Faculty of allied medical sciences

1. Faculty of allied medical sciences Histopathology and cytology (MLHC-201)

2. Pancreatic Pathology Inflammation of the pancreas Prof. Dr. NohaRagab

3. 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.

4. 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

5. 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

6. Acute hemorrhagic pancreatitis

7. 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

8. Fat necrosis Acute hemorrhagic pancreatitis

9. Chronic pancreatitis Definition: • Chronic inflammation, atrophy and fibrosis secondary to repeated attacks of pancreatitis Grossly: • Firm white fibrotic pancreas Microscopic: • Extensive fibrosis and parenchymal atrophy • Chronic inflammation

10. Chronic pancreatitis

11. Clinical presentation: • Abdominal pain • Pancreatic insufficiency • Pancreatic calcification • Pseudocyst • Diabetes

12. Pancreatic Tumors

13. 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.

14. Pancreatic carcinoma

15. Microscopic: • Ductal adenocarcinoma arising from the duct epithelium Clinically: • Abdominal pain • Biliary obstruction • Obstructive jaundice

16. Pancreatic carcinoma

17. GALL BLADDER AND BILIARY TRACT PATHOLOGY

18. NORMAL GALLBLADDER

19. NORMAL GALLBLADDER

20. INFLAMMATORY CONDITIONS

21. Acute cholecystitis: • Definition: Acute inflammation of the gall bladder, usually causes by cystic duct obstruction by gall stones • Clinical presentation: • Biliary colic • Right upper quadrant tenderness on palpation • Nausea and vomiting • Low-grade fever and leukocytosis

22. Acute cholecystitis

23. Complications: • Gangrene of the gall bladder • Perforation and peritonitis • Fistula formation and small bowel obstruction by a large gall stone)

24. Chronic cholecystitis: • Definition: Ongoing chronic inflammation of the gallbladder usually caused by gall stones • Microscopically: Chronic inflammation • Complication: Calcification of the gall bladder (porcelain gall bladder)

25. Chronic cholecystitis

26. GALL BLADDER CANCER

27. Gallbladder cancer • Clinical presentation: • Frequently asymptomatic until late in the course • Cholecystitis • Enlarged palpable gallbladder • Biliary tract obstruction (uncommon) • Microscopically: • Adenocarcinoma

28. Gallbladder cancer

29. Gallbladder cancer

30. 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?

31. THANK YOU GOOD LUCK