胰腺疾病英文版培训课件.ppt

1、胰腺疾病英文版 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 cell2胰腺疾病英文版3胰腺疾病英文版c Causes Gallstones:60%(3550%in USA)Alcohol:14%(60%in USA)Duodenal juice countercurrent flow:Sphincter of Oddi dysfunction Trauma Pancreas

2、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4胰腺疾病英文版5胰腺疾病英文版 Pathology acute edematous pancreatitis acute hemorrhagic necrotizing pancreatitis (ac

3、ute hemorrhagic pancreatitis,acute necrotizing pancreatitis)急性胰腺炎急性胰腺炎6胰腺疾病英文版 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7胰腺疾病英文版 Clinical findi

4、ng Abdominal 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8胰腺疾病英文版急性胰腺炎急性胰腺炎 Peritoneal irritation sign（Abdominal tenderness，rebound ten

5、derness and rigidity）Shifting dullness Decreased bowel sounds Cullen sign:discoloration of periumbilical area Grey Turner sign:discoloration of flanks9胰腺疾病英文版10胰腺疾病英文版 Laboratory finding Amylase and lipase(elevations of amylase are more sensitive but less specific than lipase in the diagnosis of acu

6、te pancreatitis)500 400 300 200 100 0 0 1H 24H 48H 5DAY急性胰腺炎急性胰腺炎Blood amylaseUrine amylase11胰腺疾病英文版急性胰腺炎急性胰腺炎 Serum calcium Serum glucose Blood gas analysis Imunolipase ALT and AST(gallstone pancreatitis)12胰腺疾病英文版 Imaging finding X-ray Dilated loop of small bowel(sentinel loop)Abrupt cessation of g

7、as in the distal transverse 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13胰腺疾病英文版CT is the best diagnostic test for the diagnosis of acute pancreatitis.Contrast-enhanced CT is excellent for diagnosis of

8、 pancreatic necrosis14胰腺疾病英文版急性胰腺炎急性胰腺炎 Assessment of severity of acute pancreatitis Ransons criteria On Admission Within 48 Hours 15胰腺疾病英文版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-SAP17胰腺

9、疾病英文版 Diagnosis and differential Diagnosis 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 paracentesis18胰腺疾病英文版急性胰腺炎急性胰腺炎

10、 Treatment Acute edematous pancreatitisinternal 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

11、 suction and antibiotics 19胰腺疾病英文版 Agents to inhibit 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

12、peripancreatic Infection and abscess)Combined with biliary diseases(Gallstone ASP)20胰腺疾病英文版 Surgical approach Resection of necrotic tissue and peritoneal lavage severe,progressive necrotizing pancreatitis or pancreatic abscess.Cholecystectomy recurrent acute pancreatitis and microlithiasis.Surgical

13、sphincteroplasty of the pancreatic sphincter pancreatic sphincter dysfunctionoutcome is the same as for the endoscopic pancreatic sphincterotomy more invasiverequiring laparotomy and duodenotomy21胰腺疾病英文版急性胰腺炎急性胰腺炎 Endoscopic therapy 1)acute gallstone pancreatitis 2)recurrent pancreatitis due to panc

14、reatic 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 flow of pancreatic juice 22胰腺疾病英文版23胰腺疾病英文版24胰腺疾病英文版25胰腺疾病英文版慢性胰腺炎慢性胰腺炎 Causes Alcohol Pancreas divisum Acute pancreatitis Hyperparathyr

15、oidism Trauma Obstructive pancreatitis Idiopathic chronic pancreatitis Cystic fibrosis Hereditary chronic pancreatitis26胰腺疾病英文版慢性胰腺炎慢性胰腺炎 Classification Obstructive chronic pancreatitis Calcified chronic pancreatitis Inflammatory chronic pancreatitis Pathology pancreatic fibrosis-27胰腺疾病英文版慢性胰腺炎慢性胰腺炎

16、 Clinical finding and diagnosis Abdominal pain,distention Diarrhage Dyspepsia Malnutrtion Diabetes Narcotic addiction Jaundice 28胰腺疾病英文版 Biochemical measurements Isoamylase,lipase trypsin,and elastase弹性蛋白酶 Quantitative measurement of fecal fat glucose tolerance test Secretin stimulation test Plasma

17、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29胰腺疾病英文版30胰腺疾病英文版慢性胰腺炎慢性胰腺炎 Imaging finding Plain abdominal film Transabdominal ultrasound CT MRCP Endoscopic diagnosis procedures(ERCP,EUS)31胰腺疾病英文版32胰腺疾病英文版33胰腺疾病英文版慢性胰腺炎慢性胰腺炎 Medical therapy Alcohol and cigarette avoidan

18、ce 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 endoscopy34胰腺疾病英文版36胰腺疾病英文版37胰腺疾病英文版38胰腺疾病英文版39胰腺疾病英文版40胰腺疾病英文版胰腺肿瘤胰腺肿瘤 Pancreatic carcinoma

19、 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 mass41胰腺疾病英文版 Diagnosis of pancreatic carcinoma Laboratory test:AKP,r-GT,LDH

20、;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42胰腺疾病英文版 Treatment of pancreatic carcinoma Radical operation Pancreatoduodenectomy-tumor in pancreatic head Resection of pancreatic body and tail-tumor in pancreatic body or tai

21、l Palliative operation:to relieve jaundice Biotherapy胰腺肿瘤胰腺肿瘤43胰腺疾病英文版SPN44胰腺疾病英文版胰腺密度胰腺肿瘤密度低于胰腺密度45胰腺疾病英文版 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 Repe

22、ated 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46胰腺疾病英文版 Arise from:Papilla of duodenum Vater ampulla Distal CBD Symptom:obstructive jaundice Diagnosis Treatment:similar to pancreatic carcinoma壶腹周围癌47胰腺疾病英文版48胰腺疾病英文版49胰腺疾病英文版