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Pancreas

Neoplasms
1. Pancreatic Carcinoma (adenocarcinoma)
  1. Smoking
  2. Chronic pancreatitis
  3. (KRAS), p16, SMDA4 mutations
  4. initially: painLESS obstructive JAUNDICE (dark urine, icterus, steatorrhea)
  5. Later: painFUL d/t perineural invasion
  6. Diabetes (islets of langerhan destruction (endocrine))
  7. Trousseau's sign: recurrent migratory thromboplebitis _ Renal vein thrombosis (mucin is thrombogenic)
  8. Metastasis to mesenteric lymph nodes and LIVER
  9. Treatment: Wipple's procedure + chemo (poor prognosis)
  10. C 19.9 _ Ultrasound, CT
  11. Mucinous
    1. Cystic neoplasms
      1. tall columnar mucin secreting cells
        with surrounding ovarian type stroma
        Tail
        not connected to the ducts
        women ONLY
  12. Acinar Cell Carcinoma
    1. subcutaneous fat necrosis and panniculitis due to lipase
      1. Whites
  13. Intra-ductul papillary mucinous neoplasm (IPMN)
    1. duct is dilated and filled with mucin
      1. HEAD
        NO ovarian type stroma
2. Endocrine tumors
  1. Insulinoma
    1. Benign, solitory tumors from BETA CELLS
      1. Increase insulin
        WIPPLE'S TRIAD
        Symptoms of Hypoglycemia
        confusion, blurred vision, muscle weakness, sweating, palpitations
        relieved by glucose intake and accentuated by fasting
        Low blood glucose
  2. Gastrinoma
Inflammatory lesions
1. Acute Pancreatitis
  1. liquidative necrosis _ of exocrine pancreas ONLY
    1. NO DIABETES
    2. fever, nausea, vomiting, CONSTANT epigastric pain radiating to the back
  2. Fat necrosis (because Trypsin is activated first
    1. amylase and lipase break down fats >> FAs >> combine with Ca2+
      1. Saponification (Chaly White deposits on surface
        Radio-OPAQUE on X-ray
        Hypercalcemia and tetany
  3. investigation
    1. amylase _ sensitive _ not specific (24-48 hours)
    2. Lipase _ specific_ not sensitive (72-96 hours)
    3. CT >> fat and liquifactive necrosis
  4. Complication
    1. ARDS
    2. secondary bacterial infection w/ sepsis
      1. hypovolemic shock
        acute tubular necrosis
        acute renal failure
      2. DIC
    3. Pseudocysts
    4. Hemorrhage
  5. GET SMASHED
    1. Alcohol
      1. contracts sphincter of Oddi _ alcohol increases protein concentration >> increased this thickness of pancreatic enzymes >> obstruction
        premature activation of the enzymes INSIDE the pancreas
    2. Gallstones
      1. acinar cell injury and duct obstruction
    3. HypERcalcemia
    4. Trauma
    5. Scorpion toxin
    6. mumps
    7. Autoimmune
    8. Steroids
    9. hyperlipidemia
    10. Endoscopic Retrograde Colangiocreatography
    11. Drugs
2. Chronic Pancreatitis
  1. Chronic bouts of acute pancreatitis
    1. pancreatic parenchyma becomes fibrotic and atrophies
      1. no production of pancreatic enzymes (NO INTRALUMINAL HYDROLYSIS)
        malabsorption (corrected by enzyme supplements) / steatorrhea
        No Vit D
        Hypercalcemia
        Cardiac arythmia
      2. Obstruction
        JAUNDICE
    2. Reduced number and size of acini dilation of the main duct
    3. dystrophic calcification
  2. alcohol
    1. toxin
      1. oxidative stress
  3. CFTR
  4. CT
  5. Pseudocysts
    1. fluid filled cavities NOT lined by epithelium - fibrous scar
  6. Pancreatic insufficiency
  7. islets of langerhans are USUALLY spared but if they're damaged
    1. Diabetes
  8. pain ATTACKS from perineural fibrosis
  9. Cancer
  10. pleural effusion
Congenital
1. Pancreas divisor
2. Ectopic Pancreatic tissue in GIT
Autoimmune Pancreatitis (Lymphoplasmacytic sclerosing pancreatitis / duct-destructive pancreatitis
1. Type 1: lymphoplasmacytic infiltrate centered around LARGE & medium sized interlobular ducts
  1. Periductual & perivenular fibrosis
  2. OBLITERATIVE PHLEBITIS (arteries are spared)
  3. IgG4 plasma cells
  4. Male in 60's
2. Type 2: lymphoplasmacytitc infiltrate centered around small ducts
  1. Granulytic epithelial lesions with partial/complete duct obstruction/ obliteration
  2. NO IgG4
  3. both genders, 40's
3. JAUNDICE, abdominal pain, MASS-LIKE LESION (differentiate it from Chronic pancreatitis), Diabetes Mellitus, weight loss
4. increase pancreatic enzymes and IgG4
5. auto-Ab (ANA, lactoferrin (ALF) , anti-carbonic anhydrase I (ACA-II), Rheumatoid factor (Rh) )

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Pancreas

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	Created by Nazik Al-Hashimi about 9 years ago