胰腺疾病(英文)课件

胰腺疾病1精选可编辑ppt

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,Gcell2精选可编辑ppt3精选可编辑pptcCausesGallstones: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4精选可编辑ppt5精选可编辑pptPathologyacuteedematouspancreatitisacutehemorrhagicnecrotizingpancreatitis

(acutehemorrhagicpancreatitis,acutenecrotizingpancreatitis)急性胰腺炎6精选可编辑pptPathophysiologyHypersecretionandobstruction

Self-enzymaticdigestion

EnhancementofVesselpermibilityCytokine，infection

DecreasedarterialperfusionEdematoushemorrhagicnecrotizing急性胰腺炎7精选可编辑pptClinicalfindingAbdominalpainAbdominaldistentionNauseaandvomitingPeritonitisOther:Respiratoryfailure,confusion,orcoma.Low-gradetomoderatefeverTachycardiaandhypotensionandShockMildjaundice,Pleuraleffusion.急性胰腺炎8精选可编辑ppt急性胰腺炎Peritonealirritationsign（Abdominaltenderness，reboundtendernessandrigidity）ShiftingdullnessDecreasedbowelsoundsCullen’sign:discolorationofperiumbilicalareaGreyTurner’sign:discolorationofflanks9精选可编辑ppt10精选可编辑pptLaboratoryfindingAmylaseandlipase(elevationsofamylasearemoresensitivebutlessspecificthanlipaseinthediagnosisofacutepancreatitis)500400300200100001H24H48H5DAY急性胰腺炎BloodamylaseUrineamylase11精选可编辑ppt急性胰腺炎Serumcalcium

Serumglucose

BloodgasanalysisImunolipaseALTandAST(gallstonepancreatitis)12精选可编辑pptImagingfindingX-ray

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

Left-sidedpleuraleffusionB-US:pancreaticedema,ascites----CT:Important急性胰腺炎13精选可编辑ppt•CTisthebestdiagnostictestforthediagnosisofacutepancreatitis.•Contrast-enhancedCTisexcellentfordiagnosisofpancreaticnecrosis有力武器14精选可编辑ppt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>6L15精选可编辑ppt急性胰腺炎GlasgowCriteriaWithin48HoursAge>55WBC>15,000/mm³LDH>600IU/LGlucose>180mg/dlAlbumin<3.2g/dlCalcium<8mg/dlUrea>45mg/dlArterialPaO2<60mmHg16精选可编辑ppt急性胰腺炎APACHEIIIcriteriaTemperature•BUNMeanbloodpressure•LeukocytesSerumCreatinine•HematocritHeartrate•AlbuminRespiratoryrate•BilirubinOxygenationArterialpHSerumsodiumandpotassiumSerumglucose>8Scores----SAP17精选可编辑pptDiagnosisanddifferentialDiagnosisAcuteedematouspancreatitisandacutehemorrhagicnecrotizingpancreatitisOtherdiseasesAcuteappendtitisIleusPerforatedgastroduodenalulcerBiliarydiseaseRupturedhepatoma急性胰腺炎ClinicalfindingAmylaseCTAbdominalparacentesis18精选可编辑ppt急性胰腺炎TreatmentAcuteedematouspancreatitis—internalmedicine(Emergencysurgeryisnotindicatedinmildacutepancreatitis)AcutehemorrhagicnecrotizingpancreatitisSupportivecareReplacementoffluidandelectrolytesCorrectionofmetabolicabnormalitiesNutritionalsupportOthermeasures:nasogastricsuctionandantibiotics19精选可编辑pptAgentstoinhibitpancreaticsecretionHavenotbeenfoundtobeusefulinalteringthecourseinacutepancreatitis

Somatostatin(sandostatinstilamin)Proteaseinhibitors(trasylol抑肽酶)SurgicaltherapyInefficiencybyinternalmedicineComplication(pancreaticor/andperipancreaticInfectionandabscess)Combinedwithbiliarydiseases(GallstoneASP)20精选可编辑pptSurgicalapproachResectionofnecrotictissueandperitoneallavage

severe,progressivenecrotizingpancreatitisorpancreaticabscess.

Cholecystectomy

recurrentacutepancreatitisandmicrolithiasis.

Surgicalsphincteroplastyofthepancreaticsphincter

pancreaticsphincterdysfunctionoutcomeisthesameasfortheendoscopicpancreaticsphincterotomymoreinvasiverequiringlaparotomyandduodenotomy21精选可编辑ppt急性胰腺炎Endoscopictherapy

1)acutegallstonepancreatitis2)recurrentpancreatitisduetopancreaticsphincterdysfunction,3)recurrentpancreatitisduetopancreasdivisum分裂.Therationaleforendoscopictherapyineachareaisthereliefofobstructiontoflowofpancreaticjuice22精选可编辑ppt23精选可编辑ppt24精选可编辑ppt25精选可编辑ppt慢性胰腺炎Causes

AlcoholPancreasdivisumAcutepancreatitisHyperparathyroidismTraumaObstructivepancreatitisIdiopathicchronicpancreatitisCysticfibrosisHereditarychronicpancreatitis26精选可编辑ppt慢性胰腺炎ClassificationObstructivechronicpancreatitisCalcifiedchronicpancreatitisInflammatorychronicpancreatitisPathologypancreaticfibrosis----27精选可编辑ppt慢性胰腺炎ClinicalfindinganddiagnosisAbdominalpain,distentionDiarrhageDyspepsiaMalnutrtionDiabetesNarcoticaddictionJaundice28精选可编辑pptBiochemicalmeasurementsIsoamylase,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29精选可编辑ppt30精选可编辑ppt慢性胰腺炎ImagingfindingPlainabdominalfilmTransabdominalultrasoundCTMRCPEndoscopicdiagnosisprocedures(ERCP,EUS)31精选可编辑ppt32精选可编辑ppt33精选可编辑ppt慢性胰腺炎MedicaltherapyAlcoholandcigaretteavoidanceAnalgesics镇痛EnzymetherapyTreatmentofmalnutrition

SurgicaltherapyBiliaryObstruction,pancreaticpseudocysts,combinedwithbiliarydiseases,intractabepain,Celiacnerveblock（难处理）Therapeuticendoscopy34精选可编辑ppt35精选可编辑ppt36精选可编辑ppt37精选可编辑ppt38精选可编辑ppt39精选可编辑ppt40精选可编辑ppt胰腺肿瘤PancreaticcarcinomaArisefromacinar腺泡orductcellsEarlydiagnosisverydifficulty,prognosispoorObstructivejaundice(permanent):mainsymptomAbdominalpainDiabetesWeakness,emaciation(消瘦)Stools:acholic无胆汁

Gallbladder:DistendedAbdominalmass41精选可编辑pptDiagnosisofpancreaticcarcinomaLaboratorytest: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42精选可编辑pptTreatmentofpancreaticcarcinomaRadicaloperation

Pancreatoduodenectomy----tumorinpancreatichead

Resectionofpan