胰腺疾病英文-课件

胰腺疾病英文胰腺疾病英文胰腺疾病英文胰腺疾病英文解剖解剖头，颈，体，尾，钩突。头，颈，体，尾，钩突。主胰管主胰管(duct of Wirsung)副胰管副胰管(duct of Santorini)胰腺分泌胰腺分泌外分泌外分泌Exocrine内分泌内分泌EndocrineB,A,D,D1,Gcell胰腺疾病英文解剖胰腺疾病英文-课件胰腺疾病英文CausesGallstones:60%(3550%in USA)Alcohol:14%(60%in USA)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急性胰腺炎急性胰腺炎胰腺疾病英文Causes急性胰腺炎胰腺疾病英文-课件Pathologyacute edematous pancreatitisacute hemorrhagic necrotizing pancreatitis (acute hemorrhagic pancreatitis,acute necrotizing pancreatitis)胰腺疾病英文胰腺疾病英文Pathology胰腺疾病英文Pathophysiology Hypersecretion and obstruction Self-enzymatic digestion Enhancement of Vessel permibility Cytokine，infection Decreased arterial perfusion Edematous hemorrhagic necrotizing 胰腺疾病英文胰腺疾病英文Pathophysiology胰腺疾病英文Clinical findingAbdominal 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.胰腺疾病英文胰腺疾病英文Clinicalfinding胰腺疾病英文胰腺疾病英文胰腺疾病英文Peritonealirritationsign（Abdominaltenderness，reboundtendernessandrigidity）ShiftingdullnessDecreasedbowelsoundsCullensign:discolorationofperiumbilicalareaGreyTurnersign:discolorationofflanks胰腺疾病英文Peritonealirritationsi胰腺疾病英文-课件Laboratory findingAmylase and lipase(elevations of amylase are more sensitive but less specific than lipase in the diagnosis of acute pancreatitis)5004003002001000 0 1H 24H 48H 5DAY胰腺疾病英文胰腺疾病英文Blood amylaseUrine amylaseLaboratoryfinding胰腺疾病英文Blood胰腺疾病英文胰腺疾病英文Serum calcium Serum glucose Blood gas analysisImunolipase ALT and AST(gallstone pancreatitis)胰腺疾病英文SerumcalciumImagingfindingX-rayDilated loop of small bowel(sentinel loop)Abrupt cessation of gas in the distal transverse colon(colon cutoff sign)Radioopaque densities(biliary calculi)Left-sidedpleuraleffusionB-US:pancreaticedema,ascites-CT:Important胰腺疾病英文胰腺疾病英文Imagingfinding胰腺疾病英文CT is the best diagnostic test for the diagnosis of acute pancreatitis.Contrast-enhanced CT is excellent for diagnosis of pancreatic necrosisCTisthebestdiagnostictes胰腺疾病英文胰腺疾病英文Assessmentofseverityofacutepancreatitis Ransons criteria On Admission Within 48 Hours Age 55 years Hematocrit decrease by 10%Age 55 years Hematocrit decrease by 10%WBC 16,000/mm WBC 16,000/mm Urea nitrogen increase 5 mg/dl Urea nitrogen increase 5 mg/dl LDH 350 IU/L Serum calcium 350 IU/L Serum calcium 11.1mmol/l Arterial PO Glucose 11.1mmol/l Arterial PO 8KPa(60 mm Hg)250 IU/L Base deficit 4 mEq/L AST 250 IU/L Base deficit 4 mEq/L Estimated fluid sequestration 6 L Estimated fluid sequestration 6 L胰腺疾病英文Assessmentofseverityo胰腺疾病英文胰腺疾病英文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胰腺疾病英文APACHEIIIcriteriaDiagnosis and differential DiagnosisAcute edematous pancreatitis and acute hemorrhagic necrotizing pancreatitisOther diseasesAcute appendtitisIleus Perforated gastroduodenal ulcer Biliary disease Ruptured hepatoma胰腺疾病英文胰腺疾病英文ClinicalfindingAmylaseCTAbdominalparacentesisDiagnosisanddifferentialDia胰腺疾病英文胰腺疾病英文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:nasogastric suction and antibiotics 胰腺疾病英文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 InefficiencybyinternalmedicineComplication(pancreatic or/and peripancreatic Infectionandabscess)Combinedwithbiliarydiseases(GallstoneASP)AgentstoinhibitpancreaticsSurgicalapproachResectionofnecrotictissueandperitoneallavagesevere,progressivenecrotizingpancreatitisorpancreaticabscess.Cholecystectomyrecurrentacutepancreatitisandmicrolithiasis.SurgicalsphincteroplastyofthepancreaticsphincterpancreaticsphincterdysfunctionoutcomeisthesameasfortheendoscopicpancreaticsphincterotomymoreinvasiverequiringlaparotomyandduodenotomySurgicalapproach胰腺疾病英文胰腺疾病英文Endoscopic therapy 1)acute gallstone pancreatitis 2)recurrent pancreatitis due to pancreatic sphincter dysfunction,3)recurrent pancreatitis due to pancreas divisum分裂分裂.The rationale for endoscopic therapy in each area is the relief of obstruction to flow of pancreatic juice 胰腺疾病英文Endoscopictherapy胰腺疾病英文-课件胰腺疾病英文-课件胰腺疾病英文-课件胰腺疾病英文胰腺疾病英文Causes AlcoholPancreas divisumAcute pancreatitisHyperparathyroidismTraumaObstructive pancreatitisIdiopathic chronic pancreatitisCystic fibrosisHereditary chronic pancreatitis胰腺疾病英文Causes胰腺疾病英文胰腺疾病英文ClassificationObstructive chronic pancreatitisCalcifiedchronic pancreatitisInflammatorychronic pancreatitisPathology pancreatic fibrosis-胰腺疾病英文Classification胰腺疾病英文胰腺疾病英文ClinicalfindinganddiagnosisAbdominalpain,distentionDiarrhageDyspepsiaMalnutrtionDiabetesNarcoticaddictionJaundice胰腺疾病英文ClinicalfindinganddiaBiochemical measurementsIsoamylase,lipase trypsin,and elastase弹性蛋白酶Quantitative measurement of fecal fat glucosetolerancetestSecretin stimulation testPlasma cholecystokinin(CCK)(may be elevated)Bentiromide(苯酪肽)test（与糜蛋白酶反应）胰腺疾病英文胰腺疾病英文Biochemicalmeasurements胰腺疾病英文胰腺疾病英文-课件胰腺疾病英文胰腺疾病英文Imaging findingPlain abdominal filmTransabdominal ultrasound CT MRCP Endoscopic diagnosis procedures(ERCP,EUS)胰腺疾病英文Imagingfinding胰腺疾病英文-课件胰腺疾病英文-课件胰腺疾病英文胰腺疾病英文Medical therapyAlcohol and cigarette avoidanceAnalgesics 镇痛镇痛Enzyme therapyTreatment of malnutrition Surgical therapyBiliary Obstruction,pancreatic pseudocysts,combined with biliary diseases,intractabe pain,Celiac nerve block （难处理）（难处理）Therapeutic endoscopy胰腺疾病英文Medicaltherapy胰腺疾病英文-课件胰腺疾病英文-课件胰腺疾病英文-课件胰腺疾病英文-课件胰腺疾病英文-课件胰腺疾病英文-课件胰腺疾病英文胰腺疾病英文PancreaticcarcinomaArisefromacinar腺泡orductcellsEarlydiagnosisverydifficulty,prognosispoorObstructivejaundice(permanent):mainsymptomAbdominalpainDiabetesWeakness,emaciation(消瘦)Stools:acholic无胆汁Gallbladder:DistendedAbdominalmass胰腺疾病英文PancreaticcarcinomaDiagnosisofpancreaticcarcinomaLaboratorytest: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胰腺疾病英文胰腺疾病英文DiagnosisofpancreaticcarcinTreatmentofpancreaticcarcinomaRadicaloperationPancreatoduodenectomy-tumorinpancreaticheadResectionofpancreaticbodyandtail-tumorinpancreaticbodyortailPalliativeoperation:torelievejaundiceBiotherapy胰腺疾病英文胰腺疾病英文Treatmentofpancreaticcarcin胰腺疾病英文SPN胰腺疾病英文SPN胰腺疾病英文胰腺密度胰腺肿瘤密度低于胰腺密度胰腺疾病英文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 administration of glucoseDiagnosis:symptom and IRI/G0.3,B-us,CT,MRI,Endo-US,Angiography,PTPSTreatment:operation(resection)胰腺疾病英文胰腺疾病英文Pancreaticendocrineneoplasm(Arisefrom:PapillaofduodenumVaterampullaDistalCBDSymptom:obstructivejaundiceDiagnosisTreatment:similartopancreaticcarcinoma胰腺疾病英文Arisefrom:胰腺疾病英文胰腺疾病英文胰腺疾病英文