IPLab:Lab 1:Fat Necrosis - Revision history

Peter Anderson: /* Journal Articles */

2016-11-21T18:30:21Z

‎Journal Articles

Peter Anderson: /* Journal Articles */

2016-08-25T14:36:35Z

‎Journal Articles

Peter Anderson: /* Virtual Microscopy */

2015-09-16T18:58:49Z

‎Virtual Microscopy

Seung Park at 15:37, 3 January 2014

2014-01-03T15:37:43Z

Seung Park at 01:22, 30 August 2013

2013-08-30T01:22:48Z

Seung Park at 23:31, 18 August 2013

2013-08-18T23:31:52Z

Seung Park at 05:15, 16 August 2013

2013-08-16T05:15:04Z

Seung Park at 03:13, 16 August 2013

2013-08-16T03:13:47Z

Seung Park at 01:34, 16 August 2013

2013-08-16T01:34:18Z

Seung Park: Created page with "== Clinical Summary == This was a 37-year-old female with chronic renal failure that necessitated a renal transplant. Following transplantation, the patient developed a herpes..."

2013-08-16T01:26:52Z

Created page with "== Clinical Summary == This was a 37-year-old female with chronic renal failure that necessitated a renal transplant. Following transplantation, the patient developed a herpes..."

New page

== Clinical Summary ==
This was a 37-year-old female with chronic renal failure that necessitated a renal transplant. Following transplantation, the patient developed a herpes simplex virus (HSV) infection in her nasal cavity, oral candidiasis, pneumonia, hematuria, pyuria, and gastrointestinal bleeding. Subsequently, the patient became septic and died.

== Autopsy Findings ==
Major findings at autopsy included extensive hemorrhagic bronchopneumonia (Pseudomonas aeruginosa) and multiple ulcers affecting the stomach and esophagus. There was also evidence of disseminated intravascular coagulation (DIC) with multiple hemorrhages present. Firm, whitish foci of necrotic tissue were found in the fat around the pancreas.

== Images ==
{| cellpadding="10"
| [[Image:IPLab1FatNecrosis1.jpg|frameless]]
| This gross photograph shows the intestines and omentum at autopsy. Note the small (5-15 mm in diameter) white nodules on the surface of the omental and mesenteric fat tissue (arrows).
|-
| [[Image:IPLab1FatNecrosis2.jpg|frameless]]
| This gross photograph of the pancreas from this case shows white nodules (arrows) in the pancreas and the adjacent mesenteric fat tissue.
|-
| [[Image:IPLab1FatNecrosis3.jpg|frameless]]
| This low-power photomicrograph of the pancreas from this case shows the fat tissue (1) surrounding the pancreas. Note the rim of inflammatory cells (arrows) and the blue areas in the fat adjacent to the pancreas (2).
|-
| [[Image:IPLab1FatNecrosis4.jpg|frameless]]
| This high-power photomicrograph shows areas of inflammation (1) and fat necrosis (arrows) in the peripancreatic fat tissue (2) of the pancreas from this case.
|-
| [[Image:IPLab1FatNecrosis5.jpg|frameless]]
| Another high-power photomicrograph shows blue discoloration in the fat tissue in the interlobular spaces (1) of the pancreas.
|-
| [[Image:IPLab1FatNecrosis6.jpg|frameless]]
| A higher-power photomicrograph of the previous slide contains a small area of fat necrosis (1) in the upper right portion of the image. The fat necrosis is within the fat tissue that is normally found adjacent to the pancreas. The appearance of the pancreatic tissue in this area is somewhat disrupted due to autolysis (the pancreas autolyzes very rapidly after death) but there is some premortem necrosis as well.
|-
| [[Image:IPLab1FatNecrosis7.jpg|frameless]]
| This is a higher-power photomicrograph of the fat necrosis involving the fat cells in the interlobular spaces (arrow) of the pancreas. Note the blue to purple staining of the calcium deposits within the fat cells.
|-
| [[Image:IPLab1FatNecrosis8.jpg|frameless]]
| This high-power photomicrograph demonstrates fat necrosis in the interlobular spaces of the pancreas. Note the granular blue-staining calcium deposits (arrows) within the fat cells. The clear areas represent artifact caused by the "washing-out" of fat from cells during tissue processing for histology.
|-
| [[Image:IPLab1FatNecrosis9.jpg|frameless]]
| This is another high-power photomicrograph demonstrating the calcification (arrows) seen in fat necrosis involving the interlobular spaces of the pancreas.
|}

== Study Questions ==
* <spoiler text="What is the definition of enzymatic fat necrosis?">Focal areas of destruction of fat tissue resulting from abnormal release of activated lipases.</spoiler>
* <spoiler text="Where else can enzymatic fat necrosis occur besides the pancreas?">Salivary glands.</spoiler>
* <spoiler text="What causes the formation of the white, chalky, nodules that are seen in the fat tissue adjacent to the pancreatic tissue?">Injury to the pancreas (infection, toxins, viruses, trauma, ischemia) causes release of activated pancreatic enzymes which liquefy fat cell membranes. The released lipases split the triglyceride esters contained within the fat cells and these released fatty acids combine with calcium to form the grossly visible chalky white nodules characteristic of fat necrosis.</spoiler>

== Additional Resources ==

=== Reference ===
* [http://emedicine.medscape.com/article/807499-overview eMedicine Medical Library: Empyema and Abscess Pneumonia]
* [http://www.merckmanuals.com/professional/pulmonary_disorders/lung_abscess/lung_abscess.html Merck Manual: Lung Abscess]

=== Journal Articles ===
* Brandenburg JA ''et al''. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495594/ Clinical presentation, processes and outcomes of care for patients with Pneumococcal pneumonia]. ''J Gen Intern Med'' 2000 September; 15(9): 638–646.

=== Images ===
* [http://peir.path.uab.edu/library/index.php?/tags/61-abscess/27-lung PEIR Digital Library: Lung Abscess Images]
* [http://library.med.utah.edu/WebPath/LUNGHTML/LUNGIDX.html WebPath: Pulmonary Pathology Images]

== Related IPLab Cases ==
* [[IPLab:Lab 3:Lobar Pneumonia|Lab 3: Lung: Lobar Pneumonia]]
* [[IPLab:Lab 3:Bronchopneumonia|Lab 3: Lung: Bronchopneumonia]]

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[[Category:IPLab]]

@@ Line 37: / Line 37: @@
 === Journal Articles ===
-* Bhatnagar A, Wig J, Vaiphei K, Majumdar S. [http://www.ncbi.nlm.nih.gov/pubmed/11560386 Intracellular cytokines in cells of necrotic tissue from patients with acute pancreatitis].  ''Eur J Surg'' 2001 Jul;167(7):510-7.
+* Forsmark CE, Vege SS, Wilcox CM. [http://www.nejm.org/doi/full/10.1056/NEJMra1505202 Acute Pericarditis].  ''N Engl J Med" 2016; 375:1972-1981. November 17, 2016.
 * LeWinter MM. [http://http://www.nejm.org/doi/full/10.1056/NEJMcp1404070 Acute Pericarditis].  ''NEJM'' 2014 Dec 18;371:2410-2416.

@@ Line 19: / Line 19: @@
 == Virtual Microscopy ==
 <peir-vm>IPLab1FatNecrosis</peir-vm>
 == Study Questions ==

@@ Line 17: / Line 17: @@
 File:IPLab1FatNecrosis9.jpg|This is another high-power photomicrograph demonstrating the calcification (arrows) seen in fat necrosis involving the interlobular spaces of the pancreas.
 </gallery>
 == Study Questions ==

@@ Line 33: / Line 33: @@
 === Images ===
-* [http://peir.path.uab.edu/library/index.php?/tags/333-pancreas PEIR Digital Library: Pancreas Images]
+* [{{SERVER}}/library/index.php?/tags/333-pancreas PEIR Digital Library: Pancreas Images]
 * [http://library.med.utah.edu/WebPath/CINJHTML/CINJIDX.html WebPath: Cellular Injury Images]

@@ Line 6: / Line 6: @@
 == Images ==
-<gallery>
+<gallery heights="250px" widths="250px">
 File:IPLab1FatNecrosis1.jpg|This gross photograph shows the intestines and omentum at autopsy. Note the small (5-15 mm in diameter) white nodules on the surface of the omental and mesenteric fat tissue (arrows).
 File:IPLab1FatNecrosis2.jpg|This gross photograph of the pancreas from this case shows white nodules (arrows) in the pancreas and the adjacent mesenteric fat tissue.

@@ Line 6: / Line 6: @@
 == Images ==
-{| cellpadding="10"
+<gallery>
-| [[Image:IPLab1FatNecrosis1.jpg|frameless]]
+File:IPLab1FatNecrosis1.jpg|This gross photograph shows the intestines and omentum at autopsy. Note the small (5-15 mm in diameter) white nodules on the surface of the omental and mesenteric fat tissue (arrows).
-| This gross photograph shows the intestines and omentum at autopsy. Note the small (5-15 mm in diameter) white nodules on the surface of the omental and mesenteric fat tissue (arrows).
+File:IPLab1FatNecrosis2.jpg|This gross photograph of the pancreas from this case shows white nodules (arrows) in the pancreas and the adjacent mesenteric fat tissue.
-|-
+File:IPLab1FatNecrosis3.jpg|This low-power photomicrograph of the pancreas from this case shows the fat tissue (1) surrounding the pancreas. Note the rim of inflammatory cells (arrows) and the blue areas in the fat adjacent to the pancreas (2).
-| [[Image:IPLab1FatNecrosis2.jpg|frameless]]
+File:IPLab1FatNecrosis4.jpg|This high-power photomicrograph shows areas of inflammation (1) and fat necrosis (arrows) in the peripancreatic fat tissue (2) of the pancreas from this case.
-| This gross photograph of the pancreas from this case shows white nodules (arrows) in the pancreas and the adjacent mesenteric fat tissue.
+File:IPLab1FatNecrosis5.jpg|Another high-power photomicrograph shows blue discoloration in the fat tissue in the interlobular spaces (1) of the pancreas.
-|-
+File:IPLab1FatNecrosis6.jpg|A higher-power photomicrograph of the previous slide contains a small area of fat necrosis (1) in the upper right portion of the image. The fat necrosis is within the fat tissue that is normally found adjacent to the pancreas. The appearance of the pancreatic tissue in this area is somewhat disrupted due to autolysis (the pancreas autolyzes very rapidly after death) but there is some premortem necrosis as well.
-| [[Image:IPLab1FatNecrosis3.jpg|frameless]]
+File:IPLab1FatNecrosis7.jpg|This is a higher-power photomicrograph of the fat necrosis involving the fat cells in the interlobular spaces (arrow) of the pancreas. Note the blue to purple staining of the calcium deposits within the fat cells.
-| This low-power photomicrograph of the pancreas from this case shows the fat tissue (1) surrounding the pancreas. Note the rim of inflammatory cells (arrows) and the blue areas in the fat adjacent to the pancreas (2).
+File:IPLab1FatNecrosis8.jpg|This high-power photomicrograph demonstrates fat necrosis in the interlobular spaces of the pancreas. Note the granular blue-staining calcium deposits (arrows) within the fat cells. The clear areas represent artifact caused by the "washing-out" of fat from cells during tissue processing for histology.
-|-
+File:IPLab1FatNecrosis9.jpg|This is another high-power photomicrograph demonstrating the calcification (arrows) seen in fat necrosis involving the interlobular spaces of the pancreas.
-| [[Image:IPLab1FatNecrosis4.jpg|frameless]]
+</gallery>
 == Study Questions ==

← Older revision		Revision as of 03:13, 16 August 2013
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−	[[Category:IPLab]]	+	[[Category:IPLab:Lab 1]]

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 === Reference ===
-* [http://emedicine.medscape.com/article/807499-overview eMedicine Medical Library: Empyema and Abscess Pneumonia]
+* [http://emedicine.medscape.com/article/775867-overview eMedicine Medical Library: Emergent Management of Pancreatitis]
-* [http://www.merckmanuals.com/professional/pulmonary_disorders/lung_abscess/lung_abscess.html Merck Manual: Lung Abscess]
+* [http://www.merckmanuals.com/professional/gastrointestinal_disorders/pancreatitis/acute_pancreatitis.html Merck Manual: Acute Pancreatitis]
 === Journal Articles ===
-* Brandenburg JA ''et al''. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495594/ Clinical presentation, processes and outcomes of care for patients with Pneumococcal pneumonia].  ''J Gen Intern Med'' 2000 September; 15(9): 638–646.
+* Bhatnagar A, Wig J, Vaiphei K, Majumdar S. [http://www.ncbi.nlm.nih.gov/pubmed/11560386 Intracellular cytokines in cells of necrotic tissue from patients with acute pancreatitis].  ''Eur J Surg'' 2001 Jul;167(7):510-7.
 === Images ===
-* [http://peir.path.uab.edu/library/index.php?/tags/61-abscess/27-lung PEIR Digital Library: Lung Abscess Images]
+* [http://peir.path.uab.edu/library/index.php?/tags/333-pancreas PEIR Digital Library: Pancreas Images]
-* [http://library.med.utah.edu/WebPath/LUNGHTML/LUNGIDX.html WebPath: Pulmonary Pathology Images]
+* [http://library.med.utah.edu/WebPath/CINJHTML/CINJIDX.html WebPath: Cellular Injury Images]
 {{Template:IPLab 1}}
 [[Category:IPLab]]