Pathology Of The Pancreas... 23

Front 1

Egs of

1.Exocrine pathology of the pancreas

2. Endocrine pathology of the pancreas

Back 1

1.Exocrine pathology of the pancreas include;

a) cystic fibrosis,

b) congenital anomalies,

c) acute and chronic pancreatitis,

d) pseudocysts, and

e) neoplasms.

2. Endocrine pathology of the pancreas:

a) DM and

b) exocrine neoplasms.

Front 2

List Egs of congenital anomalies of the pancreas .. Which is the commonest?

Back 2

1. Agenesis

2. Pancreas divisum

3. Annular pancreas

4. Ectopic pancreas

Pancreas divisum Is the commonest.

Front 3

About pancreas divisum; intro, incidence, is caused by?

Back 3

PANCREAS DIVISUM : Pancreas divisum is the most common congenital anomaly of the pancreas, with an incidence of 3% to 10%. This anomaly is caused by a failure of fusion of the fetal duct systems of the dorsal and ventral pancreatic primordia.

Front 4

What part of the duodenum is affected in annular pancreas

Back 4

The second part of the duodenum is affected in annular pancreas..

Front 5

About annular pancreas

Back 5

ANNULAR PANCREAS Annular pancreas is a band-like ring of normal pancreatic tissue that completely encircles the second portion of the duodenum. It can be associated with signs and symptoms of duodenal obstruction such as gastric distention and vomiting.

Front 6

About ectopic pancreas

Back 6

ECTOPIC PANCREAS: Aberrantly situated pancreatic tissue seen outside its normal anatomical site. The favored sites for ectopic pancreas are the stomach and duodenum, followed by the jejunum, Meckel diverticula, and ileum.

Front 7

Favorite sites for ectopic pancreas are?

Back 7

The favored sites for ectopic pancreas are

1. the stomach and

2.duodenum,

followed by the

3. jejunum,

4.Meckel diverticula, and

5. ileum.

Front 8

Define acute Vs chronic pancreatitis

Back 8

Acute pancreatitis is reversible pancreatic parenchymal injury associated with inflammation.

Chronic pancreatitis is defined as prolonged inflammation of the pancreas with irreversible destruction of exocrine parenchyma, fibrosis, and, in the late stages, the destruction of endocrine parenchyma.

Front 9

Causes of acute pancreatitis

Back 9

1. Metabolic

2. Mechanical

3. Vascular

4. Infections

5. Genetic

Front 10

List the outline you will use to discuss acute pancreatitis

Back 10

1. Intro / definition

2. Epidemiology

3. Causes

4. Pathogenesis

5. Morphology

6. Clinical features

7. Treatment

8. Conclusion

Front 11

Causes of acute pancreatitis + Egs

Back 11

1.METABOLIC:Alcoholism, hyperlipoproteinemia hypercalcemia,

Drugs (e.g., azathioprine) 2.MECHANICAL: Gallstones, Trauma, Iatrogenic injury, Operative injury, Endoscopic procedures with dye injection

3.VASCULAR: Shock, Atheroembolism, Vasculitis 4.INFECTIOUS: Mumps virus. 5.GENETIC: Mutations in the cationic trypsinogen -trypsin inhibitor genes.

Front 12

Eg of drugs that cause cause acute pancreatitis

Back 12

1. Azathioprine

Front 13

About morphology of acute pancreatitis

Back 13

Macroscopically: The pancreatic substance shows areas of red-black hemorrhage interspersed with foci of yellow-white, chalky fat necrosis. Foci of fat necrosis may also be found in extra-pancreatic collections of fat. Microscopically: Edema, fat necrosis, inflammatory cells, destruction of pancreatic parenchyma, and destruction of blood vessels and subsequent interstitial hemorrhage.

Front 14

Clinical features of acute pancreatitis

Back 14

Abdominal pain and is often referred to the upper back and occasionally can be associated with referred pain to the left shoulder. Anorexia, nausea, and vomiting Full-blown acute pancreatitis is a medical emergency and it usually leads to onset of an “ACUTE ABDOMEN.” There is associated release of toxic enzymes, cytokines, and other mediators into the circulation and explosive activation of the systemic inflammatory response, resulting in leukocytosis, hemolysis, disseminated intravascular coagulation, fluid sequestration, acute respiratory distress syndrome, and diffuse fat necrosis, Peripheral vascular collapse and shock with acute renal tubular necrosis .

Front 15

Epidemiology of 1. Chronic pancreatitis. 2. Acute pancreatitis

Back 15

. EPIDEMIOLOGY:

1. Chronic pancreatitis -->The prevalence of chronic pancreatitis ranges between 0.04% and 5%.

2. Acute pancreatitis -->Acute pancreatitis is relatively common, with an annual incidence rate in Western countries of 10 to 20 cases per 100,000 people. Biliary tract disease and alcoholism account for approximately 80% of cases in Western countries . Gallstones are also implicated in cases of acute pancreatitis. The male-to-female ratio is 1 : 3 in the group with biliary tract disease and 6 : 1 in those with alcoholism.

Front 16

Most common cause of acute pancreatitis is

Back 16

Long time alcohol abuse

Front 17

Causes of chronic pancreatitis

Back 17

A. the most common cause of chronic pancreatitis is long-term alcohol abuse.

B. Long-standing obstruction of the pancreatic duct by pseudocysts, calculi, trauma, neoplasms, or pancreas divisum.

C. Hereditary pancreatitis, which is caused by germline mutations in PRSS1 (cationic trypsinogen gene) or SPINK1 or CFTR gene mutations

D. Autoimmune injury to the gland.

Front 18

Hereditary pancreatitis is

1. A cause of?

2. Is caused by?

Back 18

1. A cause of chronic pancreatitis

2. Hereditary pancreatitis, which is caused by germline mutations in PRSS1 (cationic trypsinogen gene) or SPINK1 or CFTR gene mutations .

Front 19

Chronic pancreatitis most often follows

Back 19

Repeated episodes of acute pancreatitis

Front 20

Discuss pathogenesis of chronic pancreatitis

Back 20

Chronic pancreatitis most often follows repeated episodes of acute pancreatitis. It has been proposed that acute pancreatitis initiates a sequence of perilobular fibrosis, duct distortion, and altered pancreatic secretions. Whatever is the cause of chronic pancreatitis can lead to loss of pancreatic parenchyma and fibrosis. Cytokines produced during chronic pancreatitis are similar to those produced in acute pancreatitis, but the fibrogenic cytokines tend to predominate in chronic pancreatitis These cytokines like transforming growth factor β (TGF-β) and PDGF induce the activation and proliferation of periacinar myofibroblasts (pancreatic stellate cells), resulting in the deposition of collagen and ultimately fibrosis.

Front 21

List Egs of pancreatic carcinoma, which is the most common?

Back 21

Pancreatic carcinoma: 1.Adenocarcinoma: Ductal carcinoma is the commonest carcinoma. Adenosquamous carcinomas, colloid carcinoma, hepatoid carcinoma, medullary carcinoma, signet-ring cell carcinoma, undifferentiated carcinoma, and undifferentiated carcinomas with osteoclast-like giant cells. Acinar cell carcinoma Pancreatoblastoma