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Gross pathology: Main duct, branch duct, and mixed duct lesions, which determines surgical management. Main duct lesion is the segmental or diffuse dilatation of main pancreatic duct greater than 5 mm without other causes of obstruction. Meanwhile, branch duct lesion is the pancreatic cyst more than 5 mm that communicates with the main duct.
These zymogens become pancreatic enzymes. Activated enzymes will get into the pancreatic tissue and later the peritoneal cavity and circulation. The effects of this include: interstitial oedema, necrosis of the acinar cells, haemorrhage, and necrosis of the peripancreatic fat; these trigger an inflammatory response from neutrophils and ...
Bile backing up into the pancreatic duct may initiate pancreatitis. [8] The pancreatic duct is generally regarded as abnormally enlarged if being over 3 mm in the head and 2 mm in the body or tail on CT scan. [9] Pancreatic duct or parts of pancreatic duct can be demonstrated on ultrasound in 75 to 85% of people. [10]
[3] [12] A biopsy of the pancreas is not required for the diagnosis. [3] On imaging, pancreatic and bile duct dilatation, atrophy of the pancreas, multiple calcifications of the pancreas, and enlargement of pancreatic glands can be found. [12] On MRI scan, there is a low T1 signal due to inflammation, fibrosis, focal lesions, and calcifications.
Normally, the two ducts will fuse together to form one main pancreatic duct; this occurs in more than 90% of embryos. In approximately 10% of embryos the ventral and dorsal ducts fail to fuse together, resulting in pancreas divisum. In utero, the majority of the pancreas is drained by the dorsal duct which opens up into the minor duodenal papilla.
Type I: Most common variety (80-90%) involving saccular or fusiform dilatation of a portion or entire common bile duct (CBD) with normal intrahepatic duct. Type II: These cysts are present as an isolated diverticulum protruding from the CBD. Type III or Choledochocele: Arise from dilatation of duodenal portion of CBD or where pancreatic duct meets.
Acute pancreatitis (AP) is a sudden inflammation of the pancreas.Causes include a gallstone impacted in the common bile duct or the pancreatic duct, heavy alcohol use, systemic disease, trauma, elevated calcium levels, hypertriglyceridemia (with triglycerides usually being very elevated, over 1000 mg/dL), certain medications, hereditary causes and, in children, mumps.
Cyst size greater than 3 cm, main pancreatic duct dilation of 5-10 mm, or a change in caliber or a narrowing of the main pancreatic duct with atrophy of the duct distally, presence of lymph node swelling, thickened or enhancing cyst walls, or an increase in cyst size over a year are considered intermediate risk imaging findings for cancer. [1]