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PANCREAS

PANCREAS. OBJECTIVES. Understand the etiology/risk factors, pathogenesis, morphology, clinical features and outcome of pancreatic inflammations and neoplasms. Ventral Bud. Chapter 19. Posterior view of duodenum/pancreas. Arterial supply and venous drainage of the pancreas and spleen.

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PANCREAS

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  1. PANCREAS

  2. OBJECTIVES • Understand the etiology/risk factors, pathogenesis, morphology, clinical features and outcome of pancreatic inflammations and neoplasms

  3. Ventral Bud

  4. Chapter 19

  5. Posterior view of duodenum/pancreas

  6. Arterial supply and venous drainage of the pancreas and spleen

  7. Lymphatic drainage of the distal pancreas and spleen

  8. Hepaticopancreatic ampulla(Ampulla of Vater)

  9. L2

  10. makes HCO3¯

  11. Pancreatic Enzymes • Amylase • Lipase • DNA-ase • RNA-ase • Zymogens: Trypsinogen Chymotrypsinogen Procarboxypeptidase A, B

  12. PANCREAS DISEASES • Congenital • Inflammatory • Acute • Chronic • Cysts • Neoplasms

  13. Congenital • Agenesis (very rare) • Pancreas Divisum (failure of 2 ducts to fuse)(common) • Annular Pancreas (pancreas encircles duodenum)(rare) • Ectopic Pancreas (very common)

  14. PANCREATITIS • ACUTE (VERY SERIOUS) • CHRONIC (Calcifications, Pseudocyst)

  15. CONSEQUENCES of ACUTE and CHRONIC pancreatitis

  16. ACUTE PANCREATITIS • ALCOHOLISM • Bile reflux • Medications (thiazides) • Hypertriglyceridemia, hypercalcemia • Acute ischemia • Trauma, blunt, iatrogenic • Genes: PRSS1, SPINK1 • Idiopathic, 10-20%

  17. CLINICAL FEATURES • ABDOMINAL PAIN • EXTREME emergency situation • HIGH mortality • …but MOST important lab test is……….????? 

  18. AMYLASE !!!!!!!

  19. MORPHOLOGY • EDEMA • FAT NECROSIS • ACUTE INFLAMMATORY INFILTRATE • PANCREAS AUTODIGESTION • BLOOD VESSEL DESTRUCTION • “SAPONIFICATION” (stearates, Na+, Ca++)

  20. CHRONIC PANCREATITIS • Pancreatic duct obstruction, LONGSTANDING • Tropical • Hereditary (PRSS1, SPINK1 mutations) • IDIOPATHIC (40%)

  21. CHRONIC PANCREATITIS

  22. CLINICAL FEATURES • Abdominal Pain • Vague abdominal symptoms • Nothing • CT calcifications (why?), amylase elevated, chronic diarrhea if chronic pancreatic insuffiency develops, high likelihood of pseudocysts

  23. 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

  24. Pancreas Neoplasms • Serous • Mucinous • Cystic • Microcystic • Papillary • Benign • Malignant (dense sclerosis is the rule)

  25. SEROUS CYSTADENOMA

  26. MUCINOUS CYSTADENOMA

  27. INTRADUCTAL PAPILLARY MUCINOUS “NEOPLASM”

  28. CARCINOGENESISof PANCREATICADENOCARCINOMA

  29. Pancreatic CA

  30. Pancreatic Adenocarcinoma

  31. FATE: • Regional lymph nodes • Liver • Often L-2 spine • Lungs Grading (WMP), Staging, TNM

  32. 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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