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Faculty of allied medical sciences Histopathology and cytology (MLHC-201) Pancreatic Pathology Inflammation of the pancreas Prof. Dr. Noha Ragab Learning Outcomes By the end of this lecture, the student will be able to : 1- Differentiate between acute, and chronic pancreatitis. 2- Identify pancreatic tumours. 3- Identify gall bladder, and biliary tract pathology. Acute hemorrhagic pancreatitis Etiology: Gall-stones Alcohols Hypercalcaemia Drugs Infection Pathogenesis: Pancreatic acinar cell injury results in activation of pancreatic enzymes and the enzymes consequently causes destruction of the pancreatic parenchyma Clinical presentation Stabbing epigastric abdominal pain radiating to the back Shock Hypercalcaemia Laboratory investigation: elevation of serum amylase and lipase Gross pathology: Focal pancreatic hemorrhage and liquefaction Chalky, white yellow fat necrosis of adjacent adipose tissue Acute hemorrhagic pancreatitis Microscopically: Liquifactive necrosis of pancreatic parenchyma Acute inflammation Enzymatic fat necrosis Necrosis of blood vessels causes hemorrhage Complication: Acute respiratory distress syndrome (ARDS) Disseminated intra-vascular coagulopathy (DIC) Pseudo cyst of pancreas Pancreatic calcification Fat necrosis Acute hemorrhagic pancreatitis Chronic pancreatitis Definition: Chronic inflammation, atrophy and fibrosis secondary to repeated attacks of pancreatitis Grossly: Firm white fibrotic pancreas Microscopic: Extensive fibrosis atrophy Chronic inflammation and parenchymal Chronic pancreatitis Clinical presentation: 1. Abdominal pain 2. Pancreatic insufficiency 3. Pancreatic calcification 4. Pseudocyst 5. Diabetes Pancreatic Tumors Pancreatic carcinoma Grossly: On gross examination, pancreatic carcinoma is a firm, gray, poorly demarcated, multi-nodular mass, often embedded in a dense connective tissue stroma. Tumors of the head of the pancreas may invade the common bile duct and duodenal wall. Pancreatic carcinoma Microscopic: Ductal adenocarcinoma arising from the duct epithelium Clinically: Abdominal pain Biliary obstruction Obstructive jaundice Pancreatic carcinoma GALL BLADDER AND BILIARY TRACT PATHOLOGY NORMAL GALLBLADDER NORMAL GALLBLADDER INFLAMMATORY CONDITIONS Acute cholecystitis: Definition: Acute inflammation of the gall bladder, usually causes by cystic duct obstruction by gall stones Clinical presentation: 1. 2. 3. 4. Biliary colic Right upper quadrant tenderness on palpation Nausea and vomiting Low-grade fever and leukocytosis Acute cholecystitis Complications: 1. 2. 3. Gangrene of the gall bladder Perforation and peritonitis Fistula formation and small bowel obstruction by a large gall stone) Chronic cholecystitis: Definition: Ongoing chronic inflammation of the gallbladder usually caused by gall stones Microscopically: Chronic inflammation Complication: Calcification of the gall (porcelain gall bladder) bladder Chronic cholecystitis GALL BLADDER CANCER Gallbladder cancer Clinical presentation: 1. 2. 3. 4. Frequently asymptomatic until late in the course Cholecystitis Enlarged palpable gallbladder Biliary tract obstruction (uncommon) Microscopically: Adenocarcinoma Gallbladder cancer Gallbladder cancer Questions 1- What is the clinical presentation of chronic pancreatitis? 2- What does the microscopic examination of pancreatic carcinoma reveal? 3- What is the definition of acute cholecystitis? 4- What is the clinical presentation of gallbladder cancer? THANK YOU GOOD LUCK