This document provides an overview of diseases of the pancreas. It begins with the anatomy and physiology of the pancreas and then discusses specific diseases including diabetes mellitus, pancreatitis, neoplasms (benign and malignant tumors), cysts, and pseudocysts of the pancreas. For each disease, it provides details on causes, clinical presentation, diagnostic evaluation, and treatment. The document contains teaching slides with images, tables, diagrams and text to comprehensively cover various pancreatic diseases for educational purposes.
15 cm in length, 60-140 gm, consists of head, body & tail; pancreatic duct empty into duodenum or common bile duct
Histologically, consists of 2 components:
1) Exocrine: 80-85%, consists of numerous glands (acini) lined by columnar basophilic cells containing zymogen granules, which form lobules; ductal system
Trypsin, chemotrypsin, aminopeptidase, amylase, lipase
2) Endocrine: islets of Langerhans, which are invaded by capillaries. Islets consist of:
4 main cell types: B (insulin), A (glucagon), D (somatostatin), PP cells (pancreatic polypeptide)
2 minor cell types: D1 (VIP) & enterochromaffin cells (serotonin
CHRONIC PANCREATITIS- EPIGASTRIC PAIN
#surgicaleducator #epigastricabdominalpain #chronicpancreatitis #usmle #babysurgeon #surgicaltutor
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Chronic Pancreatitis- a didactic lecture. I have already uploaded 1 more video on the same topic, in image- based questions for Hepato-biliary- pancreatic pathologies.
• It is one of the uncommon surgical problems you see in surgical wards.
• I have discussed the various causes for Epigastric pain, etiology, pathology, clinical features, investigations, complications and treatment of Acute Pancreatitis.
• I have also included a mind map and a treatment algorithm for Chronic Pancreatitis.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
15 cm in length, 60-140 gm, consists of head, body & tail; pancreatic duct empty into duodenum or common bile duct
Histologically, consists of 2 components:
1) Exocrine: 80-85%, consists of numerous glands (acini) lined by columnar basophilic cells containing zymogen granules, which form lobules; ductal system
Trypsin, chemotrypsin, aminopeptidase, amylase, lipase
2) Endocrine: islets of Langerhans, which are invaded by capillaries. Islets consist of:
4 main cell types: B (insulin), A (glucagon), D (somatostatin), PP cells (pancreatic polypeptide)
2 minor cell types: D1 (VIP) & enterochromaffin cells (serotonin
CHRONIC PANCREATITIS- EPIGASTRIC PAIN
#surgicaleducator #epigastricabdominalpain #chronicpancreatitis #usmle #babysurgeon #surgicaltutor
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Chronic Pancreatitis- a didactic lecture. I have already uploaded 1 more video on the same topic, in image- based questions for Hepato-biliary- pancreatic pathologies.
• It is one of the uncommon surgical problems you see in surgical wards.
• I have discussed the various causes for Epigastric pain, etiology, pathology, clinical features, investigations, complications and treatment of Acute Pancreatitis.
• I have also included a mind map and a treatment algorithm for Chronic Pancreatitis.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
An inflammatory condition of the pancreas
Acute pancreatitis is a reversible process,
whereas Chronic pancreatitis (CP) is irreversible
Acinar Cell Injury
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Introduction (anatomy and physiology)
Diabetes mellitus
Pancreatitis
Neoplasms
Benign
Malignant
Cysts and Pseudocysts
12-Feb-16 2Diseases of the pancreas
3. Gland with both exocrine and endocrine
functions.
15-25 cm long
60-100 g
Location: retro-peritoneum, 2nd lumbar
vertebral level
Extends in an oblique, transverse position
Parts of pancreas: head, neck, body and tail
12-Feb-16 3Diseases of the pancreas
8. Rich periacinar network that drain into 5
nodal groups
Superior nodes
Anterior nodes
Inferior nodes
Posterior PD nodes
Splenic nodes
12-Feb-16 8Diseases of the pancreas
9. Sympathetic fibers from the splanchnic
nerves
Parasympathetic fibers from the vagus
Both give rise to intrapancreatic periacinar
plexuses
Parasympathetic fibers stimulate both
exocrine and endocrine secretion
Sympathetic fibers have a predominantly
inhibitory effect
12-Feb-16 9Diseases of the pancreas
10. Exocrine pancreas
Trypsin
Chymotrypsin
Elastase
Carboxypeptidase A
Carboxypeptidase B
Colipase
Pancreatic lipase
Cholesterol ester hydrolase
Pancreatic α amylase
Ribonuclease
Deoxyribonuclease
Phospholipase A
Endocrine Pancreas
Insulin
12-Feb-16 10Diseases of the pancreas
11. Alpha cells produce glucagon.
Beta cells produce insulin.
Delta cells produce somatostatin.
12-Feb-16 11Diseases of the pancreas
12. Alpha cells secrete glucagon.
Stimulus is decrease in blood
[glucose].
Stimulates glycogenolysis and
lipolysis.
Stimulates conversion of fatty
acids to ketones.
Beta cells secrete insulin.
Stimulus is increase in blood
[glucose].
Promotes entry of glucose into
cells.
Converts glucose to glycogen
and fat.
Aids entry of amino acids into
cells.
12-Feb-16 12Diseases of the pancreas
14. Diabetes Mellitus is a chronic disorder of
carbohydrate, fat, and protein metabolism .
In which there is impaired glucose
utilization due to defective or deficient
insulin secretory response inducing
hyperglycemia
12-Feb-16 14Diseases of the pancreas
15. Primary (idiopathic) Diabetes Mellitus
Type-1 (Insulin Dependent Diabetes Mellitus)
Type-2 (Non-insulin Dependent Diabetes
Mellitus)
* Non-obese NIDDM
* Obese NIDDM
* Maturity onset diabetes of the young (MOD)
* Gestational DM
12-Feb-16 15Diseases of the pancreas
17. Secondary (idiopathic) Diabetes Mellitus
Chronic pancreatitis
Post pancreatectomy
Hormonal tumours (acromegaly, Cushing’s)
Drugs (corticosteroids)
Haemochromatosis
Genetic disorders e.g. lipodystrophy
Gestational DM
12-Feb-16 17Diseases of the pancreas
18. By far the most common in Malaysia and
worldwide.
Type 1 and type2 have different pathogenesis
and metabolic characteristics.
Similar long term complications occur in both
types.
12-Feb-16 18Diseases of the pancreas
19. Young
Rare
Linked to chrom. 7 & 20
Autosomal dominant
Mild hyperglycemia
12-Feb-16 19Diseases of the pancreas
20. 1. Diabetic Ketoacidosis coma (DKA)
In Type I Diabetes Mellitus
Due to severe insulin deficiency with increase
glucagons
2. Non ketotic Hyperosmolar Coma
In Type II DM (NIDDM)
Elderly
Uncontroled DM
Sustained hyperglycemic diuresis
Severe dehydration coma
12-Feb-16 20Diseases of the pancreas
21. Depends on :
- Duration
- Metabolic control
- Genetic factors
12-Feb-16 21Diseases of the pancreas
22. Microangiopathy:
Thickening of basement membrane
- Renal Glomeruli nephropathy
- Retina retinopathy
- Nerves neuropathy
12-Feb-16 22Diseases of the pancreas
23. Atherosclerosis:
- Myocardial infarction
- Cerebral stroke .
- Aortic aneurysm .
- Gangrene of lower extremities
12-Feb-16 23Diseases of the pancreas
25. Neuropathy:
- Symmetric peripheral neuropathy .
- Sexual impotence .
- Bowel and bladder dysfunction.
12-Feb-16 25Diseases of the pancreas
26. Change in lifestyle:
Increase exercise:
Increases the amount of membrane GLUT-4 carriers in
the skeletal muscle cells.
Weight reduction.
Increased fiber in diet.
Reduce saturated fat
Pharmacotherapy, insulin and oral agents
Surgery, pancreatic transplant and bariatric
surgery.
12-Feb-16 26Diseases of the pancreas
27.
28. Inflammatory process in the pancreas
Types:
1. Acute pancreatitis
2. Acute relapsing pancreatitis
3. Chronic relapsing pancreatitis
4. Chronic pancreatitis
12-Feb-16 28Diseases of the pancreas
29. Common Causes
Gallstones (including microlithiasis)
Alcohol (acute and chronic alcoholism)
Hypertriglyceridemia
Endoscopic retrograde cholangiopancreatography
(ERCP), especially after biliary manometry
Trauma (especially blunt abdominal trauma)
Postoperative (abdominal and nonabdominal
operations)
Drugs (azathioprine, 6-mercaptopurine,
sulfonamides, estrogens, tetracycline, valproic acid,
anti-HIV medications)
Sphincter of Oddi dysfunction
12-Feb-16 29Diseases of the pancreas
30. Uncommon Causes
Vascular causes and vasculitis (ischemic-hypoperfusion
states after cardiac surgery)
Connective tissue disorders
Thrombotic thrombocytopenic purpura (TTP)
Cancer of the pancreas
Hypercalcemia
Periampullary diverticulum
Pancreas divisum
Hereditary pancreatitis
Cystic fibrosis
Renal failure
12-Feb-16 30Diseases of the pancreas
31. Abdominal pain
Vomiting
Nausea
Lethargy
12-Feb-16 31Diseases of the pancreas
32. Grey Turner sign Cullen’s sign
12-Feb-16 32Diseases of the pancreas
33. Requires two of the following:
typical abdominal pain,
threefold or greater elevation in serum amylase
and/or lipase level,
and/or confirmatory findings on cross-sectional
abdominal imaging.
Plain X-ray
USG
CT Scan
MRI
12-Feb-16 33Diseases of the pancreas
34. IV fluids
Analgesia
Supportive management
Surgery
- to relieve biliary obstruction
- to drain collection
12-Feb-16 34Diseases of the pancreas
35.
36. Benign v/s malignant
Exocrine v/s Endocrine ( Pancreatic islet cell
tumors )
12-Feb-16 36Diseases of the pancreas
38. Usually diabetic patient
Weight loss
Dermatitis
Anemia
Stomatitis
70% malignant
12-Feb-16 38Diseases of the pancreas
39. Peptic ulceration
Abdominal pain
Diarrhea
GI bleed
Perforation of ulcer
Dehydration and malnutrition
Diagnosis: 12 hour overnight acid output and
increased serum gastrin
12-Feb-16 39Diseases of the pancreas
40. They are adenomas, 90% benign 10%
malignant.
Whipple’s triad
- episodes of illness precipitated by fasting
- hypoglycemia
- relief of symptoms by oral or intraveinous
glucose.
Diagnosis: fasting insulin and glucose levels
Treatment: surgical, resection of tumor,
medical for incurable patients or malignant
disease.
12-Feb-16 40Diseases of the pancreas
41. Adenocarcinomas
Most common pancreas tumor
Etiology unknown
Risk factors
Cigarette smoking
High intake animal fat and meat
Chronic pancreatitis
Several hereditary disorders
Hereditary pancreatitis
Von Hippel-Lindau syndrome
Lynch-syndrome
Ataxiatelangiectasia
12-Feb-16 42Diseases of the pancreas
42. Symptoms:
Early non-specific
Anorexia
Weight loss
Abdominal discomfort
Nausea
Specific symptoms
Jaundice
Purities
Moderate pain
DM
Unexplained attack of pancreatitis
12-Feb-16 43Diseases of the pancreas
43. Physical findings
Jaundice
Enlarged liver
Courvoisier`s law
Palpable mass)
Ascites
Virchow-Troisier node
Sister Josephs node
Wasting
12-Feb-16 44Diseases of the pancreas
44. LFT ( raised ALP, Bili.)
CA 19-9
CA 494
12-Feb-16 45Diseases of the pancreas
51. Symptoms
Abdominal pain (80 – 90%)
Lump in abdomen
Nausea / vomiting ( due to gastric or duodenal
compression)
Early satiety
Bloating, indigestion
Jaundice ( due to compression of bile duct)
Hemorrhage
Signs
Tenderness
Abdominal fullness
Palpable mass
Blood test: amylase, lipase
52. Ultrasonography
Most practical & Sensitivity 75 – 90%
limited by patient habitus, operator experience and air in stomach
CT scan
Gold standard for initial assessment and follow-up
Sensitivity 90- 100%
MRI
Better detail of content of cyst
MRCP
Establish the relationship of the pseudocyst to the pancreatic ducts
Endoscopic Ultrasonography (EUS +/- FNA)
Distinguishing pancreatic cystic lesions, helps in FNA
54. Most common, 10% to 45%
> 95% in women
Mean age 50 years
Typically involve the body and tail of the
pancreas
Never multifocal, occurring only in one
location within the pancreas.
55. Asymptomatic in 75% cases
If symptoms, usually due to mass effect
Addominal pain
Palpable mass
56. CT or MRI of the abdomen
Complex macrocystic mass with internal septations
MRCP no communication between duct and the cyst
Presence of mural nodule and septal calcification
suspicion of malignancy
57. Complex macrocystic lesion with internal septations
Peripheral and septal calcification indicative of malignancy
(arrowheads)
58. Second MC Cystic tumor of the pancreas
Occurring mostly in women (75%) with a mean
62 years
Most (50% to 70%) occur in the body or tail of the
pancreas
An association with von Hippel-Lindau disease
59. Mostly asymptomatic
being detected during evaluation for other unrelated
conditions
Can present with a palpable mass - size (10 to
25 cm)
61. Pathognomonic image by CT scan is that of a
spongy mass with a central “sunburst”
calcification - only 10% of patients
location in the pancreatic body and tail
wall thickness < 2 mm
lobulated contour
lack of communication with the pancreatic duct
minimal wall enhancement
62. Types - depend on involvement of duct
main pancreatic duct, isolated side branches, or a combination of
both
Benign (adenoma), borderline, or malignant
Malignant neoplasms account for 60% of IPMNs
63. Equal frequency in men and women
Median age at diagnosis - about 65 years
75% of patients are symptomatic
Abdominal pain and weight loss – MC complaints
Recurrent pancreatitis or
Acute pancreatitis
Patients with malignant neoplasms are more likely to be
older and more likely to present with jaundice or new-onset
diabetes
64. Differentiation of IPMN from other cystic
pancreatic masses may be difficult at CT
Most reliable findings for the diagnosis
Presence of a communication between the cystic lesion
and the main pancreatic duct
Presence of mural nodules projecting into the
main pancreatic duct or cystic lesions
65. Pathognomonic for IPMN in ERCP
A wide and gaping papilla with secretion of mucin and filling
defects in the dilated pancreatic duct –FISH MOUTH
AMPULLA