ch19 pancreas
TRANSCRIPT
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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