胰腺疾病英文-课件.ppt

1、胰腺疾病英文胰腺疾病英文胰腺疾病英文 解剖解剖 头，颈，体，尾，钩突。头，颈，体，尾，钩突。主胰管主胰管(duct of Wirsung)副胰管副胰管(duct of Santorini)胰腺分泌胰腺分泌 外分泌外分泌Exocrine 内分泌内分泌Endocrine B,A,D,D1,G cell胰腺疾病英文 Causes Gallstones:60%(3550%in USA)Alcohol:14%(60%in USA)Duodenal juice countercurrent flow:Sphincter of Oddi dysfunction Trauma Pancreas circula

2、tion disorder Other factors:Drug:Azathioprine(硫唑嘌呤).6-Mercaptopurine(6-巯基嘌呤),Pancreas divisum(胰分裂),Microlithiasis Metabolic cause Infectious causes,ascaris worms蛔虫,HIV-Miscellaneous急性胰腺炎急性胰腺炎 Pathology acute edematous pancreatitis acute hemorrhagic necrotizing pancreatitis (acute hemorrhagic pancrea

3、titis,acute necrotizing pancreatitis)胰腺疾病英文胰腺疾病英文 Pathophysiology Hypersecretion and obstruction Self-enzymatic digestion Enhancement of Vessel permibility Cytokine，infection Decreased arterial perfusion Edematous hemorrhagic necrotizing 胰腺疾病英文胰腺疾病英文 Clinical finding Abdominal pain Abdominal distent

4、ion Nausea and vomiting Peritonitis Other:Respiratory failure,confusion,or coma.Low-grade to moderate fever Tachycardia and hypotension and Shock Mild jaundice,Pleural effusion.胰腺疾病英文胰腺疾病英文胰腺疾病英文胰腺疾病英文 Peritoneal irritation sign（Abdominal tenderness，rebound tenderness and rigidity）Shifting dullness

5、Decreased bowel sounds Cullen sign:discoloration of periumbilical area Grey Turner sign:discoloration of flanks Laboratory finding Amylase and lipase(elevations of amylase are more sensitive but less specific than lipase in the diagnosis of acute pancreatitis)500 400 300 200 100 0 0 1H 24H 48H 5DAY胰

6、腺疾病英文胰腺疾病英文Blood amylaseUrine amylase胰腺疾病英文胰腺疾病英文 Serum calcium Serum glucose Blood gas analysis Imunolipase ALT and AST(gallstone pancreatitis)Imaging finding X-ray Dilated loop of small bowel(sentinel loop)Abrupt cessation of gas in the distal transverse colon(colon cutoff sign)Radioopaque densiti

7、es(biliary calculi)Left-sided pleural effusion B-US:pancreatic edema,ascites-CT:Important胰腺疾病英文胰腺疾病英文CT is the best diagnostic test for the diagnosis of acute pancreatitis.Contrast-enhanced CT is excellent for diagnosis of pancreatic necrosis胰腺疾病英文胰腺疾病英文 Assessment of severity of acute pancreatitis

8、Ransons criteria On Admission Within 48 Hours 胰腺疾病英文胰腺疾病英文 Glasgow Criteria Within 48 Hours Age 55 WBC 15,000/mm LDH 600 IU/L Glucose 180 mg/dl Albumin 3.2 g/dl Calcium 45 mg/dl Arterial PaO2 8 Scores-SAP Diagnosis and differential Diagnosis Acute edematous pancreatitis and acute hemorrhagic necroti

9、zing pancreatitis Other diseases Acute appendtitis Ileus Perforated gastroduodenal ulcer Biliary disease Ruptured hepatoma胰腺疾病英文胰腺疾病英文Clinical findingAmylaseCT Abdominal paracentesis胰腺疾病英文胰腺疾病英文 Treatment Acute edematous pancreatitisinternal medicine(Emergency surgery is not indicated in mild acute

10、pancreatitis)Acute hemorrhagic necrotizing pancreatitis Supportive care Replacement of fluid and electrolytes Correction of metabolic abnormalities Nutritional support Other measures:nasogastric suction and antibiotics Agents to inhibit pancreatic secretion Have not been found to be useful in alteri

11、ng the course in acute pancreatitis Somatostatin(sandostatin stilamin)Protease inhibitors(trasylol抑肽酶)Surgical therapy Inefficiency by internal medicine Complication(pancreatic or/and peripancreatic Infection and abscess)Combined with biliary diseases(Gallstone ASP)Surgical approach Resection of nec

12、rotic tissue and peritoneal lavage severe,progressive necrotizing pancreatitis or pancreatic abscess.Cholecystectomy recurrent acute pancreatitis and microlithiasis.Surgical sphincteroplasty of the pancreatic sphincter pancreatic sphincter dysfunctionoutcome is the same as for the endoscopic pancrea

13、tic sphincterotomy more invasiverequiring laparotomy and duodenotomy胰腺疾病英文胰腺疾病英文 Endoscopic therapy 1)acute gallstone pancreatitis 2)recurrent pancreatitis due to pancreatic sphincter dysfunction,3)recurrent pancreatitis due to pancreas divisum分裂分裂.The rationale for endoscopic therapy in each area i

14、s the relief of obstruction to flow of pancreatic juice 胰腺疾病英文胰腺疾病英文 Causes Alcohol Pancreas divisum Acute pancreatitis Hyperparathyroidism Trauma Obstructive pancreatitis Idiopathic chronic pancreatitis Cystic fibrosis Hereditary chronic pancreatitis胰腺疾病英文胰腺疾病英文 Classification Obstructive chronic p

15、ancreatitis Calcified chronic pancreatitis Inflammatory chronic pancreatitis Pathology pancreatic fibrosis-胰腺疾病英文胰腺疾病英文 Clinical finding and diagnosis Abdominal pain,distention Diarrhage Dyspepsia Malnutrtion Diabetes Narcotic addiction Jaundice Biochemical measurements Isoamylase,lipase trypsin,and

16、 elastase弹性蛋白酶 Quantitative measurement of fecal fat glucose tolerance test Secretin stimulation test Plasma cholecystokinin(CCK)(may be elevated)Bentiromide(苯酪肽)test（与糜蛋白酶反应）胰腺疾病英文胰腺疾病英文胰腺疾病英文胰腺疾病英文 Imaging finding Plain abdominal film Transabdominal ultrasound CT MRCP Endoscopic diagnosis procedur

17、es(ERCP,EUS)胰腺疾病英文胰腺疾病英文 Medical therapy Alcohol and cigarette avoidance Analgesics 镇痛镇痛 Enzyme therapy Treatment of malnutrition Surgical therapy Biliary Obstruction,pancreatic pseudocysts,combined with biliary diseases,intractabe pain,Celiac nerve block （难处理）（难处理）Therapeutic endoscopy胰腺疾病英文胰腺疾病英文

18、Pancreatic carcinoma Arise from acinar腺泡 or duct cells Early diagnosis very difficulty,prognosis poor Obstructive jaundice(permanent):main symptom Abdominal pain Diabetes Weakness,emaciation(消瘦)Stools:acholic无胆汁 Gallbladder:Distended Abdominal mass Diagnosis of pancreatic carcinoma Laboratory test:A

19、KP,r-GT,LDH;CEA,POA胰胚抗原,PCCA胰癌相关抗原,CA19-9 Imaging finding US,CT(CTA),MRCP ERCP,PTC&PTCD PET(正电子发射断层扫描)Biopsy(FNA)and cytology胰腺疾病英文胰腺疾病英文 Treatment of pancreatic carcinoma Radical operation Pancreatoduodenectomy-tumor in pancreatic head Resection of pancreatic body and tail-tumor in pancreatic body

20、or tail Palliative operation:to relieve jaundice Biotherapy胰腺疾病英文胰腺疾病英文胰腺疾病英文SPN胰腺疾病英文胰腺密度胰腺肿瘤密度低于胰腺密度 Pancreatic endocrine neoplasm(PEN)Insulinoma Arise from B cell Symptoms:whipples triad 1 Spontaneous hypoglycemia accompanied by central nervous system,psychiatric,or vasomotor symptoms 2 Repeated

21、blood sugar levels below 2.8mmol/L(50mg%)3 Relief of symptoms by oral or intravenous administration of glucose Diagnosis:symptom and IRI/G0.3,B-us,CT,MRI,Endo-US,Angiography,PTPS Treatment:operation(resection)胰腺疾病英文胰腺疾病英文 Arise from:Papilla of duodenum Vater ampulla Distal CBD Symptom:obstructive jaundice Diagnosis Treatment:similar to pancreatic carcinoma胰腺疾病英文胰腺疾病英文