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Museum of Pathology

ACUTE PANCREATITIS

ACUTE PANCREATITIS

Clinical History

The patient was a 55 year old hypertensive woman who presented with ankle swelling, abdominal distension and shortness of breath. Examination revealed epigastric tenderness and abdominal distension with shifting dullness. The mode of death is not recorded.

Pathology

The specimen is a pancreas sectioned longitudinally to display a variegated cut surface. Brown haemorrhagic areas are interspersed with pale foci of fat necrosis which are seen within the pancreas and also in the peri-pancreatic fat. This is an example of acute haemorrhagic pancreatitis.

Note

Acute pancreatitis typically presents with severe abdominal pain, vomiting and collapse. The serum amylase is elevated (greater than 1200 iu/l). There are two distinct initial lesions in acute pancreatitis associated with different aetiologies. 1. An acute inflammation of the excretory ducts leads to periductal inflammation and necrosis, and sometimes thrombosis of the periductal venous plexus. The latter may lead to panlobular necrosis and extensive haemorrhage. This type of acute pancreatitis is associated with gallstones or alcohol abuse. 2. Peri-lobular necrosis, in which there is ischaemic necrosis of the periphery of pancreatic lobules. This type of acute pancreatitis is associated with prolonged hypotension, such as occurs in shock and hypothermia. The widespread fat necrosis which may occur in acute pancreatitis is due to release of pancreatic enzymes from damaged ducts and acini.