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PATHOLOGY OF THE PANCREAS LAB

PATHOLOGY OF THE PANCREAS LAB. January 17, 2014. CASE 1. CHIEF COMPLAINT : “My wife says my eyes look kind of yellow.”

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PATHOLOGY OF THE PANCREAS LAB

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  1. PATHOLOGY OF THE PANCREAS LAB January 17, 2014

  2. CASE 1 • CHIEF COMPLAINT: “My wife says my eyes look kind of yellow.” • HISTORY: 60 year-old male, who has a past medical history significant for a 30 pack-year history of smoking, presents with a several month history of jaundice, gnawing epigastric pain that radiates to the back, and a 20 lb weight loss. • VITAL SIGNS: BP 140/90 HR 80 RR 18 T 98 • PHYSICAL EXAMINATION: Alert and oriented, cachectic-appearing male with yellow sclerae. The abdomen is scaphoid with a palpable upper abdominal mass. No lymphadenopathy is noted. • LAB TESTS: • Alkaline phosphatase 140 U/L (reference range 20-70 U/L) • Bilirubin total 4.3 mg/dl (0.0-0.3mg/dl) • AST 21 U/L (8-20 U/L) • ALT 19 U/L (8-20)

  3. Q1: What is the clinical complaint and what is your differential diagnosis?

  4. Q2: Describe the gross findings

  5. Q3: Describe the microscopic findings

  6. Q3: Describe the microscopic findings

  7. Q4: What is your diagnosis?

  8. Example of surgical treatment –Whipple specimen

  9. Q5: Explain the jaundice in this patient

  10. Q6: Name two genetic mutations commonly described in this disease

  11. CASE 2 • CHIEF COMPLAINT: “My stomach and back really hurt.” • HISTORY: 47 year-old male presents with a several day history of severe epigastric pain after a “bender with the guys”. The pain radiates to the back and chest. He drinks alcohol daily. • VITAL SIGNS: BP 110/60 HR 110 RR 18 T 99 • PHYSICAL EXAMINATION: Thin, malnourished and anxious appearing male who is almost “doubled over” in pain. Sclera are anicteric. There is epigastric tenderness to palpation. No palpable abdominal masses. Stool is brown and hemoccult negative.

  12. Q1: What is the clinical problem and what is the differential diagnosis?

  13. Q2: What lab test(s) would be helpful?

  14. Q3: Describe the gross findings, which is normal ?

  15. Q4: Describe the microscopic findings

  16. Q5: What is your diagnosis?

  17. Q6: Discuss the lab tests in the context of the pathologic findings

  18. Q7: What are potential complications of this process?

  19. Clinico-Pathologic Correlation:Ranson Criteria to Predict Severity of Acute Pancreatitis • 0 hours • Age >55 • White blood cell count>16,000/mm3 • Blood glucose>200 mg/dL (11.1 mmol/L) • Lactate dehydrogenase>350 U/L • Aspartate aminotransferase (AST)>250 U/L • 48 hours • Hematocrit Fall by 10 percent • Blood urea nitrogen Increase by 5 mg/dL (1.8 mmol/L) despite fluids • Serum calcium<8 mg/dL (2 mmol/L • O2<60 mmHg • Base deficit>4 MEq/L • Fluid sequestation>6000 mL • The presence of 1 to 3 criteria represents mild pancreatitis; the mortality rate rises significantly with four or more criteria. .

  20. CASE 3 • CHIEF COMPLAINT: Abdominal pain • HISTORY: 53 year-old man with alcohol abuse and a 20 pack-year history of smoking has been hospitalized several times in the past for acute pancreatitis. He has a dull abdominal pain much of the time. He has “greasy” bowel movement not long after eating; his stools are malodorous. • PHYSICAL EXAMINATION: Alert and oriented male who appears older than his stated age. His abdomen is soft with no palpable masses or organomegaly. He has mild epigastric tenderness.

  21. Q1: Describe the gross findings

  22. Q2: Describe the microscopic findings

  23. Q3: What is your diagnosis?

  24. Q4: What are potential complications?

  25. CASE 4 • CHIEF COMPLAINT: None • HISTORY: An asymptomatic 60 year old male patient presents for a routine screening physical. A colonoscopy is done • LAB TESTS: Hgb 14.0 g/dL Hct 42%

  26. Colonoscopic Findings

  27. Barium Enema

  28. Q1: Describe the gross findings

  29. Q2: Describe the gross findings

  30. Q3:Describe the microscopic findings

  31. Q4: What is your diagnosis?

  32. Q5: What are major complications of this process?

  33. CASE 5 • CHIEF COMPLAINT: “My stomach really hurts.” • HISTORY: A 13 year-old girl presents to her physician with fever and right lower quadrant abdominal pain. She had a preceding episode of nausea and vomiting. • VITAL SIGNS: BP 125/80 HR 90 RR 18 T 100 • PHYSICAL EXAMINATION: The patient is a healthy, anxious appearing girl who has RLQ abdominal rebound tenderness to palpation

  34. Q1: What is the differential diagnosis

  35. Q2: Identify the organ, describe gross findings Purulent exudate

  36. Q3: Describe the microscopic findings

  37. Q4: What is your diagnosis?

  38. Q5: Correlate the clinical findings with the pathology

  39. Q6: What are potential complications of this disease process?

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