胰腺疾病(英文)课件.ppt

1、编辑ppt胰腺疾病胰腺疾病编辑ppt 解剖生理概要 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编辑ppt编辑pptc Causes Gallstones:60%(3550%in USA)Alcohol:14%(60%in USA)Duodenal juice countercurrent flow:Sphincter of Oddi dysfunction Trauma Panc

2、reas circulation 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编辑ppt编辑ppt Pathology acute edematous pancreatitis acute hemorrhagic necrotizing pancreatitis (acu

3、te hemorrhagic pancreatitis,acute necrotizing pancreatitis)急性胰腺炎急性胰腺炎编辑ppt Pathophysiology Hypersecretion and obstruction Self-enzymatic digestion Enhancement of Vessel permibility Cytokine，infection Decreased arterial perfusion Edematous hemorrhagic necrotizing 急性胰腺炎急性胰腺炎编辑ppt Clinical finding Abdo

4、minal pain Abdominal distention Nausea and vomiting Peritonitis Other:Respiratory failure,confusion,or coma.Low-grade to moderate fever Tachycardia and hypotension and Shock Mild jaundice,Pleural effusion.急性胰腺炎急性胰腺炎编辑ppt急性胰腺炎急性胰腺炎 Peritoneal irritation sign（Abdominal tenderness，rebound tenderness an

5、d rigidity）Shifting dullness Decreased bowel sounds Cullen sign:discoloration of periumbilical area Grey Turner sign:discoloration of flanks编辑ppt编辑ppt Laboratory finding Amylase and lipase(elevations of amylase are more sensitive but less specific than lipase in the diagnosis of acute pancreatitis)5

6、00 400 300 200 100 0 0 1H 24H 48H 5DAY急性胰腺炎急性胰腺炎Blood amylaseUrine amylase编辑ppt急性胰腺炎急性胰腺炎 Serum calcium Serum glucose Blood gas analysis Imunolipase ALT and AST(gallstone pancreatitis)编辑ppt Imaging finding X-ray Dilated loop of small bowel(sentinel loop)Abrupt cessation of gas in the distal transver

7、se colon(colon cutoff sign)Radioopaque densities(biliary calculi)Left-sided pleural effusion B-US:pancreatic edema,ascites-CT:Important急性胰腺炎急性胰腺炎编辑pptCT is the best diagnostic test for the diagnosis of acute pancreatitis.Contrast-enhanced CT is excellent for diagnosis of pancreatic necrosis编辑ppt急性胰腺

8、炎急性胰腺炎 Assessment of severity of acute pancreatitis Ransons criteria On Admission Within 48 Hours 编辑ppt急性胰腺炎急性胰腺炎 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编辑ppt Diagnosis and differential Diagnosi

9、s Acute edematous pancreatitis and acute hemorrhagic necrotizing pancreatitis Other diseases Acute appendtitis Ileus Perforated gastroduodenal ulcer Biliary disease Ruptured hepatoma急性胰腺炎急性胰腺炎Clinical findingAmylaseCT Abdominal paracentesis编辑ppt急性胰腺炎急性胰腺炎 Treatment Acute edematous pancreatitisintern

10、al medicine(Emergency surgery is not indicated in mild acute pancreatitis)Acute hemorrhagic necrotizing pancreatitis Supportive care Replacement of fluid and electrolytes Correction of metabolic abnormalities Nutritional support Other measures:nasogastric suction and antibiotics 编辑ppt Agents to inhi

11、bit pancreatic secretion Have not been found to be useful in altering 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 wit

12、h biliary diseases(Gallstone ASP)编辑ppt Surgical approach Resection of necrotic tissue and peritoneal lavage severe,progressive necrotizing pancreatitis or pancreatic abscess.Cholecystectomy recurrent acute pancreatitis and microlithiasis.Surgical sphincteroplasty of the pancreatic sphincter pancreat

13、ic sphincter dysfunctionoutcome is the same as for the endoscopic pancreatic sphincterotomy more invasiverequiring laparotomy and duodenotomy编辑ppt急性胰腺炎急性胰腺炎 Endoscopic therapy 1)acute gallstone pancreatitis 2)recurrent pancreatitis due to pancreatic sphincter dysfunction,3)recurrent pancreatitis due

14、 to pancreas divisum分裂分裂.The rationale for endoscopic therapy in each area is the relief of obstruction to flow of pancreatic juice 编辑ppt编辑ppt编辑ppt编辑ppt慢性胰腺炎慢性胰腺炎 Causes Alcohol Pancreas divisum Acute pancreatitis Hyperparathyroidism Trauma Obstructive pancreatitis Idiopathic chronic pancreatitis Cy

15、stic fibrosis Hereditary chronic pancreatitis编辑ppt慢性胰腺炎慢性胰腺炎 Classification Obstructive chronic pancreatitis Calcified chronic pancreatitis Inflammatory chronic pancreatitis Pathology pancreatic fibrosis-编辑ppt慢性胰腺炎慢性胰腺炎 Clinical finding and diagnosis Abdominal pain,distention Diarrhage Dyspepsia Mal

16、nutrtion Diabetes Narcotic addiction Jaundice 编辑ppt Biochemical measurements Isoamylase,lipase trypsin,and 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）慢性胰腺炎慢性胰腺炎编辑ppt编辑pp

17、t慢性胰腺炎慢性胰腺炎 Imaging finding Plain abdominal film Transabdominal ultrasound CT MRCP Endoscopic diagnosis procedures(ERCP,EUS)编辑ppt编辑ppt编辑ppt慢性胰腺炎慢性胰腺炎 Medical therapy Alcohol and cigarette avoidance Analgesics 镇痛镇痛 Enzyme therapy Treatment of malnutrition Surgical therapy Biliary Obstruction,pancreat

18、ic pseudocysts,combined with biliary diseases,intractabe pain,Celiac nerve block （难处理）（难处理）Therapeutic endoscopy编辑ppt编辑ppt编辑ppt编辑ppt编辑ppt编辑ppt编辑ppt胰腺肿瘤胰腺肿瘤 Pancreatic carcinoma Arise from acinar腺泡 or duct cells Early diagnosis very difficulty,prognosis poor Obstructive jaundice(permanent):main sympt

19、om Abdominal pain Diabetes Weakness,emaciation(消瘦)Stools:acholic无胆汁 Gallbladder:Distended Abdominal mass编辑ppt Diagnosis of pancreatic carcinoma Laboratory test:AKP,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胰腺肿瘤胰腺肿瘤编辑ppt

20、Treatment of pancreatic carcinoma Radical operation Pancreatoduodenectomy-tumor in pancreatic head Resection of pancreatic body and tail-tumor in pancreatic body or tail Palliative operation:to relieve jaundice Biotherapy胰腺肿瘤胰腺肿瘤编辑pptSPN编辑ppt胰腺密度胰腺肿瘤密度低于胰腺密度编辑ppt Pancreatic endocrine neoplasm(PEN)In

21、sulinoma Arise from B cell Symptoms:whipples triad 1 Spontaneous hypoglycemia accompanied by central nervous system,psychiatric,or vasomotor symptoms 2 Repeated 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)胰腺肿瘤胰腺肿瘤编辑ppt Arise from:Papilla of duodenum Vater ampulla Distal CBD Symptom:obstructive jaundice Diagnosis Treatment:similar to pancreatic carcinoma壶腹周围癌编辑ppt编辑ppt