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&E, e.m.
  • Histology, H&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 Presentation Transcript

  • 1. PANCREAS www.freelivedoctor.com
  • 2. OBJECTIVES
    • Understand the etiology/risk factors, pathogenesis, morphology, clinical features and outcome of pancreatic inflammations and neoplasms
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  • 3. www.freelivedoctor.com
  • 4. www.freelivedoctor.com
  • 5. www.freelivedoctor.com
  • 6. www.freelivedoctor.com
  • 7. www.freelivedoctor.com
  • 8. Chapter 19 www.freelivedoctor.com
  • 9. Posterior view of duodenum/pancreas www.freelivedoctor.com
  • 10. Arterial supply and venous drainage of the pancreas and spleen www.freelivedoctor.com
  • 11. Lymphatic drainage of the distal pancreas and spleen www.freelivedoctor.com
  • 12. www.freelivedoctor.com
  • 13. Hepaticopancreatic ampulla (Ampulla of Vater) www.freelivedoctor.com
  • 14. www.freelivedoctor.com
  • 15. www.freelivedoctor.com
  • 16. www.freelivedoctor.com
  • 17. www.freelivedoctor.com
  • 18. www.freelivedoctor.com
  • 19. www.freelivedoctor.com
  • 20. Pancreatic Enzymes
    • Amylase
    • Lipase
    • DNA-ase
    • RNA-ase
    • Zymogens: Trypsinogen Chymotrypsinogen, Procarboxypeptidase A, B
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  • 21. PANCREAS DISEASES
    • Congenital
    • Inflammatory
      • Acute
      • Chronic
    • Cysts
    • Neoplasms
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  • 22. 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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  • 23. www.freelivedoctor.com
  • 24. www.freelivedoctor.com
  • 25. PANCREATITIS
    • ACUTE (VERY SERIOUS)
    • CHRONIC
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  • 26. CONSEQUENCES of ACUTE and CHRONIC pancreatitis www.freelivedoctor.com
  • 27. ACUTE PANCREATITIS
    • ALCOHOLISM
    • Bile reflux
    • Medications (thiazides)
    • Hypertriglyceridemia, hypercalcemia
    • Acute ischemia
    • Trauma, blunt, iatrogenic
    • Genes: PRSS1, SPINK1
    • Idiopathic, 10-20%
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  • 28. CLINICAL FEATURES
    • ABDOMINAL PAIN
    • EXTREME emergency situation
    • HIGH mortality
    • … but MOST important lab test is……….????? 
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  • 29. AMYLASE www.freelivedoctor.com
  • 30. MORPHOLOGY
    • EDEMA
    • FAT NECROSIS
    • ACUTE INFLAMMATORY INFILTRATE
    • PANCREAS AUTODIGESTION
    • BLOOD VESSEL DESTRUCTION
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  • 31. www.freelivedoctor.com
  • 32. www.freelivedoctor.com
  • 33. CHRONIC PANCREATITIS
    • Pancreatic duct obstruction, LONGSTANDING
    • Tropical
    • Hereditary (PRSS1, SPINK1 mutations)
    • IDIOPATHIC (40%)
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  • 34. www.freelivedoctor.com
  • 35. www.freelivedoctor.com
  • 36. CHRONIC PANCREATITIS www.freelivedoctor.com
  • 37. CLINICAL FEATURES
    • Abdominal Pain
    • Vague abdominal symptoms
    • Nothing
    • CT calcifications (why?), amylase elevated, chronic diarrhea if chronic pancreatic insuffiency develops, high likelihood of pseudocysts
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  • 38. 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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  • 39. www.freelivedoctor.com
  • 40. www.freelivedoctor.com
  • 41. Pancreas Neoplasms
    • Serous
    • Mucinous
    • Cystic
    • Microcystic
    • Papillary
    • Benign
    • Malignant (dense sclerosis is the rule)
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  • 42. SEROUS CYSTADENOMA www.freelivedoctor.com
  • 43. MUCINOUS CYSTADENOMA www.freelivedoctor.com
  • 44. INTRADUCTAL PAPILLARY MUCINOUS “ NEOPLASM” www.freelivedoctor.com
  • 45. CARCINOGENESIS of PANCREATIC ADENOCARCINOMA www.freelivedoctor.com
  • 46. Pancreatic CA www.freelivedoctor.com
  • 47. PancreaticAdenocarcinoma www.freelivedoctor.com
  • 48. FATE:
    • Regional lymph nodes
    • Liver
    • Often T-2 spine
    • Lungs
    • Grading (WMP), Staging, TNM
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  • 49. Final TIP of the day
    • Painless jaundice in an elderly person is CARCINOMA of the head of the pancreas until proven otherwise
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