胰腺疾病英文课件最全

1、胰腺疾病英文课件胰腺疾病英文课件 解剖生理概要解剖头，颈，体，尾，钩突。 主胰管 (duct of Wirsung)副胰管 (duct of Santorini) 胰腺分泌外分泌Exocrine 内分泌Endocrine B,A,D,D1,G cell 解剖生理概要解剖胰腺疾病英文课件最全cCausesGallstones:60%( 3550% in USA)Alcohol:14% %(60% in USA)Duodenal juice countercurrent flow: Sphincter of Oddi dysfunctionTraumaPancreas circulation di

2、sorderOther 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cCauses急性胰腺炎胰腺疾病英文课件最全Pathologyacute edematous pancreatitisacute hemorrhagic necrotizing pancreatitis (acute hemorrh

3、agic pancreatitis, acute necrotizing pancreatitis)急性胰腺炎Pathology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Pathophysiology 急性胰腺炎Clinical findingA

4、bdominal painAbdominal distention Nausea and vomitingPeritonitis 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Clinical finding急性胰腺炎急性胰腺炎Peritoneal irritation sign （Abdominal tenderness， rebound

5、tenderness and rigidity）Shifting dullnessDecreased bowel sounds Cullen sign: discoloration of periumbilical area Grey Turner sign:discoloration of flanks急性胰腺炎Peritoneal irritation sig胰腺疾病英文课件最全Laboratory findingAmylase and lipase (elevations of amylase are more sensitive but less specific than lipas

6、e in the diagnosis of acute pancreatitis )5004003002001000 0 1H 24H 48H 5DAY急性胰腺炎Blood amylaseUrine amylaseLaboratory finding急性胰腺炎Blood a急性胰腺炎Serum calcium Serum glucose Blood gas analysisImunolipase ALT and AST (gallstone pancreatitis ) 急性胰腺炎Serum calcium Imaging finding X-ray Dilated loop of small

7、 bowel (sentinel loop)Abrupt cessation of gas in the distal transverse colon (colon cutoff sign)Radioopaque densities (biliary calculi) Left-sided pleural effusionB-US: pancreatic edema, ascites- CT: Important急性胰腺炎Imaging finding 急性胰腺炎CT is the best diagnostic test for the diagnosis of acute pancrea

8、titis. Contrast-enhanced CT is excellent for diagnosis of pancreatic necrosis有力武器CT is the best diagnostic tes急性胰腺炎Assessment of severity of acute pancreatitis Ransons criteria On Admission Within 48 Hours Age 55 years Hematocrit decrease by 10% WBC 16,000 /mm Urea nitrogen increase 5 mg/dl LDH 350

9、IU/L Serum calcium 11.1mmol/l Arterial PO 250 IU/L Base deficit 4 mEq/L Estimated fluid sequestration 6 L急性胰腺炎Assessment of severity of急性胰腺炎Glasgow CriteriaWithin 48 HoursAge 55WBC 15,000 /mmLDH 600 IU/LGlucose 180 mg/dlAlbumin 3.2 g/dl Calcium 45 mg/dlArterial PaO2 8 Scores -SAP急性胰腺炎APACHE III crit

10、eriaDiagnosis and differential DiagnosisAcute edematous pancreatitis and acute hemorrhagic necrotizing pancreatitisOther diseasesAcute appendtitisIleus Perforated gastroduodenal ulcer Biliary disease Ruptured hepatoma急性胰腺炎Clinical findingAmylaseCT Abdominal paracentesisDiagnosis and differential Dia

11、急性胰腺炎TreatmentAcute edematous pancreatitisinternal medicine (Emergency surgery is not indicated in mild acute pancreatitis)Acute hemorrhagic necrotizing pancreatitisSupportive care Replacement of fluid and electrolytesCorrection of metabolic abnormalitiesNutritional support Other measures :nasogastr

12、ic suction and antibiotics 急性胰腺炎TreatmentAgents to inhibit pancreatic secretionHave 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

13、 or/and peripancreatic Infection and abscess) Combined with biliary diseases(Gallstone ASP)Agents to inhibit pancreatic s Surgical approach Resection of necrotic tissue and peritoneal lavage severe, progressive necrotizing pancreatitis or pancreatic abscess. Cholecystectomy recurrent acute pancreati

14、tis and microlithiasis. Surgical sphincteroplasty of the pancreatic sphincter pancreatic sphincter dysfunctionoutcome is the same as for the endoscopic pancreatic sphincterotomy more invasiverequiring laparotomy and duodenotomy Surgical approach 急性胰腺炎Endoscopic therapy 1) acute gallstone pancreatiti

15、s 2) recurrent pancreatitis due to pancreatic sphincter dysfunction, 3) recurrent pancreatitis due to pancreas divisum分裂. The rationale for endoscopic therapy in each area is the relief of obstruction to flow of pancreatic juice 急性胰腺炎Endoscopic therapy胰腺疾病英文课件最全胰腺疾病英文课件最全胰腺疾病英文课件最全慢性胰腺炎Causes Alcoho

16、lPancreas divisumAcute pancreatitisHyperparathyroidismTraumaObstructive pancreatitisIdiopathic chronic pancreatitisCystic fibrosisHereditary chronic pancreatitis慢性胰腺炎Causes 慢性胰腺炎ClassificationObstructive chronic pancreatitisCalcified chronic pancreatitisInflammatory chronic pancreatitisPathology pan

17、creatic fibrosis -慢性胰腺炎Classification慢性胰腺炎Clinical finding and diagnosisAbdominal pain , distentionDiarrhageDyspepsiaMalnutrtionDiabetes Narcotic addictionJaundice 慢性胰腺炎Clinical finding and diagBiochemical measurementsIsoamylase,lipase trypsin,and elastase弹性蛋白酶Quantitative measurement of fecal fat g

18、lucose tolerance testSecretin stimulation testPlasma cholecystokinin (CCK)( may be elevated )Bentiromide (苯酪肽) test（与糜蛋白酶反应）慢性胰腺炎Biochemical measurements慢性胰腺炎胰腺疾病英文课件最全慢性胰腺炎Imaging findingPlain abdominal filmTransabdominal ultrasound CT MRCP Endoscopic diagnosis procedures(ERCP,EUS)慢性胰腺炎Imaging find

19、ing胰腺疾病英文课件最全Transabdominal ultrasoundStools: 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 , prognosi

20、s poorInefficiency by internal medicineAbrupt cessation of gas in the distal transverse colon (colon cutoff sign)Blood amylaseImaging findingSurgical approachAbdominal distentionTransabdominal ultrasound慢性胰腺炎Medical therapyAlcohol and cigarette avoidanceAnalgesics 镇痛Enzyme therapyTreatment of malnut

21、rition Surgical therapyBiliary Obstruction, pancreatic pseudocysts, combined with biliary diseases, intractabe pain,Celiac nerve block （难处理）Therapeutic endoscopy慢性胰腺炎Medical therapy胰腺疾病英文课件最全胰腺疾病英文课件最全胰腺疾病英文课件最全胰腺疾病英文课件最全胰腺疾病英文课件最全胰腺疾病英文课件最全胰腺肿瘤Pancreatic carcinomaArise from acinar腺泡 or duct cellsEa

22、rly diagnosis very difficulty , prognosis poorObstructive jaundice(permanent):main symptomAbdominal pain DiabetesWeakness, emaciation(消瘦)Stools: acholic无胆汁 Gallbladder:DistendedAbdominal mass胰腺肿瘤Pancreatic carcinomaDiagnosis of pancreatic carcinomaLaboratory test: AKP ,r-GT,LDH;CEA ,POA胰胚抗原, PCCA胰癌相

23、关抗原,CA19-9Imaging findingUS,CT( CTA),MRCPERCP, PTC&PTCDPET(正电子发射断层扫描)Biopsy(FNA) and cytology胰腺肿瘤Diagnosis of pancreatic carcinTreatment of pancreatic carcinomaRadical operation Pancreatoduodenectomy - tumor in pancreatic head Resection of pancreatic body and tail-tumor in pancreatic body or tailPal

24、liative operation: to relieve jaundice Biotherapy胰腺肿瘤Treatment of pancreatic carcinSPNSPN胰腺密度胰腺肿瘤密度低于胰腺密度胰腺密度胰腺肿瘤密度低于胰腺密度Pancreatic endocrine neoplasm(PEN)InsulinomaArise from B cellSymptoms: whipples triad1 Spontaneous hypoglycemia accompanied by central nervous system, psychiatric,or vasomotor symptoms2 Repeated blood sugar levels below 2.8mmol/L(50mg%)3 Relief of symptoms by oral or intravenous administrat