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

2. Pancreatic Pathology Inflammation of the pancreas Prof. Dr. Noha Ragab

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 Gall-stones Alcohols Alcohols Hypercalcaemia Hypercalcaemia Drugs Drugs Infection InfectionPathogenesis: Pancreatic acinar cell injury results in activation of pancreatic enzymes and the enzymes consequently causes destruction of the pancreatic parenchyma 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 Stabbing epigastric abdominal pain radiating to the back Shock Shock Hypercalcaemia Hypercalcaemia Laboratory investigation: elevation of serum amylase and lipase Laboratory investigation: elevation of serum amylase and lipase Gross pathology: Gross pathology: Focal pancreatic hemorrhage and liquefaction Focal pancreatic hemorrhage and liquefaction Chalky, white yellow fat necrosis of adjacent adipose tissue Chalky, white yellow fat necrosis of adjacent adipose tissue

6. Acute hemorrhagic pancreatitis

7. Microscopically: Liquifactive necrosis of pancreatic parenchyma Liquifactive necrosis of pancreatic parenchyma Acute inflammation Acute inflammation Enzymatic fat necrosis Enzymatic fat necrosis Necrosis of blood vessels causes hemorrhage Necrosis of blood vessels causes hemorrhageComplication: Acute respiratory distress syndrome (ARDS) Acute respiratory distress syndrome (ARDS) Disseminated intra-vascular coagulopathy (DIC) Disseminated intra-vascular coagulopathy (DIC) Pseudo cyst of pancreas Pseudo cyst of pancreas Pancreatic calcification Pancreatic calcification

8. Acute hemorrhagic pancreatitis Fat necrosis

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

10. Chronic pancreatitis

11. Clinical presentation: 1. Abdominal pain 2. Pancreatic insufficiency 3. Pancreatic calcification 4. Pseudocyst 5. 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. 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. 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 Ductal adenocarcinoma arising from the duct epitheliumClinically: Abdominal pain Abdominal pain Biliary obstruction Biliary obstruction Obstructive jaundice Obstructive jaundice

16. Pancreatic carcinoma

17. GALL BLADDER AND BILIARY TRACT PATHOLOGY

18. NORMAL GALLBLADDER

20. INFLAMMATORY CONDITIONS

21. Acute cholecystitis: Definition: Definition: Acute inflammation of the gall bladder, usually causes by cystic duct obstruction by gall stones Clinical presentation: Clinical presentation: 1. Biliary colic 2. Right upper quadrant tenderness on palpation 3. Nausea and vomiting 4. Low-grade fever and leukocytosis

22. Acute cholecystitis

23. Complications: Complications: 1. Gangrene of the gall bladder 2. Perforation and peritonitis 3. Fistula formation and small bowel obstruction by a large gall stone)

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

25. Chronic cholecystitis

26. GALL BLADDER CANCER

27. Gallbladder cancer Clinical presentation: Clinical presentation: 1. Frequently asymptomatic until late in the course 2. Cholecystitis 3. Enlarged palpable gallbladder 4. Biliary tract obstruction (uncommon) Microscopically: Microscopically: Adenocarcinoma Adenocarcinoma

28. 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? 4- What is the clinical presentation of gallbladder cancer?

31. THANK YOU GOOD LUCK