胰腺疾病(英文)演示

胰腺疾病(英文)课件课件目前一页\总数四十七页\编于二十一点

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目前二页\总数四十七页\编于二十一点目前三页\总数四十七页\编于二十一点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急性胰腺炎目前四页\总数四十七页\编于二十一点目前五页\总数四十七页\编于二十一点Pathologyacuteedematouspancreatitisacutehemorrhagicnecrotizingpancreatitis

(acutehemorrhagicpancreatitis,acutenecrotizingpancreatitis)急性胰腺炎目前六页\总数四十七页\编于二十一点PathophysiologyHypersecretionandobstruction

Self-enzymaticdigestion

EnhancementofVesselpermibilityCytokine，infection

DecreasedarterialperfusionEdematoushemorrhagicnecrotizing急性胰腺炎目前七页\总数四十七页\编于二十一点ClinicalfindingAbdominalpainAbdominaldistentionNauseaandvomitingPeritonitisOther:Respiratoryfailure,confusion,orcoma.Low-gradetomoderatefeverTachycardiaandhypotensionandShockMildjaundice,Pleuraleffusion.急性胰腺炎目前八页\总数四十七页\编于二十一点急性胰腺炎Peritonealirritationsign（Abdominaltenderness，reboundtendernessandrigidity）ShiftingdullnessDecreasedbowelsoundsCullen’sign:discolorationofperiumbilicalareaGreyTurner’sign:discolorationofflanks目前九页\总数四十七页\编于二十一点目前十页\总数四十七页\编于二十一点LaboratoryfindingAmylaseandlipase(elevationsofamylasearemoresensitivebutlessspecificthanlipaseinthediagnosisofacutepancreatitis)500400300200100001H24H48H5DAY急性胰腺炎BloodamylaseUrineamylase目前十一页\总数四十七页\编于二十一点急性胰腺炎Serumcalcium

Serumglucose

BloodgasanalysisImunolipaseALTandAST(gallstonepancreatitis)目前十二页\总数四十七页\编于二十一点ImagingfindingX-ray

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

Left-sidedpleuraleffusionB-US:pancreaticedema,ascites----CT:Important急性胰腺炎目前十三页\总数四十七页\编于二十一点•CTisthebestdiagnostictestforthediagnosisofacutepancreatitis.•Contrast-enhancedCTisexcellentfordiagnosisofpancreaticnecrosis有力武器目前十四页\总数四十七页\编于二十一点急性胰腺炎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目前十五页\总数四十七页\编于二十一点急性胰腺炎GlasgowCriteriaWithin48HoursAge>55WBC>15,000/mm³LDH>600IU/LGlucose>180mg/dlAlbumin<3.2g/dlCalcium<8mg/dlUrea>45mg/dlArterialPaO2<60mmHg目前十六页\总数四十七页\编于二十一点急性胰腺炎APACHEIIIcriteriaTemperature•BUNMeanbloodpressure•LeukocytesSerumCreatinine•HematocritHeartrate•AlbuminRespiratoryrate•BilirubinOxygenationArterialpHSerumsodiumandpotassiumSerumglucose>8Scores----SAP目前十七页\总数四十七页\编于二十一点DiagnosisanddifferentialDiagnosisAcuteedematouspancreatitisandacutehemorrhagicnecrotizingpancreatitisOtherdiseasesAcuteappendtitisIleusPerforatedgastroduodenalulcerBiliarydiseaseRupturedhepatoma急性胰腺炎ClinicalfindingAmylaseCTAbdominalparacentesis目前十八页\总数四十七页\编于二十一点急性胰腺炎TreatmentAcuteedematouspancreatitis—internalmedicine(Emergencysurgeryisnotindicatedinmildacutepancreatitis)AcutehemorrhagicnecrotizingpancreatitisSupportivecareReplacementoffluidandelectrolytesCorrectionofmetabolicabnormalitiesNutritionalsupportOthermeasures:nasogastricsuctionandantibiotics目前十九页\总数四十七页\编于二十一点AgentstoinhibitpancreaticsecretionHavenotbeenfoundtobeusefulinalteringthecourseinacutepancreatitis

Somatostatin(sandostatinstilamin)Proteaseinhibitors(trasylol抑肽酶)SurgicaltherapyInefficiencybyinternalmedicineComplication(pancreaticor/andperipancreaticInfectionandabscess)Combinedwithbiliarydiseases(GallstoneASP)目前二十页\总数四十七页\编于二十一点SurgicalapproachResectionofnecrotictissueandperitoneallavage

severe,progressivenecrotizingpancreatitisorpancreaticabscess.

Cholecystectomy

recurrentacutepancreatitisandmicrolithiasis.

Surgicalsphincteroplastyofthepancreaticsphincter

pancreaticsphincterdysfunctionoutcomeisthesameasfortheendoscopicpancreaticsphincterotomymoreinvasiverequiringlaparotomyandduodenotomy目前二十一页\总数四十七页\编于二十一点急性胰腺炎Endoscopictherapy

1)acutegallstonepancreatitis2)recurrentpancreatitisduetopancreaticsphincterdysfunction,3)recurrentpancreatitisduetopancreasdivisum分裂.Therationaleforendoscopictherapyineachareaisthereliefofobstructiontoflowofpancreaticjuice目前二十二页\总数四十七页\编于二十一点目前二十三页\总数四十七页\编于二十一点目前二十四页\总数四十七页\编于二十一点目前二十五页\总数四十七页\编于二十一点慢性胰腺炎Causes

AlcoholPancreasdivisumAcutepancreatitisHyperparathyroidismTraumaObstructivepancreatitisIdiopathicchronicpancreatitisCysticfibrosisHereditarychronicpancreatitis目前二十六页\总数四十七页\编于二十一点慢性胰腺炎ClassificationObstructivechronicpancreatitisCalcifiedchronicpancreatitisInflammatorychronicpancreatitisPathologypancreaticfibrosis----目前二十七页\总数四十七页\编于二十一点慢性胰腺炎ClinicalfindinganddiagnosisAbdominalpain,distentionDiarrhageDyspepsiaMalnutrtionDiabetesNarcoticaddictionJaundice目前二十八页\总数四十七页\编于二十一点BiochemicalmeasurementsIsoamylase,lipasetrypsin,andelastase弹性蛋白酶QuantitativemeasurementoffecalfatglucosetolerancetestSecretinstimulationtestPlasmacholecystokinin(CCK)(maybeelevated)Bentiromide(苯酪肽)test（与糜蛋白酶反应）慢性胰腺炎目前二十九页\总数四十七页\编于二十一点目前三十页\总数四十七页\编于二十一点慢性胰腺炎ImagingfindingPlainabdominalfilmTransabdominalultrasoundCTMRCPEndoscopicdiagnosisprocedures(ERCP,EUS)目前三十一页\总数四十七页\编于二十一点目前三十二页\总数四十七页\编于二十一点目前三十三页\总数四十七页\编于二十一点慢性胰腺炎MedicaltherapyAlcoholandcigaretteavoidanceAnalgesics镇痛EnzymetherapyTreatmentofmalnutrition

SurgicaltherapyBiliaryObstruction,pancreaticpseudocysts,combinedwithbiliarydiseases,intractabepain,Celiacnerveblock（难处理）Therapeuticendoscopy目前三十四页\总数四十七页\编于二十一点目前三十五页\总数四十七页\编于二十一点目前三十六页\总数四十七页\编于二十一点目前三十七页\总数四十七页\编于二十一点目前三十八页\总数四十七页\编于二十一点目前三十九页\总数四十七页\编于二十一点目前四十页\总数四十七页\编于二十一点胰腺肿瘤PancreaticcarcinomaArisefromacinar腺泡orductcellsEarlydiagnosisverydifficulty,prognosispoorObstructivejaundice(permanent):mainsymptomAbdominalpainDiabetesWeakness,emaciation(消瘦)Stools:acholic无胆汁

Gallbladder:DistendedAbdominalmass目前四十一页\总数四十七页\编于二十一点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胰腺肿瘤目前四十二页\总数四十七页\编于二十一点TreatmentofpancreaticcarcinomaRadicaloperation

Pancreatoduodenectomy----tumorin