Pancreas Pathology

Exocrine
1. Digestive
2. Proteolytic enzyme content can damage adjacent tissues
3. Structure
  1. Lobules of exocrine pancreatic acini, separated by fine fibrous trabeculae
  2. Cat
    1. One major pancreatic duct which shares a common entry into the duodenum with the common bile duct
  3. Dog
    1. May be several major pancreatic ducts
      1. No common entry w/ the bile duct
4. Developmental Conditions
  1. Pancreatic Acinar Atrophy
    1. Dogs
      1. Juvenile onset
      2. German Shepherds: Autosomal recessive inheritance
      3. Rough coated collies & English setters: Familial disease
    2. Likely autoimmune (Large #'s of lymphocytes & plasma cells targeting exocrine pancreas => Fibrosis)
    3. Islets of Langerhans are normal
    4. Most common cause of Exocrine pancreatic insufficiency (EPI) - Dogs
    5. Clinical signs by 6-12 months of age
5. Acquired Conditions
  1. Exocrine pancreatic insufficiency
    1. Fatty diarrhoea (steatorrhoea)
      1. Insufficient lipase => undigested fat in diarrhoea => malabsorption sydrome
    2. Weight loss (Cachexia)
    3. Voracious appetite
    4. Pica, Coprophagia
    5. Concurrent small intestine bacterial overgrowth (SIBO)
  2. Pancreatic calculi (Pancreolithiasis)
    1. Uncommon
    2. Incidental PM finding (Cattle)
6. Interstitial Pancreatitis
  1. Acute
    1. Cats
      1. Systemic toxoplasmosis
  2. Chronic
    1. Cats
      1. Often concurrent w/ Cholangitis & Enteritis (Triaditis)
    2. Extension of process that commences in the ducts
      1. Usually ascending infection of intestinal bacteria
      2. Also, migrating parasites
    3. Horses
    4. Histologically
      1. Hyperplasia of pancreatic ducts & periductular fibrosis & inflammation
    5. Can lead to exocrine pancreatic insufficiency/diabetes mellitus
7. Necrotising Pancreatitis
  1. Acute Pancreatic Necrosis
    1. Imp. in Dog (Small breeds)
    2. Less common in Cats
    3. Activation of Trypsinogen => Trypsin w/in the pancreas => activation of cascade of pancreatic proenzymes leading to autodigestion & tissue damage
      1. Occurs due to fusion of zymogen granules with lysosomes
      2. Release of pancreatic enzymes into circulation => Hepatic necrosis, Pulmonary oedema, Interstitial pneumonia, Myocardial injury (& arrhythmias), Shock & DIC
      3. Dystrophic mineralization of necrotic abdominal fat (saponification)
    4. Necrosis of the pancreas, adjacent connective tissues & abdominal fat
    5. Blood vessels also involved => Haemorrhage, thrombosis, ischaemia
    6. Sequelae:
      1. Complete resolution (fibrosis & nodular regeneration)
        Chronic relapsing "smouldering" pancreatitis => Eventual complete loss
        Diabetes Mellitus (Destruction of Islets)
8. Nodular Hyperplasia
  1. Common in older animals
  2. Multiple nodules
    1. Raised, smooth, grey or white
    2. Non-functional
  3. Often mistaken for Neoplasia
9. Neoplasia
  1. Exocrine Adenomas
    1. Rare, Solitary
  2. Exocrine Carcinomas
    1. Dog & Cat
    2. Single or multiple/confluent, firm, white or pale yellow nodules
    3. Non-functional
    4. Aggressive
      1. Invade adjacent tissues & pertoneum
        Metastasize to liver
        Obstruct bile flow => Jaundice
Endocrine
1. Metabolic
2. Structure
  1. Islets of Langerhans (Small foci b/w acini)
    1. Alpha, beta, gamma, PP(F) & other cells
Pancreatic Disease:
1. Alimentary tract signs: Maldigestion
  1. Concurrent biliary duct obstruction
    1. Jaundice (Cats - Triaditis)
    2. Metabolic Disease
      1. Endocrine pancreas

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Pancreas Pathology

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