PATH 17 PANCREATITIS

Card Set Information

Author:
njards
ID:
174075
Filename:
PATH 17 PANCREATITIS
Updated:
2012-09-28 04:10:46
Tags:
Pancreas pathology
Folders:

Description:
Pancreatitis and Cholecysitis
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user njards on FreezingBlue Flashcards. What would you like to do?


  1. Pancreas
  2. PHYSIOLOGY
    - Exocrine
    - Endocrine
    • Exocrine
    • • acini - manufacture & secrete digestive enzs as proenzymes
    • • enzs activate once in ducts
    • • ducts transport activated enzymes

    • Endocrine
    • • islet cells secrete hormones into blood stream eg insulin
  3. Pancreatic Pathology
    Pancreas (simple in terms of pathol)

    •  Exocrine:
    • • Pancreatitis - Acute vs Chronic
    • • Tumours – adenocarcinoma (next lecture)

    • Endocrine:
    • • Diabetes Mellitus
    • • Islet cell tumours
  4. PANCREATITIS
    • “Inflammation of the pancreas”
    • Variable time course and severity
    • Convention divides pancreatitis into:
    • • Acute
    • • Chronic (continuous or relapsing)
    • It is the same disease process and the distinction is blurred
  5. PATHOGENESIS of Pancreatitis
    • Auto digestion by enzymes
    • – inappropriately activated or
    • – leaking out of duct into parenchyma

    (ie digestive enzs in wrong place)
  6. AETIOLOGY - (think of oranges and kiwi fruit...)
    VITAMIN C
  7. VITAMIN C
    • V Acute ischaemia vascular occlusion, hypotension
  8. VITAMIN C

    Pancreatitis Aeitology
    • Infections/inflammation– Viral eg. Mumps, Parasitic infestation (obstruction)
  9. VITAMIN C
    Trauma – Obstruction - Biliary tract disease (gall stones), Ampullary tumour
  10. VITAMIN C
    • Auto immune pancreatitis
  11. VITAMIN C
    Metabolic Alcoholism
  12. VITAMIN C
    Idiopathic/ Iatrogenic - Drugs
  13. VITAMIN C
    Neoplastic - secondary to an ampullary tumour
  14. VITAMIN C
    C Hereditary pancreatitis  (How is that C??)

    ...scorpion bites also.... maybe they're full of Vitamin C?
  15. MECHANISM
    What is the initiating event?

    • Defective intracellular transport of proenzymes within the acinar cell

    • Primary injury to the acinar cell -oxidative stress - free radicals

    • Altered secretion of proteins

    • Duct obstruction, raised pressure

    • Fibrosis - distorts architecture, interferes with blood flow and secretion flow
  16. PATHOLOGY
    • Damage to acini, fat cells, blood vessels
    • • Necrosis
    • • Inflammation – complement, kinins, clotting (thrombosis)– chemotaxis of inflammatory cells
  17. Resolution of pancreatitis
    Remove stimulus

    • Repair
    • – Macrophages remove debris
    • – No regeneration– If extensive necrosis then fibrosis/scarring
  18. SYMPTOMS AND SIGNS
    Inflammation:- pain / swelling (oedema) / redness / heat (temperature

    An “acute” abdomen

    Abdominal pain - severe and constant, through to the back

    Abdominal tenderness - “board like” (rigidity)

    In chronic pancreatitis - unremitting or repeated attacks of pain

    Systemic effects secondary to activation of complement, kinins, clotting:

    • • DIC (diffuse intravascular coagulation) 
    • • Shock, multiorgan failure (ARDS, ARF)
    • • Death

    • If there is bile duct obstruction ---> jaundice 
    • • Due to tissue oedema
  19. INVESTIGATIONS
    Serum amylase and lipase

    • Ultrasound or CT:
    • Acute - enlarged inflamed pancreas
    • Chronic - calcifications in the pancreas
    • ACUTE PANCREATITIS
    • Swollen, haemorrhagic and fat necrosis
  20. CHRONIC PANCREATITIS 

    Shrunken, hard, pale, fibrous with visible calcification
  21. LONG TERM COMPLICATIONS
    • • Pancreatic pseudocyst (abscess)
    • • Pancreatic insufficiency
    • – Malabsorption
    • – Secondary diabetes
    • • Increased risk of carcinoma
    • Pancreatic pseudocyst 
    • (can see hole where enzs have dissolved pancres)
    • shown histologically too
  22. TREATMENT
    • • Correct the cause
    • (eg stop drinking or getting bitten by scorpions) 

    • Rest the pancreas (Tx clotting cascade, resp distress etc)

    • Support the patient

    • ?Surgery
  23. CHOLELITHIASIS, CHOLECYSTITIS
    = gall stones
  24. GALL BLADDER
    • Function
    • • Storage of bile
    • • Episodic release into duodenum

    • Bile
    • • Aids in the digestion of fats
    • • Is a vehicle for excretion of some wastes
  25. Gall Bladder Pathology
    • Cholelithiasis and Cholecystitis (Acute and Chronic)• Adenocarcinoma (next lecture)
  26. CHOLELITHIASIS
    “Gall stones”

    • Pathogenesis -  
    • Formation is due to an imbalance between bile salts, cholesterol and lecithins.

    • • Stones classified as cholesterol or pigment (bilirubin/calcium salts)
    • Form slowly over time

  27. CHOLELITHIASIS Symptoms
    • Asymptomatic, picked up on ultrasound

    • Pain – constant or colicky(ie waxes and wanes) (cholecystitis)

    Thought to be due to contraction of gall bladder attempting to pass stone into cystic duct
  28. CHOLECYSTITIS
    “Inflammation of the gall bladder”

    • • Usu assocd w gall stones (obstruction at the neck)
    • • Mechl damage of mucosa
    • • Chemical irritation
    • • Ischaemia (cystic artery inflamed leading to thrombosis)
    • • Can get superadded bacterial infection
  29. Pathology
    • • Mucosal damage - ulceration
    • • Inflammation - acute/chronic
    • • Mucosal regeneration with hyperplasia
    • • Fibrosis (repair)
    • • Muscle hypertrophy (trying to overcome inability to squirt)
    • • Diverticula (Rokitansky-Aschoff sinuses)
  30. COMPLICATIONS OF CHOLELITHIASIS/CHOLECYSTITIS
    • Superadded bacterial infection– empyaema/generalized sepsis

    • • Stone in biliary tree
    • – Obstructive jaundice or pancreatitis
    • – Infection in biliary tree (- cholangitis)

    • • GB perforation
    • – abscess formation
    • – peritonitis
    • – fistulas

    • Increased risk of carcinoma
  31. Tx of Cholelithiasis / Cholecystitis
    • Observe with pain relief, nil by mouth

    • Surgery– Open or laparoscopic

What would you like to do?

Home > Flashcards > Print Preview