Pancreatitis

1.       (a) What type of tissue necrosis is shown?

Three proposed pathogenic pathways.

�         Pancreatic duct obstruction: Obstruction of ampulla of Vater leads to interstitial edema,  impaired blood flow,  ischemia,  acinar cell injury and acute pancreatitis

�         Primary acinar cell injury: Certain virus (mumps), drugs, trauma, alcohol etc.  Release of intracellular proenzymes and lysosomal hydrolases leads to activation of enzymes. �

�         Defective intracellular trans port of proenzymes within acinar cells: Metabolic injury, alcohol, duct obstruction etc causes  delivery of proenzymes to lysosomal compartment with intracellular activation of enzymes.

(b) What type of tissue necrosis is shown?

Pancreatic enzymes, e.g. proteases, lipase, phospholipase etc

2.       What has happened to adipose tissue in the vicinity of the pancreas?

     Necrosis of the adipose tissue

     Loss of cell structure and rupture of cell membrane

3.       How do you recognize this pattern of necrosis (a)histologically and (b)with the naked eye?

Histologically:

      Foci of necrotic adipose tissue (anucleate adipocytes)

      Extensive hemorrhagic necrosis of the acinar cells and surrounding tissues

      Rim of foamy histocytes contain phagocytosed lipid within their cytoplasm

Naked eye:

      Areas of blue-black haemorrhage interspersed with areas of grey-white necrotic softening.

      Numerous chalky white spots (fat saponification) are seen in perpancreatic and omental fat.

4.       Why is this condition usually hemorrhagic?

           Destruction of blood vessels by pancreatic enzymes

           Inflammation and small vessel thromboses may lead to congestion and rupture    of already weakened vessels.

           The gastroduodenal artery and the anterior superior and posterior superior pancreaticoduodenal artery are closely related to the head of the pancreas.

5.       Name some possible outcomes in severe cases of acute pancreatitis.

           Abdominal pain in epigastrium with radiation to the back. (referred pain)

           Hypocalcemia (due to precipitation of serum calcium)

           Hyperglycemia (due to destruction of Beta cells in the pancreas)

           Glycosuria (due to hyperglycemia)

           Death

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Copyright � Joseph Ong 2003