilated pancreatic duct and dilated CBD
- Calcifications noted in one or both ducts
- Peripancreatic fluid may be present
Pancreatic Pseudocyst
- Pseudocysts are always acquired; they result from trauma to the gland or from acute or chronic pancreatitis.
- A collection of fluid that arises from the loculation of inflammatory processes, necrosis, or hemorrhage.
- Pseudocysts develop in 10% to 20% of patients with acute pancreatitis.
- Pseudocysts develop when pancreatic enzymes escape from the gland and break down adjacent tissue to form a sterile abscess somewhere in the abdomen.
- Pseudocysts develop 4 to 6 weeks after the onset of pancreatitis.
S&S include: Nausea / vomiting Loss of appetite Unexplained weight loss Diarrhea Fever Tender mass in abdomen Jaundice
Pancreatic Cysts
Causes: - Autosomal dominant polycystic disease - Congenital cystic lesions of the pancreas - Cystic fibrosis - Fibrocystic disease of the pancreas - Von Hippel-Lindau syndrome Solitary pancreatic cysts
Pancreatic Adenocarcinomas
A cancer that develops in the lining or inner surface of the pancreas and usually has secretory properties
- Involves exocrine portion of the gland (ductal epithelium)
- Most common primary neoplasm of the pancreas
- Accounts for more than 90% of all malignant pancreatic tumours.
- Accounts for approximately 5% of all cancer deaths and is the fourth most common cause of cancer-related mortality, after lung, breast, and colon cancer.
- Mainly found in the pancreatic head and uncinate process (2/3 of the time)
Risk factors: Cigarette smoking – strongest environmental risk factor Diet high in animal fats and proteins Obesity Family history Hereditary syndromes ETOH++
S&S:
Abdo pain radiating to the back (most common)
New onset of NIDDM or existing diabetes becoming more difficult to control
LOA or unexpected weight loss
Nausea / vomiting
Diarrhea / constipation
Painless jaundice and enlarged GB (Courvoisier gallbladder)
Itchy skin (associated with jaundice)
Ultrasound Presentation:
Heterogeneous hypoechoic solid mass
May have a cystic component
Double duct sign if mass in pancreatic head
Neuroendocrine Tumours (Islet Cell Tumours)
Form in hormone-making cells (islet cells)
- May or may not have signs or symptoms that vary depending on the type of NET
- Different kinds of functional NETs that make extra hormones (gastrin, insulin, glucagon) that cause specific signs and symptoms
- Some are non-functional (do not make extra amounts of hormones). Signs and symptoms caused by growth of tumour (mass effect).
- Lab tests used to detect and diagnose NETs
Gastrinoma
Gastrinoma:
- Forms in cells that make gastrin, a hormone that causes the stomach to release an acid to digest food
- Both gastrin and stomach acid are increased with gastrinomas
- Usually forms in head of the pancreas and sometimes in the small intestines
- Most are malignant
S&S: recurrent stomach ulcers, pain in abdo spreading to back (may go away with antacid), gastro-oesophageal reflux, diarrhea
Insulinoma
Insulinoma:
- Forms in cells that make insulin, a hormone that controls the amount of glucose in the blood. It moves glucose into the cells where it can be used for energy.
- Slow growing, rarely spreads
- Forms in head, body, or tail of the pancreas and sometimes in the small intestines
- Usually benign
S&S: hypoglycaemia with accompanying signs – blurred vision, headache, feeling lightheaded, tired, weak, shaky, nervous, irritable, sweaty, confused, hungry, fast heartbeat
Glucagonoma
Glucagonoma:
- Forms in cells that make glucagon, a hormone that causes the liver to break down glycogen into glucose. Too much glycogen in the blood causes hyperglycaemia (high blood sugar).
- Slow growing, rarely spreads
- Forms in tail of the pancreas
- Most are malignant
S&S: skin rash (on face, stomach or legs), high blood sugar level – headaches, frequent urination, dry skin and mouth, feeling hungry, thirsty, tired, or weak; blood clots (in the lungs – SOB, cough, pain; in the arms or legs – pain, swelling, warmth, redness); diarrhea, unexpected weight loss, sore tongue or sores in corners of mouth
Non-functional Pancreatic NET
Non-functional pancreatic NET:
- May grow for a long time without causing S&S.
- May grow large or spread to other parts of the body before S&S are seen (diarrhea, indigestion, lump in abdo, pain in abdo or back, jaundice)
- Most are malignant
Fatty Infiltrated Pancreas
Related to obesity and the aging processes
Causes: Pancreatitis Metabolic and hormonal disorders ETOH++ Some medication Liver disease
When due to dyslipidaemia and hyperglycaemia – called “non-alcoholic fatty pancreas disease”
Ultrasound Presentation:
Diffuse hyperechoic parenchyma when compared to normal
Can be enlarged
More attenuating
