胰腺疾病(英文)演示

胰腺疾病(英文)课件课件现在是1页\一共有47页\编辑于星期日

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现在是2页\一共有47页\编辑于星期日现在是3页\一共有47页\编辑于星期日cCausesGallstones:60%(35–50%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急性胰腺炎现在是4页\一共有47页\编辑于星期日现在是5页\一共有47页\编辑于星期日Pathologyacuteedematouspancreatitisacutehemorrhagicnecrotizingpancreatitis(acutehemorrhagicpancreatitis,acutenecrotizingpancreatitis)急性胰腺炎现在是6页\一共有47页\编辑于星期日PathophysiologyHypersecretionandobstruction

Self-enzymaticdigestion

EnhancementofVesselpermibilityCytokine，infection

DecreasedarterialperfusionEdematoushemorrhagicnecrotizing急性胰腺炎现在是7页\一共有47页\编辑于星期日ClinicalfindingAbdominalpainAbdominaldistentionNauseaandvomitingPeritonitisOther:Respiratoryfailure,confusion,orcoma.Low-gradetomoderatefeverTachycardiaandhypotensionandShockMildjaundice,Pleuraleffusion.急性胰腺炎现在是8页\一共有47页\编辑于星期日急性胰腺炎Peritonealirritationsign（Abdominaltenderness，reboundtendernessandrigidity）ShiftingdullnessDecreasedbowelsoundsCullen’sign:discolorationofperiumbilicalareaGreyTurner’sign:discolorationofflanks现在是9页\一共有47页\编辑于星期日现在是10页\一共有47页\编辑于星期日LaboratoryfindingAmylaseandlipase(elevationsofamylasearemoresensitivebutlessspecificthanlipaseinthediagnosisofacutepancreatitis)500400300200100001H24H48H5DAY急性胰腺炎BloodamylaseUrineamylase现在是11页\一共有47页\编辑于星期日急性胰腺炎Serumcalcium

Serumglucose

BloodgasanalysisImunolipaseALTandAST(gallstonepancreatitis)现在是12页\一共有47页\编辑于星期日ImagingfindingX-ray

Dilatedloopofsmallbowel(sentinelloop)Abruptcessationofgasinthedistaltransversecolon(coloncutoffsign)Radioopaquedensities(biliarycalculi)

Left-sidedpleuraleffusionB-US:pancreaticedema,ascites----CT:Important急性胰腺炎现在是13页\一共有47页\编辑于星期日•CTisthebestdiagnostictestforthediagnosisofacutepancreatitis.•Contrast-enhancedCTisexcellentfordiagnosisofpancreaticnecrosis有力武器现在是14页\一共有47页\编辑于星期日急性胰腺炎Assessmentofseverityofacutepancreatitis

Ranson'scriteria

OnAdmissionWithin48Hours

Age>55yearsHematocritdecreaseby>10%WBC>16,000/mm³Ureanitrogenincrease>5mg/dlLDH>350IU/LSerumcalcium<1.87mmol/lGlucose>11.1mmol/lArterialPO²<8KPa(60mmHg)AST>250IU/LBasedeficit>4mEq/L

Estimatedfluidsequestration>6L现在是15页\一共有47页\编辑于星期日急性胰腺炎GlasgowCriteriaWithin48HoursAge>55WBC>15,000/mm³LDH>600IU/LGlucose>180mg/dlAlbumin<3.2g/dlCalcium<8mg/dlUrea>45mg/dlArterialPaO2<60mmHg现在是16页\一共有47页\编辑于星期日急性胰腺炎APACHEIIIcriteriaTemperature•BUNMeanbloodpressure•LeukocytesSerumCreatinine•HematocritHeartrate•AlbuminRespiratoryrate•BilirubinOxygenationArterialpHSerumsodiumandpotassiumSerumglucose>8Scores----SAP现在是17页\一共有47页\编辑于星期日DiagnosisanddifferentialDiagnosisAcuteedematouspancreatitisandacutehemorrhagicnecrotizingpancreatitisOtherdiseasesAcuteappendtitisIleusPerforatedgastroduodenalulcerBiliarydiseaseRupturedhepatoma急性胰腺炎ClinicalfindingAmylaseCTAbdominalparacentesis现在是18页\一共有47页\编辑于星期日急性胰腺炎TreatmentAcuteedematouspancreatitis—internalmedicine(Emergencysurgeryisnotindicatedinmildacutepancreatitis)AcutehemorrhagicnecrotizingpancreatitisSupportivecareReplacementoffluidandelectrolytesCorrectionofmetabolicabnormalitiesNutritionalsupportOthermeasures:nasogastricsuctionandantibiotics现在是19页\一共有47页\编辑于星期日AgentstoinhibitpancreaticsecretionHavenotbeenfoundtobeusefulinalteringthecourseinacutepancreatitis

Somatostatin(sandostatinstilamin)Proteaseinhibitors(trasylol抑肽酶)SurgicaltherapyInefficiencybyinternalmedicineComplication(pancreaticor/andperipancreaticInfectionandabscess)Combinedwithbiliarydiseases(GallstoneASP)现在是20页\一共有47页\编辑于星期日SurgicalapproachResectionofnecrotictissueandperitoneallavage

severe,progressivenecrotizingpancreatitisorpancreaticabscess.

Cholecystectomy

recurrentacutepancreatitisandmicrolithiasis.

Surgicalsphincteroplastyofthepancreaticsphincter

pancreaticsphincterdysfunctionoutcomeisthesameasfortheendoscopicpancreaticsphincterotomymoreinvasiverequiringlaparotomyandduodenotomy现在是21页\一共有47页\编辑于星期日急性胰腺炎Endoscopictherapy

1)acutegallstonepancreatitis2)recurrentpancreatitisduetopancreaticsphincterdysfunction,3)recurrentpancreatitisduetopancreasdivisum分裂.Therationaleforendoscopictherapyineachareaisthereliefofobstructiontoflowofpancreaticjuice现在是22页\一共有47页\编辑于星期日现在是23页\一共有47页\编辑于星期日现在是24页\一共有47页\编辑于星期日现在是25页\一共有47页\编辑于星期日慢性胰腺炎Causes

AlcoholPancreasdivisumAcutepancreatitisHyperparathyroidismTraumaObstructivepancreatitisIdiopathicchronicpancreatitisCysticfibrosisHereditarychronicpancreatitis现在是26页\一共有47页\编辑于星期日慢性胰腺炎ClassificationObstructivechronicpancreatitisCalcifiedchronicpancreatitisInflammatorychronicpancreatitisPathologypancreaticfibrosis----现在是27页\一共有47页\编辑于星期日慢性胰腺炎ClinicalfindinganddiagnosisAbdominalpain,distentionDiarrhageDyspepsiaMalnutrtionDiabetesNarcoticaddictionJaundice现在是28页\一共有47页\编辑于星期日BiochemicalmeasurementsIsoamylase,lipasetrypsin,andelastase弹性蛋白酶QuantitativemeasurementoffecalfatglucosetolerancetestSecretinstimulationtestPlasmacholecystokinin(CCK)(maybeelevated)Bentiromide(苯酪肽)test（与糜蛋白酶反应）慢性胰腺炎现在是29页\一共有47页\编辑于星期日现在是30页\一共有47页\编辑于星期日慢性胰腺炎ImagingfindingPlainabdominalfilmTransabdominalultrasoundCTMRCPEndoscopicdiagnosisprocedures(ERCP,EUS)现在是31页\一共有47页\编辑于星期日现在是32页\一共有47页\编辑于星期日现在是33页\一共有47页\编辑于星期日慢性胰腺炎MedicaltherapyAlcoholandcigaretteavoidanceAnalgesics镇痛EnzymetherapyTreatmentofmalnutrition

SurgicaltherapyBiliaryObstruction,pancreaticpseudocysts,combinedwithbiliarydiseases,intractabepain,Celiacnerveblock（难处理）Therapeuticendoscopy现在是34页\一共有47页\编辑于星期日现在是35页\一共有47页\编辑于星期日现在是36页\一共有47页\编辑于星期日现在是37页\一共有47页\编辑于星期日现在是38页\一共有47页\编辑于星期日现在是39页\一共有47页\编辑于星期日现在是40页\一共有47页\编辑于星期日胰腺肿瘤PancreaticcarcinomaArisefromacinar腺泡orductcellsEarlydiagnosisverydifficulty,prognosispoorObstructivejaundice(permanent):mainsymptomAbdominalpainDiabetesWeakness,emaciation(消瘦)Stools:acholic无胆汁

Gallbladder:DistendedAbdominalmass现在是41页\一共有47页\编辑于星期日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胰腺肿瘤现在是42页\一共有47页\编辑于星期日TreatmentofpancreaticcarcinomaRadicaloperationPancreatoduodenectomy----tumor