《Slide 2.》Acute hemorrhagic pancreatitis, pancreas

A. Brief Descriptions：

1. The ultimate pathogenetic process in acute pancreatitis is the proteolysis, lipolysis, and hemorrhage resulting from the destructive effect of pancreatic enzymes released from acinar cells.

B. Gross Findings：

1.    Vary from a swollen & edematous but well-preserved organ to a hemorrhagic & necrotic

       mass.

2.    Yellow plaques & nodules (fatty necrosis) within pancreas, mesentery and peritoneal fat.

C. Micro Findings：

1.    Autodigestion resulting in destruction of the fat, interstitium & pancreatic parenchyma.

2.    Interstitial hemorrhage.

3.    Inflammatory cells infiltrate.

4.   Amorphous basophilic calcium precipitates.

D. Others:

1.    Causes: cholelithiasis, alcoholism, viruses, drugs, ischemia, trauma and nutritional.

       deficiencies... ® duct obstruction, acinar cell injury and deranged, intracellular transport

       of pancreatic enzymes.

2.    Mechanism: activated enzymes.

3.    Lesions: interstitial inflammation + proteolysis + fat necrosis + hemorrhage.

4.    Clinical manifestations:

• Acute onset of abdominal pain by increase pancreatic enzymes in blood & urine.

• Associated with biliary tract diseases, alcoholism, and trauma.

• Secondary infection with abscess formation, or fibrosis, or pseudocyst formation.

E. Reference：

Robbins Pathologic Basis of Disease, 6^th ed.  P.904-907.

　

 

 

【 Fig. 2-1 (LP)】Amorphous basophilic substance deposit within necrotic adipose tissue.

　

 

 

【 Fig. 2-2 (HP)】Fat necrosis with blurred cell boundaries and loss of nuclei.

　

 

 

【 Fig. 2-3 (HP)】Extravasated red blood cells accumulate in necrotic fat.

　

 

 

【 Fig. 2-4 (HP)】Inflammatory cells infilltrate in necrotic adipose tissue.