PANCREAS www.freelivedoctor.com
OBJECTIVES <ul><li>Understand the etiology/risk factors, pathogenesis, morphology, clinical features and outcome of pancre...
www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
Chapter 19 www.freelivedoctor.com
Posterior view of duodenum/pancreas www.freelivedoctor.com
Arterial supply and venous drainage of the pancreas and spleen www.freelivedoctor.com
Lymphatic drainage of the distal pancreas and spleen www.freelivedoctor.com
www.freelivedoctor.com
Hepaticopancreatic ampulla (Ampulla of Vater) www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
Pancreatic Enzymes <ul><li>Amylase </li></ul><ul><li>Lipase </li></ul><ul><li>DNA-ase </li></ul><ul><li>RNA-ase </li></ul>...
PANCREAS DISEASES <ul><li>Congenital </li></ul><ul><li>Inflammatory </li></ul><ul><ul><li>Acute </li></ul></ul><ul><ul><li...
Congenital <ul><li>Agenesis  (very rare) </li></ul><ul><li>Pancreas Divisum  (failure of 2 ducts to fuse)   (common) </li>...
www.freelivedoctor.com
www.freelivedoctor.com
PANCREATITIS <ul><li>ACUTE  (VERY SERIOUS) </li></ul><ul><li>CHRONIC </li></ul>www.freelivedoctor.com
CONSEQUENCES of ACUTE and CHRONIC pancreatitis www.freelivedoctor.com
ACUTE PANCREATITIS <ul><li>ALCOHOLISM </li></ul><ul><li>Bile reflux </li></ul><ul><li>Medications (thiazides) </li></ul><u...
CLINICAL FEATURES <ul><li>ABDOMINAL PAIN </li></ul><ul><li>EXTREME emergency situation </li></ul><ul><li>HIGH mortality </...
AMYLASE www.freelivedoctor.com
MORPHOLOGY <ul><li>EDEMA </li></ul><ul><li>FAT NECROSIS </li></ul><ul><li>ACUTE INFLAMMATORY INFILTRATE </li></ul><ul><li>...
www.freelivedoctor.com
www.freelivedoctor.com
CHRONIC PANCREATITIS <ul><li>Pancreatic duct obstruction, LONGSTANDING </li></ul><ul><li>Tropical </li></ul><ul><li>Heredi...
www.freelivedoctor.com
www.freelivedoctor.com
CHRONIC PANCREATITIS www.freelivedoctor.com
CLINICAL FEATURES <ul><li>Abdominal Pain </li></ul><ul><li>Vague abdominal symptoms </li></ul><ul><li>Nothing </li></ul><u...
PDEUDOCYSTS <ul><li>Why “pseudo”? </li></ul><ul><li>STRONGLY linked with pancreatitis </li></ul><ul><li>Can be as big as a...
www.freelivedoctor.com
www.freelivedoctor.com
Pancreas Neoplasms <ul><li>Serous </li></ul><ul><li>Mucinous </li></ul><ul><li>Cystic </li></ul><ul><li>Microcystic </li><...
SEROUS CYSTADENOMA www.freelivedoctor.com
MUCINOUS CYSTADENOMA www.freelivedoctor.com
INTRADUCTAL PAPILLARY MUCINOUS “ NEOPLASM” www.freelivedoctor.com
CARCINOGENESIS of PANCREATIC ADENOCARCINOMA www.freelivedoctor.com
Pancreatic CA www.freelivedoctor.com
PancreaticAdenocarcinoma www.freelivedoctor.com
FATE: <ul><li>Regional lymph nodes </li></ul><ul><li>Liver </li></ul><ul><li>Often T-2 spine </li></ul><ul><li>Lungs </li>...
Final  TIP  of the day <ul><li>Painless jaundice in an elderly person is CARCINOMA of the head of the pancreas until prove...
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Pancreas pathology

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  • Know fates of dorsal and ventral buds.
  • Know fates of dorsal and ventral buds.
  • Know fates of dorsal and ventral buds.
  • Know fates of dorsal and ventral buds.
  • Know fates of dorsal and ventral buds.
  • Know main anatomical landmarks and relationships to other organs
  • Recall blood flow, arterial, venous.
  • “ Peri-”pancreatic lymph nodes, several groups.
  • Pancreatic duct, the MAIN one from the VENTRAL bud, “usually” empties into the most dstal portion of the CBD (Common Bile Duct)
  • EGD (Esophago, Gastro, Duodenoscopy)
  • Axial diagram.
  • Typical CT landmarks.
  • Typical CT landmarks, with contrast.
  • Histology concepts.
  • H&amp;E, e.m.
  • Histology, H&amp;E
  • Classical classification again, our old friend.
  • Why the blurr? Microscope out of focus. What is autolysis?
  • Find the soap, find the calcium.
  • Unfortunately dense fibrosis is a feature BOTH of chronic pancreatitis as well as adenocarcinoma.
  • Small pseudocyst, showing organizing inflamation on right
  • Describe this in plain English.
  • Gross fibrosis on left, microscopic on right.
  • Pancreas pathology

    1. 1. PANCREAS www.freelivedoctor.com
    2. 2. OBJECTIVES <ul><li>Understand the etiology/risk factors, pathogenesis, morphology, clinical features and outcome of pancreatic inflammations and neoplasms </li></ul>www.freelivedoctor.com
    3. 3. www.freelivedoctor.com
    4. 4. www.freelivedoctor.com
    5. 5. www.freelivedoctor.com
    6. 6. www.freelivedoctor.com
    7. 7. www.freelivedoctor.com
    8. 8. Chapter 19 www.freelivedoctor.com
    9. 9. Posterior view of duodenum/pancreas www.freelivedoctor.com
    10. 10. Arterial supply and venous drainage of the pancreas and spleen www.freelivedoctor.com
    11. 11. Lymphatic drainage of the distal pancreas and spleen www.freelivedoctor.com
    12. 12. www.freelivedoctor.com
    13. 13. Hepaticopancreatic ampulla (Ampulla of Vater) www.freelivedoctor.com
    14. 14. www.freelivedoctor.com
    15. 15. www.freelivedoctor.com
    16. 16. www.freelivedoctor.com
    17. 17. www.freelivedoctor.com
    18. 18. www.freelivedoctor.com
    19. 19. www.freelivedoctor.com
    20. 20. Pancreatic Enzymes <ul><li>Amylase </li></ul><ul><li>Lipase </li></ul><ul><li>DNA-ase </li></ul><ul><li>RNA-ase </li></ul><ul><li>Zymogens: Trypsinogen Chymotrypsinogen, Procarboxypeptidase A, B </li></ul>www.freelivedoctor.com
    21. 21. PANCREAS DISEASES <ul><li>Congenital </li></ul><ul><li>Inflammatory </li></ul><ul><ul><li>Acute </li></ul></ul><ul><ul><li>Chronic </li></ul></ul><ul><li>Cysts </li></ul><ul><li>Neoplasms </li></ul>www.freelivedoctor.com
    22. 22. Congenital <ul><li>Agenesis (very rare) </li></ul><ul><li>Pancreas Divisum (failure of 2 ducts to fuse) (common) </li></ul><ul><li>Annular Pancreas (pancreas encircles duodenum) (rare) </li></ul><ul><li>Ectopic Pancreas (very common) </li></ul>www.freelivedoctor.com
    23. 23. www.freelivedoctor.com
    24. 24. www.freelivedoctor.com
    25. 25. PANCREATITIS <ul><li>ACUTE (VERY SERIOUS) </li></ul><ul><li>CHRONIC </li></ul>www.freelivedoctor.com
    26. 26. CONSEQUENCES of ACUTE and CHRONIC pancreatitis www.freelivedoctor.com
    27. 27. ACUTE PANCREATITIS <ul><li>ALCOHOLISM </li></ul><ul><li>Bile reflux </li></ul><ul><li>Medications (thiazides) </li></ul><ul><li>Hypertriglyceridemia, hypercalcemia </li></ul><ul><li>Acute ischemia </li></ul><ul><li>Trauma, blunt, iatrogenic </li></ul><ul><li>Genes: PRSS1, SPINK1 </li></ul><ul><li>Idiopathic, 10-20% </li></ul>www.freelivedoctor.com
    28. 28. CLINICAL FEATURES <ul><li>ABDOMINAL PAIN </li></ul><ul><li>EXTREME emergency situation </li></ul><ul><li>HIGH mortality </li></ul><ul><li>… but MOST important lab test is……….?????  </li></ul>www.freelivedoctor.com
    29. 29. AMYLASE www.freelivedoctor.com
    30. 30. MORPHOLOGY <ul><li>EDEMA </li></ul><ul><li>FAT NECROSIS </li></ul><ul><li>ACUTE INFLAMMATORY INFILTRATE </li></ul><ul><li>PANCREAS AUTODIGESTION </li></ul><ul><li>BLOOD VESSEL DESTRUCTION </li></ul>www.freelivedoctor.com
    31. 31. www.freelivedoctor.com
    32. 32. www.freelivedoctor.com
    33. 33. CHRONIC PANCREATITIS <ul><li>Pancreatic duct obstruction, LONGSTANDING </li></ul><ul><li>Tropical </li></ul><ul><li>Hereditary (PRSS1, SPINK1 mutations) </li></ul><ul><li>IDIOPATHIC (40%) </li></ul>www.freelivedoctor.com
    34. 34. www.freelivedoctor.com
    35. 35. www.freelivedoctor.com
    36. 36. CHRONIC PANCREATITIS www.freelivedoctor.com
    37. 37. CLINICAL FEATURES <ul><li>Abdominal Pain </li></ul><ul><li>Vague abdominal symptoms </li></ul><ul><li>Nothing </li></ul><ul><li>CT calcifications (why?), amylase elevated, chronic diarrhea if chronic pancreatic insuffiency develops, high likelihood of pseudocysts </li></ul>www.freelivedoctor.com
    38. 38. PDEUDOCYSTS <ul><li>Why “pseudo”? </li></ul><ul><li>STRONGLY linked with pancreatitis </li></ul><ul><li>Can be as big as a football and often are. </li></ul><ul><li>Can cause obstruction </li></ul><ul><li>Can get infected </li></ul><ul><li>Do NOT become malignant </li></ul>www.freelivedoctor.com
    39. 39. www.freelivedoctor.com
    40. 40. www.freelivedoctor.com
    41. 41. Pancreas Neoplasms <ul><li>Serous </li></ul><ul><li>Mucinous </li></ul><ul><li>Cystic </li></ul><ul><li>Microcystic </li></ul><ul><li>Papillary </li></ul><ul><li>Benign </li></ul><ul><li>Malignant (dense sclerosis is the rule) </li></ul>www.freelivedoctor.com
    42. 42. SEROUS CYSTADENOMA www.freelivedoctor.com
    43. 43. MUCINOUS CYSTADENOMA www.freelivedoctor.com
    44. 44. INTRADUCTAL PAPILLARY MUCINOUS “ NEOPLASM” www.freelivedoctor.com
    45. 45. CARCINOGENESIS of PANCREATIC ADENOCARCINOMA www.freelivedoctor.com
    46. 46. Pancreatic CA www.freelivedoctor.com
    47. 47. PancreaticAdenocarcinoma www.freelivedoctor.com
    48. 48. FATE: <ul><li>Regional lymph nodes </li></ul><ul><li>Liver </li></ul><ul><li>Often T-2 spine </li></ul><ul><li>Lungs </li></ul><ul><li>Grading (WMP), Staging, TNM </li></ul>www.freelivedoctor.com
    49. 49. Final TIP of the day <ul><li>Painless jaundice in an elderly person is CARCINOMA of the head of the pancreas until proven otherwise </li></ul>www.freelivedoctor.com
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