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3785615
Pancreas
Descrição
...
Sem etiquetas
.
m
n
Mapa Mental por
Nazik Al-Hashimi
, atualizado more than 1 year ago
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Criado por
Nazik Al-Hashimi
quase 9 anos atrás
19
0
0
Resumo de Recurso
Pancreas
Neoplasms
Pancreatic Carcinoma (adenocarcinoma)
Smoking
Chronic pancreatitis
(KRAS), p16, SMDA4 mutations
initially: painLESS obstructive JAUNDICE (dark urine, icterus, steatorrhea)
Later: painFUL d/t perineural invasion
Diabetes (islets of langerhan destruction (endocrine))
Trousseau's sign: recurrent migratory thromboplebitis _ Renal vein thrombosis (mucin is thrombogenic)
Metastasis to mesenteric lymph nodes and LIVER
Treatment: Wipple's procedure + chemo (poor prognosis)
C 19.9 _ Ultrasound, CT
Mucinous
Cystic neoplasms
tall columnar mucin secreting cells
with surrounding ovarian type stroma
Tail
not connected to the ducts
women ONLY
Acinar Cell Carcinoma
subcutaneous fat necrosis and panniculitis due to lipase
Whites
Intra-ductul papillary mucinous neoplasm (IPMN)
duct is dilated and filled with mucin
HEAD
NO ovarian type stroma
Endocrine tumors
Insulinoma
Benign, solitory tumors from BETA CELLS
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
Gastrinoma
Inflammatory lesions
Acute Pancreatitis
liquidative necrosis _ of exocrine pancreas ONLY
NO DIABETES
fever, nausea, vomiting, CONSTANT epigastric pain radiating to the back
Fat necrosis (because Trypsin is activated first
amylase and lipase break down fats >> FAs >> combine with Ca2+
Saponification (Chaly White deposits on surface
Radio-OPAQUE on X-ray
Hypercalcemia and tetany
investigation
amylase _ sensitive _ not specific (24-48 hours)
Lipase _ specific_ not sensitive (72-96 hours)
CT >> fat and liquifactive necrosis
Complication
ARDS
secondary bacterial infection w/ sepsis
hypovolemic shock
acute tubular necrosis
acute renal failure
DIC
Pseudocysts
Hemorrhage
GET SMASHED
Alcohol
contracts sphincter of Oddi _ alcohol increases protein concentration >> increased this thickness of pancreatic enzymes >> obstruction
premature activation of the enzymes INSIDE the pancreas
Gallstones
acinar cell injury and duct obstruction
HypERcalcemia
Trauma
Scorpion toxin
mumps
Autoimmune
Steroids
hyperlipidemia
Endoscopic Retrograde Colangiocreatography
Drugs
Chronic Pancreatitis
Chronic bouts of acute pancreatitis
pancreatic parenchyma becomes fibrotic and atrophies
no production of pancreatic enzymes (NO INTRALUMINAL HYDROLYSIS)
malabsorption (corrected by enzyme supplements) / steatorrhea
No Vit D
Hypercalcemia
Cardiac arythmia
Obstruction
JAUNDICE
Reduced number and size of acini dilation of the main duct
dystrophic calcification
alcohol
toxin
oxidative stress
CFTR
CT
Pseudocysts
fluid filled cavities NOT lined by epithelium - fibrous scar
Pancreatic insufficiency
islets of langerhans are USUALLY spared but if they're damaged
Diabetes
pain ATTACKS from perineural fibrosis
Cancer
pleural effusion
Congenital
Pancreas divisor
Ectopic Pancreatic tissue in GIT
Autoimmune Pancreatitis (Lymphoplasmacytic sclerosing pancreatitis / duct-destructive pancreatitis
Type 1: lymphoplasmacytic infiltrate centered around LARGE & medium sized interlobular ducts
Periductual & perivenular fibrosis
OBLITERATIVE PHLEBITIS (arteries are spared)
IgG4 plasma cells
Male in 60's
Type 2: lymphoplasmacytitc infiltrate centered around small ducts
Granulytic epithelial lesions with partial/complete duct obstruction/ obliteration
NO IgG4
both genders, 40's
JAUNDICE, abdominal pain, MASS-LIKE LESION (differentiate it from Chronic pancreatitis), Diabetes Mellitus, weight loss
increase pancreatic enzymes and IgG4
auto-Ab (ANA, lactoferrin (ALF) , anti-carbonic anhydrase I (ACA-II), Rheumatoid factor (Rh) )
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