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Microscopy
(1) microvascular leakage causing oedema,
(2) fat necrosis
(3) acute inflammation
(4) proteolytic destruction of pancreatic
parenchyma
(5) destruction of blood vessels leading to
hemorrhage.
The extent of each of these alterations
depends on the duration and severity of
the process.
Normal pancrease
Clinical features
Abdominal pain -Constant and intense and is often referred
to the upper back and occasionally can be associated with
referred pain to the left shoulder. Anorexia, nausea, and
vomiting
Full-blown acute pancreatitis is a medical emergency.
sudden onset of an acute abdomen.
Many of the systemic features of severe acute pancreatitis
can be attributed to release of toxic enzymes, cytokines,
and other mediators into the circulation and explosive
activation of the systemic inflammatory response,
resulting in leukocytosis, hemolysis, disseminated
intravascular coagulation, fluid sequestration, acute
respiratory distress syndrome, and diffuse fat necrosis.
Peripheral vascular collapse and shock with acute renal
tubular necrosis may occur.
Laboratory findings
marked elevation of serum amylase levels
during the first 24 hours,
followed within 72 to 96 hours by a rising
serum lipase level.
Glycosuria occurs in 10% of cases.
Hypocalcemia may result from precipitation
of calcium soaps in necrotic fat if persistent,
it is a poor prognostic sign.
Direct visualization of the enlarged
inflamed pancreas by radiography is useful
in the diagnosis of pancreatitis.
.
Prognosis
80% recover fully
15-20 %develop multiple organ failure
and pancratic necrosis
Mortality rate 20%
Systemic complications.
Acute respiratory distress syndrome
Acute renal failure
Endotoxic shock
Chemical and bacterial peritonitis
Local Sequelae
Sterile pancreatic abscess
Pancreatic pseudocyst
In 40% to 60% of patients with acute necrotizing
pancreatitis the necrotic debris becomes
infected, usually by gram-negative organisms
from the alimentary tract(bacterial
transposition)
Chronic Pancreatitis
Chronic pancreatitis is defined as chronic
inflammation of the pancreas with
irreversible destruction of exocrine
parenchyma, fibrosis, and, in the late stages,
the destruction of endocrine parenchyma.
Presents with recurrent attacks of severe
abdominal pain,weight loss ,DM and
steatorrhoea
Abdominal X ray calcification in the
pancreatic region
.
Lymphoplasmacytic sclerosing
pancreatitis (autoimmune pancreatitis)
is a distinct form of chronic pancreatitis
characterized by a duct-centric mixed
inflammatory cell infiltrate, and
increased numbers of IgG4-producing
plasma cells. It is important to recognize
since it can clinically mimic pancreatic
cancer and also because it responds to
steroid therapy.
PSEUDOCYSTS
Pseudocysts are localized collections
of necrotic-hemorrhagic material rich
in pancreatic enzymes.Such cysts
lack an epithelial lining and account
for approximately 75% of cysts in the
pancreas.
Pseudocysts usually arise after an
episode of acute pancreatitis
Traumatic injury to the pancreas can
also give rise to pseudocysts.
Neoplasms
A broad spectrum of exocrine
neoplasms can arise in the pancreas.
cystic or solid
benign or malignant
CYSTIC NEOPLASMS
Serous cystadenomas
mucinous cystic neoplasms
Solid pseudopapillary tumours
Pancreatic carcinomas
Grossly, pancreatic carcinoma
presents as a hard infiltrative mass
that obstructs the pancreatic duct
frequently causing chronic
pancreatitis in the distal gland.
Carcinomas of the head tend to
obstruct the common bile duct
Tumors in the body and tail tend to
present late and be very large.
Pancreatic neuroendocrine
tumors
Benign ormalignant
Pancreatic NETs are much less
common than pancreatic exocrine
tumors and have a better prognosis.
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