胰腺疾病(英文)ppt课件

胰腺疾病(英文),1,胰腺疾病,胰腺疾病(英文),2,解剖生理概要,解剖头，颈，体，尾，钩突。主胰管(ductofWirsung)副胰管(ductofSantorini)胰腺分泌外分泌Exocrine内分泌EndocrineB,A,D,D1,Gcell,胰腺疾病(英文),3,胰腺疾病(英文),4,c,CausesGallstones:60%(3550%inUSA)Alcohol:14%(60%inUSA)Duodenaljuicecountercurrentflow:SphincterofOddidysfunctionTraumaPancreascirculationdisorderOtherfactors:Drug:Azathioprine(硫唑嘌呤).6-Mercaptopurine(6-巯基嘌呤),Pancreasdivisum(胰分裂),MicrolithiasisMetaboliccauseInfectiouscauses,ascarisworms蛔虫,HIV-Miscellaneous,急性胰腺炎,胰腺疾病(英文),5,胰腺疾病(英文),6,Pathologyacuteedematouspancreatitisacutehemorrhagicnecrotizingpancreatitis(acutehemorrhagicpancreatitis,acutenecrotizingpancreatitis),急性胰腺炎,胰腺疾病(英文),7,PathophysiologyHypersecretionandobstructionSelf-enzymaticdigestionEnhancementofVesselpermibilityCytokine，infectionDecreasedarterialperfusionEdematoushemorrhagicnecrotizing,急性胰腺炎,胰腺疾病(英文),8,ClinicalfindingAbdominalpainAbdominaldistentionNauseaandvomitingPeritonitisOther:Respiratoryfailure,confusion,orcoma.Low-gradetomoderatefeverTachycardiaandhypotensionandShockMildjaundice,Pleuraleffusion.,急性胰腺炎,胰腺疾病(英文),9,急性胰腺炎,Peritonealirritationsign（Abdominaltenderness，reboundtendernessandrigidity）ShiftingdullnessDecreasedbowelsoundsCullensign:discolorationofperiumbilicalareaGreyTurnersign:discolorationofflanks,胰腺疾病(英文),10,胰腺疾病(英文),11,LaboratoryfindingAmylaseandlipase(elevationsofamylasearemoresensitivebutlessspecificthanlipaseinthediagnosisofacutepancreatitis)500400300200100001H24H48H5DAY,急性胰腺炎,Bloodamylase,Urineamylase,胰腺疾病(英文),12,急性胰腺炎,SerumcalciumSerumglucoseBloodgasanalysisImunolipaseALTandAST(gallstonepancreatitis),胰腺疾病(英文),13,ImagingfindingX-rayDilatedloopofsmallbowel(sentinelloop)Abruptcessationofgasinthedistaltransversecolon(coloncutoffsign)Radioopaquedensities(biliarycalculi)Left-sidedpleuraleffusionB-US:pancreaticedema,ascites-CT:Important,急性胰腺炎,胰腺疾病(英文),14,CTisthebestdiagnostictestforthediagnosisofacutepancreatitis.Contrast-enhancedCTisexcellentfordiagnosisofpancreaticnecrosis,有力武器,胰腺疾病(英文),15,急性胰腺炎,AssessmentofseverityofacutepancreatitisRansonscriteriaOnAdmissionWithin48HoursAge55yearsHematocritdecreaseby10%WBC16,000/mmUreanitrogenincrease5mg/dlLDH350IU/LSerumcalcium11.1mmol/lArterialPO250IU/LBasedeficit4mEq/LEstimatedfluidsequestration6L,胰腺疾病(英文),16,急性胰腺炎,GlasgowCriteriaWithin48HoursAge55WBC15,000/mmLDH600IU/LGlucose180mg/dlAlbumin45mg/dlArterialPaO28Scores-SAP,胰腺疾病(英文),18,DiagnosisanddifferentialDiagnosisAcuteedematouspancreatitisandacutehemorrhagicnecrotizingpancreatitisOtherdiseasesAcuteappendtitisIleusPerforatedgastroduodenalulcerBiliarydiseaseRupturedhepatoma,急性胰腺炎,ClinicalfindingAmylaseCTAbdominalparacentesis,胰腺疾病(英文),19,急性胰腺炎,TreatmentAcuteedematouspancreatitisinternalmedicine(Emergencysurgeryisnotindicatedinmildacutepancreatitis)AcutehemorrhagicnecrotizingpancreatitisSupportivecareReplacementoffluidandelectrolytesCorrectionofmetabolicabnormalitiesNutritionalsupportOthermeasures:nasogastricsuctionandantibiotics,胰腺疾病(英文),20,AgentstoinhibitpancreaticsecretionHavenotbeenfoundtobeusefulinalteringthecourseinacutepancreatitisSomatostatin(sandostatinstilamin)Proteaseinhibitors(trasylol抑肽酶)SurgicaltherapyInefficiencybyinternalmedicineComplication(pancreaticor/andperipancreaticInfectionandabscess)Combinedwithbiliarydiseases(GallstoneASP),胰腺疾病(英文),21,SurgicalapproachResectionofnecrotictissueandperitoneallavagesevere,progressivenecrotizingpancreatitisorpancreaticabscess.Cholecystectomyrecurrentacutepancreatitisandmicrolithiasis.Surgicalsphincteroplastyofthepancreaticsphincterpancreaticsphincterdysfunctionoutcomeisthesameasfortheendoscopicpancreaticsphincterotomymoreinvasiverequiringlaparotomyandduodenotomy,胰腺疾病(英文),22,急性胰腺炎,Endoscopictherapy1)acutegallstonepancreatitis2)recurrentpancreatitisduetopancreaticsphincterdysfunction,3)recurrentpancreatitisduetopancreasdivisum分裂.Therationaleforendoscopictherapyineachareaisthereliefofobstructiontoflowofpancreaticjuice,胰腺疾病(英文),23,胰腺疾病(英文),24,胰腺疾病(英文),25,胰腺疾病(英文),26,慢性胰腺炎,CausesAlcoholPancreasdivisumAcutepancreatitisHyperparathyroidismTraumaObstructivepancreatitisIdiopathicchronicpancreatitisCysticfibrosisHereditarychronicpancreatitis,胰腺疾病(英文),27,慢性胰腺炎,ClassificationObstructivechronicpancreatitisCalcifiedchronicpancreatitisInflammatorychronicpancreatitisPathologypancreaticfibrosis-,胰腺疾病(英文),28,慢性胰腺炎,ClinicalfindinganddiagnosisAbdominalpain,distentionDiarrhageDyspepsiaMalnutrtionDiabetesNarcoticaddictionJaundice,胰腺疾病(英文),29,BiochemicalmeasurementsIsoamylase,lipasetrypsin,andelastase弹性蛋白酶QuantitativemeasurementoffecalfatglucosetolerancetestSecretinstimulationtestPlasmacholecystokinin(CCK)(maybeelevated)Bentiromide(苯酪肽)test（与糜蛋白酶反应）,慢性胰腺炎,胰腺疾病(英文),30,胰腺疾病(英文),31,慢性胰腺炎,ImagingfindingPlainabdominalfilmTransabdominalultrasoundCTMRCPEndoscopicdiagnosisprocedures(ERCP,EUS),胰腺疾病(英文),32,胰腺疾病(英文),33,胰腺疾病(英文),34,慢性胰腺炎,MedicaltherapyAlcoholandcigaretteavoidanceAnalgesics镇痛EnzymetherapyTreatmentofmalnutritionSurgicaltherapyBiliaryObstruction,pancreaticpseudocysts,combinedwithbiliarydiseases,intractabepain,Celiacnerveblock（难处理）Therapeuticendoscopy,胰腺疾病(英文),35,胰腺疾病(英文),36,胰腺疾病(英文),37,胰腺疾病(英文),38,胰腺疾病(英文),39,胰腺疾病(英文),40,胰腺疾病(英文),41,胰腺肿瘤,PancreaticcarcinomaArisefromacinar腺泡orductcellsEarlydiagnosisverydifficulty,prognosispoorObstructivejaundice(permanent):mainsymptomAbdominalpainDiabetesWeakness,emaciation(消瘦)Stools:acholic无胆汁Gallbladder:DistendedAbdominalmass,胰腺疾病(英文),42,DiagnosisofpancreaticcarcinomaLaboratorytest:AKP,r-GT,LDH;CEA,POA胰胚抗原,PCCA胰癌相关抗原,CA19-9ImagingfindingUS,CT(CTA),MRCPERCP,PTC&PTCDPET(正电子发射断层扫描)Biopsy(FNA)andcytology,胰腺肿瘤,胰腺疾病(英文),43,TreatmentofpancreaticcarcinomaRadicaloperationPancreatoduodenectomy-tumorinpancreaticheadResectionofpancreaticbodyandtail-tumorinpancreaticbodyortailPalliativeoperation:torelievejaundiceBiotherapy,胰腺肿瘤