Pancreatic Disorders Question and Answers

Pancreas

Question 1. Discuss the pathogenesis and morphology of acute pancreatitis.
Answer:

Pathogenesis of acute pancreatitis

• Intrapancreatic activation of trypsin, pro phospholipase, and proelastase

Mechanisms by which activation of these enzymes is brought about

1. Pancreatic duct obstruction

• Causes: Gallstones, biliary sludge, pancreatic cancer, choledochal, parasites (Ascaris and Clonorchis)
• Results in activation of lipases, which brings about fat necrosis
• There occurs resultant interstitial edema, impaired blood flow, and ischemia

Read and Learn More Preparatory Manual of Pathology Question and Answers

2. Primary acinar cell injury

• Causes: Alcohol, drugs, trauma, ischemia, viruses, hypocalcemia
• Resulting in the release and activation of proenzymes, especially trypsin

Genes implicated in hereditary pancreatitis

• Gain-of-function mutations in the trypsinogen gene (also known as PRSS1)
• Loss of function mutations in SPINK1
• Loss of function mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene

Morphology of acute pancreatitis

Gross

• Pancreas appears red-black due to hemorrhage with foci of yellow-white, chalky fat necrosis

Microscopy

• Fat necrosis
• Acute inflammation
• Destruction of the pancreatic parenchyma
• Interstitial hemorrhage

Question 2. Write a note on chronic pancreatitis.
Answer:

Chronic pancreatitis

• Definition: Prolonged inflammation of the pancreas associated with irreversible destruction of exocrine and endocrine parenchyma with accompanying fibrosis

Chronic pancreatitis Causes

• Alcohol abuse (most common cause)
• Obstruction of the pancreatic duct by calculi
• Autoimmune injury to the gland
• Hereditary pancreatitis associated with germline mutations in CFTR genes

Chronic pancreatitis  Pathogenesis

• Chronic pancreatic injury results in the stimulation of pancreatic periacinar my fibroblasts, which secrete TGF-β and platelet-derived growth factor (PDGF)
• Autoimmune pancreatitis: Associated with the presence of IgG4-secreting plasma cells in the pancreas

Chronic pancreatitis Morphology

Microscopy:

• The entire pancreatic parenchymal is replaced by fibrotic bands with atrophy of pancreatic islets and ducts
• Interspersed chronic inflammatory cells are seen admixed in the sclerotic stroma
• Autoimmune pancreatitis is characterized by increased IgG4 plasma cells

Chronic pancreatitis Complications:

• Pancreatic pseudocyst
• Chronic malabsorption
• Diabetes mellitus
• Pancreatic cancer (in hereditary pancreatitis)

Question 3. Enumerate the pancreatic changes in diabetes mellitus.
Answer:

Morphology of pancreas in type I DM

1. Insults: Leukocyte infiltrates in the islets
2.  Reduction in the number and size of the islets

Morphology of pancreas in type II DM

Amyloid deposition within the islets, in and around capillaries, and between cells