Pancreatitis
1) Periductal Obstruction -> necrosis
2) Perilobar Necrosis due to ischemia
3) panlobular necrosis with hemorrhage from vessels
Interstitial inflammation, edema, proteolysis, fat necrosis, hemorrhage
PANCREAS ARISE FROM 2 DUODENAL FOLDS AS DORSAL AND VENTRAL PANCREAS THAT FUSE TO BECOME ONE
Activation of trypsinogen an important triggering event in pancreatitis
ACUTE PANCREATITIS
- SYSTEMIC ORGAN FAILURE
SHOCK
ARDS
ACUTE RENAL FAILURE
- PANCREATIC ABSCESS
- PANCREATIC PSEUDOCYST
- DUODENAL OBSTRUCTION
Pseudocyst - unilocular; multiloculation suggests a neoplastic cyst
- virtually all arise after acute/chronic pancreatitis
Cyst
- lined by flattened cuboidal epithelium with clear glycogen rich cytoplasm
Pancreatic Carcinoma
- virtually all cancers begin in the ductal epithelium
60% head of pancreas, earlier detection
15-20% body
5% tail
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ENDOCRINE PANCREAS
ALPHA - GLUCAGON
BETA - INSULIN
DELTA - SOMATOSTATIN
PP - PANCREATIC POLYPEPTIDE
small dark granules present in islets as well as in exocrine pancreas
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CHRONIC PANCREATITIS, POSSIBLE CAUSES
1) DUCTAL OBSTRUCTION BY CONCRETIONS
2) SECRETED PROTEINS - LITHOSTATHINE
3) OXIDATIVE STRESS
EtOH induced
- free radical in acinar cells
- abnormal protein secretion
- acinar cell necrosis, inflammation, fibrosis
- interstitital fibrosis
ACUTE PANCREATITIS -> NECROSIS -> FIBROSIS
also, abnormal intrapancreatic lipid metabolites
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Islet cell tumors
1) hyperinsulinism (insulinoma) - Beta cell tumor
2) hypergastrinemia / Zollinger-Ellison syndrome
3) multiple endocrine neoplasia
MEN I (for 1 and 2)
1) hyperinsulinism
- blood glucose < 50 mg/dL hypoglycemic attack
- CNS manifestation
- resolve with increased glucose
- high insulin glucose ratio
2) gastrinomas
- hypersecretion of gastrin with severe peptic ulceration
ulcer (90~95%) duodenal : gastric = 6 : 1
- diarrhea
- in duodenum, peripancreatic soft tissues or pancreas
Treatment - control of gastric acid secretion by histamine (H2) receptor blockers, resection
3) other islet cell tumors
alpha cell tumor - glucagonomas
delta cell tumor - somatostatinoma
VIPomas - VIP
pancreatic carcinoid tumors - serotonin
