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PANCREAS

PANCREAS. OBJECTIVES. Understand the etiology/risk factors, pathogenesis, morphology, clinical features and outcome of pancreatic inflammations and neoplasms. 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. Chapter 19

  4. Posterior view of duodenum/pancreas

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

  6. Lymphatic drainage of the distal pancreas and spleen

  7. Hepaticopancreatic ampulla(Ampulla of Vater)

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

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

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

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

  12. CONSEQUENCES of ACUTE and CHRONIC pancreatitis

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

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

  15. AMYLASE !!!!!!!

  16. MORPHOLOGY • EDEMA • FAT NECROSIS • ACUTE INFLAMMATORY INFILTRATE • PANCREAS AUTODIGESTION • BLOOD VESSEL DESTRUCTION • “SAPONIFICATION”

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

  18. CHRONIC PANCREATITIS

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

  20. 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

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

  22. SEROUS CYSTADENOMA

  23. MUCINOUS CYSTADENOMA

  24. INTRADUCTAL PAPILLARY MUCINOUS “NEOPLASM”

  25. CARCINOGENESISof PANCREATICADENOCARCINOMA

  26. Pancreatic CA

  27. Pancreatic Adenocarcinoma

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

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