Mapa mental
Pancreas
Mind map: pancreas pathology
Contenido del mapa
Pancreas
Neoplasms
- Pancreatic Carcinoma (adenocarcinoma)
- Smoking
- Chronic pancreatitis
- (KRAS), p16, SMDA4 mutations
- initially: painLESS obstructive JAUNDICE (dark urine, icterus, steatorrhea)
- Later: painFUL d/t perineural invasion
- Diabetes (islets of langerhan destruction (endocrine))
- Trousseau's sign: recurrent migratory thromboplebitis _ Renal vein thrombosis (mucin is thrombogenic)
- Metastasis to mesenteric lymph nodes and LIVER
- Treatment: Wipple's procedure + chemo (poor prognosis)
- C 19.9 _ Ultrasound, CT
- Mucinous
- Cystic neoplasms
- tall columnar mucin secreting cells
- with surrounding ovarian type stroma
- Tail
- not connected to the ducts
- women ONLY
- not connected to the ducts
- Tail
- with surrounding ovarian type stroma
- tall columnar mucin secreting cells
- Cystic neoplasms
- Acinar Cell Carcinoma
- subcutaneous fat necrosis and panniculitis due to lipase
- Whites
- subcutaneous fat necrosis and panniculitis due to lipase
- Intra-ductul papillary mucinous neoplasm (IPMN)
- duct is dilated and filled with mucin
- HEAD
- NO ovarian type stroma
- HEAD
- duct is dilated and filled with mucin
- Endocrine tumors
- Insulinoma
- Benign, solitory tumors from BETA CELLS
- Increase insulin
- WIPPLE'S TRIAD
- Symptoms of Hypoglycemia
- confusion, blurred vision, muscle weakness, sweating, palpitations
- relieved by glucose intake and accentuated by fasting
- Low blood glucose
- Symptoms of Hypoglycemia
- WIPPLE'S TRIAD
- Increase insulin
- Benign, solitory tumors from BETA CELLS
- Gastrinoma
- Insulinoma
- Pancreatic Carcinoma (adenocarcinoma)
Inflammatory lesions
- Acute Pancreatitis
- liquidative necrosis _ of exocrine pancreas ONLY
- NO DIABETES
- fever, nausea, vomiting, CONSTANT epigastric pain radiating to the back
- Fat necrosis (because Trypsin is activated first
- amylase and lipase break down fats >> FAs >> combine with Ca2+
- Saponification (Chaly White deposits on surface
- Radio-OPAQUE on X-ray
- Hypercalcemia and tetany
- Saponification (Chaly White deposits on surface
- amylase and lipase break down fats >> FAs >> combine with Ca2+
- investigation
- amylase _ sensitive _ not specific (24-48 hours)
- Lipase _ specific_ not sensitive (72-96 hours)
- CT >> fat and liquifactive necrosis
- Complication
- ARDS
- secondary bacterial infection w/ sepsis
- hypovolemic shock
- acute tubular necrosis
- acute renal failure
- acute tubular necrosis
- DIC
- hypovolemic shock
- Pseudocysts
- Hemorrhage
- GET SMASHED
- Alcohol
- contracts sphincter of Oddi _ alcohol increases protein concentration >> increased this thickness of pancreatic enzymes >> obstruction
- premature activation of the enzymes INSIDE the pancreas
- contracts sphincter of Oddi _ alcohol increases protein concentration >> increased this thickness of pancreatic enzymes >> obstruction
- Gallstones
- acinar cell injury and duct obstruction
- acinar cell injury and duct obstruction
- HypERcalcemia
- Trauma
- Scorpion toxin
- mumps
- Autoimmune
- Steroids
- hyperlipidemia
- Endoscopic Retrograde Colangiocreatography
- Drugs
- Alcohol
- liquidative necrosis _ of exocrine pancreas ONLY
- Chronic Pancreatitis
- Chronic bouts of acute pancreatitis
- pancreatic parenchyma becomes fibrotic and atrophies
- no production of pancreatic enzymes (NO INTRALUMINAL HYDROLYSIS)
- malabsorption (corrected by enzyme supplements) / steatorrhea
- No Vit D
- Hypercalcemia
- Cardiac arythmia
- Hypercalcemia
- No Vit D
- malabsorption (corrected by enzyme supplements) / steatorrhea
- Obstruction
- JAUNDICE
- no production of pancreatic enzymes (NO INTRALUMINAL HYDROLYSIS)
- Reduced number and size of acini dilation of the main duct
- dystrophic calcification
- pancreatic parenchyma becomes fibrotic and atrophies
- alcohol
- toxin
- oxidative stress
- toxin
- CFTR
- CT
- Pseudocysts
- fluid filled cavities NOT lined by epithelium - fibrous scar
- Pancreatic insufficiency
- islets of langerhans are USUALLY spared but if they're damaged
- Diabetes
- pain ATTACKS from perineural fibrosis
- Cancer
- pleural effusion
- Chronic bouts of acute pancreatitis
- Acute Pancreatitis
Congenital
- Pancreas divisor
- Ectopic Pancreatic tissue in GIT
Autoimmune Pancreatitis (Lymphoplasmacytic sclerosing pancreatitis / duct-destructive pancreatitis
- Type 1: lymphoplasmacytic infiltrate centered around LARGE & medium sized interlobular ducts
- Periductual & perivenular fibrosis
- OBLITERATIVE PHLEBITIS (arteries are spared)
- IgG4 plasma cells
- Male in 60's
- Type 2: lymphoplasmacytitc infiltrate centered around small ducts
- Granulytic epithelial lesions with partial/complete duct obstruction/ obliteration
- NO IgG4
- both genders, 40's
- JAUNDICE, abdominal pain, MASS-LIKE LESION (differentiate it from Chronic pancreatitis), Diabetes Mellitus, weight loss
- increase pancreatic enzymes and IgG4
- auto-Ab (ANA, lactoferrin (ALF) , anti-carbonic anhydrase I (ACA-II), Rheumatoid factor (Rh) )
- Type 1: lymphoplasmacytic infiltrate centered around LARGE & medium sized interlobular ducts