Page 466 - Concise Pathology for Exam Preparation ( PDFDrive )

15 Diseases of the Hepatobiliary System and Pancreas 451

• Abscess: Infection superimposed on pancreatic necrosis leads to abscess formation.
It is associated with high mortality.
• Haemorrhagic ascites.
• Subcutaneous fat necrosis: Foci of fat necrosis develop and are related to the action of
lipolytic enzymes that have entered the circulation.
• Chronic pancreatitis: Most patients with acute pancreatitis recover if treated appropri-
ately. Persistence of inflammation leads to chronic pancreatitis.

Q. Write briefly on the clinicopathological features of chronic
pancreatitis.
Ans. Chronic pancreatitis is characterized by chronic inflammation with fibrosis leading
to a progressive loss of pancreatic function. The pancreas is reduced in size and often
showed calcification.

Causes
• Chronic alcohol abuse
• Cystic fibrosis of the pancreas
• Familial chronic pancreatitis and ‘tropical chronic pancreatitis’
• Idiopathic

Clinical Features

• Persistent upper abdominal pain radiating to the back, often precipitated by alcohol
• Malabsorption due to pancreatic insufficiency—steatorrhoea, vitamins A, D, E and K
deficiency
• Diabetes mellitus
• X-ray may show calcifications and distorted ducts can be visualized by ERCP

Pathology

• Persistent chronic inflammation composed of lymphocytes, macrophages and plasma
cells.
• Fibrosis, calcification and intraductal concretions
• Loss and atrophy of acini, with partial preservation of ducts and islets of Langerhans
• Cystic dilatation of ducts distal to narrowing by fibrous tissue

Q. Classify pancreatic tumours. Write briefly on the clinico-
pathological features of pancreatic carcinoma (infiltrating ductal
carcinoma of pancreas).

Ans. Classification of Pancreatic Tumours
1. Ductal tumours (90%)
2. Islet cell tumours (5%)
3. Acinar tumours (2%)
4. Others

Pancreatic Carcinoma
• Pancreatic carcinoma accounts for 6% of all cancer deaths
• Most patients are old (.60 years)
• Males and females are almost equally affected

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