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D-Pancreas pathology

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PANCREAS

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OBJECTIVES Understand the etiology/riskfactors, pathogenesis,morphology, clinical features

and outcome of pancreaticinflammations andneoplasms

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Ventral Bud

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Chapter 19

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Posterior view of duodenum/pancreas

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Lymphatic drainage of the distalpancreas and spleen

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Hepaticopancreatic ampulla(Ampulla of Vater)

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L2

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makes HCO3!

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Pancreatic Enzymes Amylase

Lipase

DNA-ase

RNA-ase

Zymogens: Trypsinogen

ChymotrypsinogenProcarboxypeptidase A, B

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PANCREAS DISEASES

CongenitalInflammatory

Acute

Chronic

CystsNeoplasms

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Congenital Agenesis (very rare)

Pancreas Divisum (failure of 2

ducts to fuse)(common)

Annular Pancreas (pancreas

encircles duodenum)(rare)

Ectopic Pancreas (very common)

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PANCREATITIS ACUTE (VERY SERIOUS)

CHRONIC (Calcifications,Pseudocyst)

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CONSEQUENCES of ACUTE and CHRONIC pancreatitis

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ACUTE PANCREATITIS

ALCOHOLISM

Bile reflux Medications (thiazides)

Hypertriglyceridemia, hypercalcemia

Acute ischemia

Trauma, blunt, iatrogenic Genes: PRSS1, SPINK1

Idiopathic, 10-20%

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CLINICAL FEATURES

ABDOMINAL PAIN

EXTREME emergency situation

HIGH mortality

but MOST important lab test

is.?????

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AMYLASE

!!!!!!!

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MORPHOLOGY EDEMA

FAT NECROSIS

ACUTE INFLAMMATORY INFILTRATE

PANCREAS AUTODIGESTION

BLOOD VESSEL DESTRUCTION

SAPONIFICATION (stearates, Na+, Ca++)

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CHRONIC PANCREATITIS

Pancreatic duct obstruction,LONGSTANDING

Tropical

Hereditary (PRSS1, SPINK1

mutations)

IDIOPATHIC (40%)

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CHRONIC PANCREATITIS

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CLINICAL FEATURES

Abdominal Pain

Vague abdominal symptoms

Nothing

CT calcifications (why?), amylase

elevated, chronic diarrhea if chronicpancreatic insuffiency develops, highlikelihood of pseudocysts

PDEUDOCYSTS

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PDEUDOCYSTS Why pseudo?

STRONGLY linked with pancreatitis

Can be as big as a football and often

are.

Can cause obstruction

Can get infected

Do NOT become malignant

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P N l

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Pancreas Neoplasms

Serous

Mucinous

Cystic

Microcystic

Papillary

Benign

Malignant (dense sclerosis is therule)

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SEROUS

CYSTADENOMA

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MUCINOUSCYSTADENOMA

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INTRADUCTAL

PAPILLARY

MUCINOUS

NEOPLASM

CARCINOGENESIS

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CARCINOGENESIS

of PANCREATIC

ADENOCARCINOMA

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Pancreatic CA

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Pancreatic

Adenocarcinoma

FATE

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FATE: Regional lymph nodes

Liver

Often L-2 spine

Lungs

Grading (WMP), Staging, TNM

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Final TIPof the day Painless jaundice in an

elderly person is

CARCINOMA of the headof the pancreas until

proven otherwise