1、胰腺疾病英文课件 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 cellc Causes Gallstones:60%(3550%in USA)Alcohol:14%(60%in USA)Duodenal juice countercurrent flow:Sphincter of Oddi dysfunction Trauma Pancreas circulation dis
2、order 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 pancreatitis,ac
3、ute necrotizing pancreatitis)急性胰腺炎急性胰腺炎 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 Clinical finding Abdominal pain Abdominal distention Nausea a
4、nd 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急性胰腺炎急性胰腺炎 Peritoneal irritation sign（Abdominal tenderness，rebound tenderness and rigidity）Shifting dullness Decreased bowel
5、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急性胰腺炎急性胰腺炎Blood a
6、mylaseUrine amylase急性胰腺炎急性胰腺炎 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 densities(biliary calculi)L
7、eft-sided pleural effusion B-US:pancreatic edema,ascites-CT:Important急性胰腺炎急性胰腺炎CT is the best diagnostic test for the diagnosis of acute pancreatitis.Contrast-enhanced CT is excellent for diagnosis of pancreatic necrosis急性胰腺炎急性胰腺炎 Assessment of severity of acute pancreatitis Ransons criteria On Admi
8、ssion Within 48 Hours 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 Diagnosis and differential Diagnosis Acute edematous pancreatitis and acute hemorrhagic necrotizing pancreatitis Other di
9、seases Acute appendtitis Ileus Perforated gastroduodenal ulcer Biliary disease Ruptured hepatoma急性胰腺炎急性胰腺炎Clinical findingAmylaseCT Abdominal paracentesis急性胰腺炎急性胰腺炎 Treatment Acute edematous pancreatitisinternal medicine(Emergency surgery is not indicated in mild acute pancreatitis)Acute hemorrhagic
10、 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 altering the course in acute pancrea
11、titis 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 necrotic tissue and peritoneal la
12、vage 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 pancreatic sphincterotomy more invasi
13、verequiring laparotomy and duodenotomy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 to pancreas divisum分裂分裂.The rationale for endoscopic therapy in each area is the relief of obstruction to f
14、low of pancreatic juice 慢性胰腺炎慢性胰腺炎 Causes Alcohol Pancreas divisum Acute pancreatitis Hyperparathyroidism Trauma Obstructive pancreatitis Idiopathic chronic pancreatitis Cystic fibrosis Hereditary chronic pancreatitis慢性胰腺炎慢性胰腺炎 Classification Obstructive chronic pancreatitis Calcified chronic pancre
15、atitis Inflammatory chronic pancreatitis Pathology pancreatic fibrosis-慢性胰腺炎慢性胰腺炎 Clinical finding and diagnosis Abdominal pain,distention Diarrhage Dyspepsia Malnutrtion Diabetes Narcotic addiction Jaundice Biochemical measurements Isoamylase,lipase trypsin,and elastase弹性蛋白酶 Quantitative measuremen
16、t 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慢性胰腺炎慢性胰腺炎 Imaging finding Plain abdominal film Transabdominal ultrasound CT MRCP Endoscopic diagnosis procedures(ERCP,EUS)Transabdominal ultrasoundStool
17、s:acholic无胆汁Glucose 11.Abdominal paracentesisWeakness,emaciation(消瘦)Temperature BUNPerforated gastroduodenal ulcerALT and AST(gallstone pancreatitis)ClassificationAlcohol and cigarette avoidanceSurgical approachEarly diagnosis very difficulty,prognosis poorInefficiency by internal medicineAbrupt ces
18、sation of gas in the distal transverse colon(colon cutoff sign)Blood amylaseImaging findingSurgical approachAbdominal distention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,pancreatic pseudocy
19、sts,combined with biliary diseases,intractabe pain,Celiac nerve block （难处理）（难处理）Therapeutic endoscopy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 symptom Abdominal pain Diabetes Weakness,emaciation
20、(消瘦)Stools:acholic无胆汁 Gallbladder:Distended Abdominal mass 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 Treatment of pancreatic carcinoma Radical operation Panc
21、reatoduodenectomy-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SPN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 hypogl
22、ycemia 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
23、腺肿瘤胰腺肿瘤Pancreas circulation disorderoutcome is the same as for the endoscopic pancreatic sphincterotomyEndoscopic diagnosis procedures(ERCP,EUS)Laboratory test:AKP,r-GT,LDH;CEA,POA胰胚抗原,PCCA胰癌相关抗原,CA19-9Other measures:nasogastric suction and antibioticsEarly diagnosis very difficulty,prognosis poorPr
24、otease inhibitors(trasylol抑肽酶)Dilated loop of small bowel(sentinel loop)Diagnosis:symptom and IRI/G0.CT is the best diagnostic test for the diagnosis of acute pancreatitis.Arise from:Papilla of duodenum Vater ampulla Distal CBD Symptom:obstructive jaundice Diagnosis Treatment:similar to pancreatic carcinoma壶腹周围癌
