CAM202 Lecture Notes - Lecture 12: Common Bile Duct, Pancreas Divisum, Annular Pancreas

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26 Oct 2018
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Fusion of ducts at week 7 creates main pancreatic duct (wirsung) which extends to papilla of. Vater, usually with common bile duct: abnormal fusion of ventral and dorsal buds causes annular pancreas or heterotopic pancreas. Congenital anomalies: agenesis, usually associated with severe malformations. Infection (mumps, mycoplasma, coxsackievirus: drugs (thiazides, oestrogen, metabolic disorders (hyperlipidaemia, acute ischemia (thromboemboli, trauma (including operative, ercp) Swollen, oedematous or hemorrhagic/necrotic: yellow nodules represent fat necrosis in pancreas, mesenteric and peritoneal fat. Fat necrosis, neutrophils, acinar and blood vessel destruction, interstitial haemorrhage: diffuse interstitial oedema due to microvascular leakage, also acinar cell homogenization, ductal dilation, fibroblasts, thrombi in capillaries and venules, calcification occurs early and extensively. Initially neutrophils are present, then macrophages and later lymphocytes. Lymphoplasmacytic sclerosing pancreatitis: hyper-igg4 disease, resembles primary sclerosing cholangitis involving the pancreas. Laboratory: elevated serum igg4: treatment: steroids, overall prognosis is excellent. Localized collections of pancreatic secretions that develop after: pancreatitis (acute or chronic, trauma, ductal calculi, obstructive neoplasms.

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