Digestive Pathology

Front 1

Pancreatic Divisum

Back 1

1. Failure of fusion of the dorsal & ventral primordial fetal duct system

2. Predisposes to chronic pancreatitis

Front 2

Annular Pancreas

Back 2

1. Band-like ring of pancreatic tissue around the second part of the duodenum

2. Risk of intestinal obstruction

Front 3

Acute Pancreatitis

Back 3

1. Inflammation and hemorrhage of the pancreas; associated with acing cell injury

2. Autodigestion of parenchyma by pancreatic enzymes activated by trypsin.

3. Liquefactive hemorrhagic necrosis of the pancreas and fat necrosis of peripancreatic fat.

Front 4

Acute Pancreatitis: Causes

Back 4

1. Alcohol and Gallstones (80%)

2. Trauma, hypolipidemia

3. Drugs, Scorpion Stings, Mumps

4. Rupture of posterior duodenal ulcer

Front 5

Acute Pancreatitis: Clinical Features

Back 5

1. Epigastric pain that radiates to the back

2. Nausea and vomiting

3. Periumbilical and flank hemorrhage

4. Elevated serum lipase and amylase; lipase is more specific

5. Saponification; calcium binds w/ released fatty acids in areas of fat necrosis

Front 6

Acute Pancreatitis: Complications

Back 6

1. Shock (result of hemorrhage and kinin system)

2. Pancreatic pseudocyst

3. Abscess

4. DIC and ARDS

Front 7

Acute Pancreatitis: Morphology

Back 7

1. Proteolytic destruction of pancreatic tissue

2. Necrosis of blood vessels w/ subsequent interstitial hemorrhage

3. Fat necrosis by lipolytic enzymes

4. Associated acute inflammatory reaction

Front 8

Chronic Pancreatitis

Back 8

1. Repeated bouts of mild to moderate pancreatic inflammation

2. Damaged tissue replaced by fibrosis

3. Seen most often in middle-aged alcoholic males

Front 9

Chronic Pancreatitis: Causes

Back 9

1. Alcohol (Adults)

2. Cystic Fibrosis (Children)

3. Longstanding obstruction of duct by gallstones

4. Pancreas divisum

Front 10

Chronic Pancreatitis: Clinical Features

Back 10

1. Epigastric abdominal pain that radiates to the back

2. Pancreatic insufficiency- results in malabsorption w/ steatorrhea and fat soluble vitamin deficiencies.

3. Dystrophic calcification; "chain of lakes" pattern due to dilatation of ducts

4. Secondary Diabetes Mellitus

5. Increased risk for Pancreatic Carcinoma

Front 11

Chronic Pancreatitis: Morphology

Back 11

1. Densely fibrotic organ w/ atrophic exocrine glands

2. Chronic inflammation around the lobules

3. Ducts w/ proteinaceous plugs

4. Calcification seen grossly

Front 12

Pancreatic Pseudocyst

Back 12

1. Cystic space formed by wall of fibrosis and filled w/ blood & necrotic tissue

2. No true epithelial lining

3. Caused by acute and chronic pancreatitis

4. May present as abdominal mass

Front 13

Tumors of the Pancreas

Back 13

1. Cystadenoma

2. Intraductal mucinous neoplasms

3. Adenocarcinoma

**Arises from the exocrine portion of the pancreas, associated with cigarette smoking**

Front 14

Tumors of the Pancreas: Associations

Back 14

1. 60-70% arise in the head of the pancreas

2. Adenocarcinomas arise from ductal epithelium

3. Lesions of the head obstruct bile flow at the ampullary region

4. Body and tail lesions remain silent and invade adjacent tissue

Front 15

Adenocarcinoma of the Pancreas

Back 15

1. Arises from ducts; very aggressive tumor

2. Associated with CA19-9 marker

3. Usually metastasized by presentation

Front 16

Adenocarcinoma of the Pancreas: Risk Factors

Back 16

1. Tobacco Use

2. Chronic Pancreatitis (> 20 years)

3. Diabetes

4. Age > 50 years

5. Jewish and African American Males

Front 17

Adenocarcinoma of the Pancreas: Clinical Features

Back 17

1. Abdominal pain radiating to the back

2. Weight Loss (due to malabsorption)

3. Migratory Thrombophlebitis- redness and tenderness on palpation of extremities (Trousseau Syndrome)

4. Obstructive jaundice w/ palpable, nontender gallbladder

Front 18

Adenocarcinoma of the Pancreas: Treatment

Back 18

1. Whipple Procedure

2. Chemotherapy, Radiation