胰腺疾病(英文)ppt课件

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,胰腺疾病,胰腺疾病,解剖生理概要,解剖,头，颈，体，尾，钩突。,主胰管,(duct of Wirsung),副胰管,(duct of Santorini),胰腺分泌,外分泌,Exocrine,内分泌,Endocrine B,A,D,D1,G cell,解剖生理概要解剖,胰腺疾病(英文)ppt课件,c,Causes,Gallstones:60%( 3550% in USA),Alcohol:14% %(60% in USA),Duodenal juice countercurrent flow: Sphincter of Oddi dysfunction,Trauma,Pancreas circulation disorder,Other factors:,Drug:,Azathioprine(,硫唑嘌呤,).6-Mercaptopurine(,6-,巯基嘌呤,),Pancreas divisum(,胰分裂,),Microlithiasis,Metabolic cause,Infectious causes, ascaris worms,蛔虫,HIV-,Miscellaneous,急性胰腺炎,cCauses急性胰腺炎,胰腺疾病(英文)ppt课件,Pathology,acute edematous pancreatitis,acute hemorrhagic necrotizing pancreatitis,(acute hemorrhagic pancreatitis, acute necrotizing pancreatitis),急性胰腺炎,Pathology急性胰腺炎,Pathophysiology,Hypersecretion and obstruction,Self-enzymatic digestion,Enhancement of Vessel permibility C,ytokine,，,infection,Decreased arterial perfusion,Edematous hemorrhagic necrotizing,急性胰腺炎,Pathophysiology 急性胰腺炎,Clinical finding,Abdominal pain,Abdominal distention,Nausea and vomiting,Peritonitis,Other:,Respiratory failure, confusion, or coma.,Low-grade to moderate fever,Tachycardia and hypotension and Shock,Mild jaundice,Pleural effusion,.,急性胰腺炎,Clinical finding急性胰腺炎,急性胰腺炎,Peritoneal irritation sign,（,Abdominal tenderness,，,rebound tenderness and rigidity,）,Shifting dullness,Decreased bowel sounds,Cullen sign: discoloration of periumbilical area,Grey Turner sign:discoloration of flanks,急性胰腺炎Peritoneal irritation sig,胰腺疾病(英文)ppt课件,Laboratory finding,Amylase and lipase,(,elevations of amylase are more sensitive but less specific than lipase in the diagnosis of acute pancreatitis ),500,400,300,200,100,0,0 1H 24H 48H 5DAY,急性胰腺炎,Blood amylase,Urine amylase,Laboratory finding急性胰腺炎Blood a,急性胰腺炎,Serum calcium,Serum glucose,Blood gas analysis,Imunolipase,ALT and AST (gallstone pancreatitis ),急性胰腺炎Serum calcium,Imaging finding,X-ray,Dilated loop of small bowel (sentinel loop),Abrupt cessation of gas in the distal transverse colon (colon cutoff sign),Radioopaque densities (biliary calculi),Left-sided pleural effusion,B-US:,pancreatic edema, ascites-,CT:,Important,急性胰腺炎,Imaging finding 急性胰腺炎,CT,is the best diagnostic test for the diagnosis of acute pancreatitis.,Contrast-enhanced CT,is excellent for diagnosis of pancreatic necrosis,有力武器,CT is the best diagnostic tes,急性胰腺炎,Assessment of severity of acute pancreatitis,Ransons criteria,On Admission Within 48 Hours,Age 55 years Hematocrit decrease by 10%,WBC 16,000 /mm Urea nitrogen increase 5 mg/dl,LDH 350 IU/L Serum calcium 11.1mmol/l Arterial PO 250 IU/L Base deficit 4 mEq/L,Estimated fluid sequestration 6 L,急性胰腺炎Assessment of severity of,急性胰腺炎,Glasgow Criteria,Within 48 Hours,Age 55,WBC 15,000 /mm,LDH 600 IU/L,Glucose 180 mg/dl,Albumin 3.2 g/dl,Calcium 45 mg/dl,Arterial PaO,2,8 Scores -SAP,急性胰腺炎APACHE III criteria,Diagnosis and differential Diagnosis,Acute edematous pancreatitis and acute hemorrhagic necrotizing pancreatitis,Other diseases,Acute appendtitis,Ileus,Perforated gastroduodenal ulcer,Biliary disease,Ruptured hepatoma,急性胰腺炎,Clinical finding,Amylase,CT,Abdominal paracentesis,Diagnosis and differential Dia,急性胰腺炎,Treatment,Acute edematous pancreatitis,internal medicine (,Emergency surgery is not indicated in mild acute pancreatitis),Acute hemorrhagic necrotizing pancreatitis,Supportive care,Replacement of fluid and electrolytes,Correction of metabolic abnormalities,Nutritional support,Other measures :nasogastric suction and antibiotics,急性胰腺炎Treatment,Agents to inhibit pancreatic secretion,Have not been found to be useful in altering the course in acute pancreatitis,Somatostatin(sandostatin stilamin),Protease inhibitors (trasylol,抑肽酶,),Surgical therapy,Inefficiency by internal medicine,Complication (pancreatic or/and peripancreatic Infection and abscess),Combined with biliary diseases(Gallstone ASP),Agents to inhibit pancreatic s,Surgical approach,Resection of necrotic tissue and peritoneal lavage,severe, progressive necrotizing pancreatitis or pancreatic abscess.,Cholecystectomy,recurrent acute pancreatitis and microlithiasis,.,Surgical sphincteroplasty of the pancreatic sphincter,pancreatic sphincter dysfunction,outcome is the same as for the endoscopic pancreatic sphincterotomy,more invasive,requiring laparotomy and duodenotomy,Surgical approach,急性胰腺炎,Endoscopic therapy,1) acute gallstone pancreatitis,2) recurrent pancreatitis due to pancreatic sphincter dysfunction,3) recurrent pancreatitis due to pancreas divisum,分裂,.,The rationale for endoscopic therapy in each area is the relief of obstruction to flow of pancreatic juice,急性胰腺炎Endoscopic therapy,胰腺疾病(英文)ppt课件,胰腺疾病(英文)ppt课件,胰腺疾病(英文)ppt课件,慢性胰腺炎,Causes,Alcohol,Pancreas divisum,Acute pancreatitis,Hyperparathyroidism,Trauma,Obstructive pancreatitis,Idiopathic chronic pancreatitis,Cystic fibrosis,Hereditary chronic pancreatitis,慢性胰腺炎Causes,慢性胰腺炎,Classification,Obstructive chronic pancreatitis,Calcified,chronic pancreatitis,Inflammatory,chronic pancreatitis,Pathology,pancreatic fibrosis,-,慢性胰腺炎Classification,慢性胰腺炎,Clinical finding and diagnosis,Abdominal pain , distention,Diarrhage,Dyspepsia,Malnutrtion,Diabetes,Narcotic addiction,Jaundice,慢性胰腺炎Clinical finding and diag,Biochemical measurements,Isoamylase,lipase trypsin,and elastase,弹性蛋白酶,Quantitative measurement of fecal fat,glucose tolerance test,Secretin stimulation test,Plasma cholecystokinin (CCK)(,may be elevated,),Bentiromide (,苯酪肽,),test,（与糜蛋白酶反应）,慢性胰腺炎,Biochemical measurements慢性胰腺炎,胰腺疾病(英文)ppt课件,慢性胰腺炎,Imaging finding,Plain abdominal film,Transabdominal ultrasound,CT,MRCP,Endoscopic diagnosis procedures(ERCP,EUS),慢性胰腺炎Imaging finding,胰腺疾病(英文)ppt课件,胰腺疾病(英文)ppt课件,慢性胰腺炎,Medical therapy,Alcohol and cigarette avoidance,Analgesics,镇痛,Enzyme therapy,Treatment of malnutrition,Surgical therapy,Biliary Obstruction, pancreatic pseudocysts, combined with biliary diseases, intractabe pain,Celiac nerve block,（难处理）,Therapeutic endoscopy,慢性胰腺炎Medical therapy,胰腺疾病(英文)ppt课件,胰腺疾病(英文)ppt课件,胰腺疾病(英文)ppt课件,胰腺疾病(英文)ppt课件,胰腺疾病(英文)ppt课件,胰腺疾病(英文)ppt课件,胰腺肿瘤,Pancreatic carcinoma,Arise from acinar,腺泡,or,duct cells,Early diagnosis very difficulty , prognosis poor,Obstructive jaundice(permanent):main symptom,Abdominal pain,Diabetes,Weakness, emaciation(,消瘦,),Stools: acholic,无胆汁,Gallbladder:Distended,Abdominal mass,胰腺肿瘤Pancreatic carcinoma,Diagnosis of pancreatic carcinoma,Laboratory test:,AKP ,r-GT,LDH;CEA ,POA,胰胚抗原, PCCA,胰癌相关抗原,CA19-9,Imaging finding,US,CT( CTA),MRCP,ERCP, PTC&PTCD,PET(,正电子发射断层扫描,),Biopsy(FNA) and cytology,胰腺肿瘤,Diagnosis of pancreatic carcin,Treatment of pancreatic carcinoma,Radical operation,Pancreatoduodenectomy - tumor in pancreatic,head,Resection of pancreatic body and tail-tumor in pancreatic body or tail,Palliative operation:,to relieve jaundice,Biotherapy,胰腺肿瘤,Treatment of pancreatic carcin,SPN,SPN,胰腺密度,胰腺肿瘤密度低于胰腺密度,胰腺密度胰腺肿瘤密度低于胰腺密度,Pancreatic endocrine neoplasm(PEN),Insulinoma,Arise from B cell,Symptoms: whipples triad,1 Spontaneous hypoglycemia accompanied by central nervous system, psychiatric,or vasomotor symptoms,2 Repeated blood sugar levels below 2.8mmol/L(50mg%),3 Relief of symptoms by oral or intravenous administration of glucose,Diagnosis:,symptom and IRI/G0.3,B-us,CT,MRI, Endo-US,Angiography,PTPS,Treatment:,operation(resection),胰腺肿瘤,Pancreatic endocrine neoplasm(,Arise from:,Papilla of duodenum,Vater ampulla,Distal CBD,Symptom:,obstructive jaundice,Diagnosis,Treatment,:,similar to pancreatic carcinoma,壶腹周围癌,Arise from:壶腹周围癌,胰腺疾病(英文)ppt课件,Thank you very much,Thank you very much,