胰腺疾病英文示范課件

胰腺疾病英文胰腺疾病英文1

解剖生理概要解剖頭，頸，體，尾，鉤突。

主胰管

(ductofWirsung)副胰管

(ductofSantorini)

胰腺分泌外分泌Exocrine內分泌EndocrineB,A,D,D1,Gcell解剖生理概要解剖胰腺疾病英文示范課件cCausesGallstones:60%(35–50%inUSA)Alcohol:14%%(60%inUSA)Duodenaljuicecountercurrentflow:SphincterofOddidysfunctionTraumaPancreascirculationdisorderOtherfactors:Drug:Azathioprine(硫唑嘌呤)

.6Mercaptopurine(6巰基嘌呤),Pancreasdivisum(胰分裂),MicrolithiasisMetaboliccauseInfectiouscauses,ascarisworms蛔蟲,HIVMiscellaneous急性胰腺炎cCauses急性胰腺炎胰腺疾病英文示范課件Pathologyacuteedematouspancreatitisacutehemorrhagicnecrotizingpancreatitis(acutehemorrhagicpancreatitis,acutenecrotizingpancreatitis)急性胰腺炎Pathology急性胰腺炎PathophysiologyHypersecretionandobstruction

Selfenzymaticdigestion

EnhancementofVesselpermibilityCytokine，infectionDecreasedarterialperfusionEdematoushemorrhagicnecrotizing急性胰腺炎Pathophysiology急性胰腺炎ClinicalfindingAbdominalpainAbdominaldistentionNauseaandvomitingPeritonitisOther:Respiratoryfailure,confusion,orcoma.LowgradetomoderatefeverTachycardiaandhypotensionandShockMildjaundice,Pleuraleffusion.急性胰腺炎Clinicalfinding急性胰腺炎急性胰腺炎Peritonealirritationsign（Abdominaltenderness，reboundtendernessandrigidity）ShiftingdullnessDecreasedbowelsoundsCullen’sign:discolorationofperiumbilicalareaGreyTurner’sign:discolorationofflanks急性胰腺炎Peritonealirritationsig胰腺疾病英文示范課件LaboratoryfindingAmylaseandlipase(elevationsofamylasearemoresensitivebutlessspecificthanlipaseinthediagnosisofacutepancreatitis)500400300200100001H24H48H5DAY急性胰腺炎BloodamylaseUrineamylaseLaboratoryfinding急性胰腺炎Blooda急性胰腺炎SerumcalciumSerumglucoseBloodgasanalysisImunolipaseALTandAST(gallstonepancreatitis)急性胰腺炎SerumcalciumImagingfindingXrayDilatedloopofsmallbowel(sentinelloop)Abruptcessationofgasinthedistaltransversecolon(coloncutoffsign)Radioopaquedensities(biliarycalculi)LeftsidedpleuraleffusionBUS:pancreaticedema,ascitesCT:Important急性胰腺炎Imagingfinding急性胰腺炎?CTisthebestdiagnostictestforthediagnosisofacutepancreatitis.?Contrast-enhancedCTisexcellentfordiagnosisofpancreaticnecrosis有力武器?CTisthebestdiagnostictes急性胰腺炎AssessmentofseverityofacutepancreatitisRanson'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急性胰腺炎AssessmentofseverityofResectionofpancreaticbodyandtailtumorinpancreaticbodyortailBiliaryObstruction,pancreaticpseudocysts,combinedwithbiliarydiseases,intractabepain,InflammatorychronicpancreatitisUS,CT(CTA),MRCP8mmol/L(50mg%)Resectionofnecrotictissueandperitoneallavagesevere,progressivenecrotizingpancreatitisorpancreaticabscess.VaterampullaCalcifiedchronicpancreatitisacuteedematouspancreatitisOtherdiseasesTransabdominalultrasoundSurgicalsphincteroplastyofthepancreaticsphincterLDH>600IU/L1)acutegallstonepancreatitisPlainabdominalfilmacutehemorrhagicnecrotizingpancreatitisAlbumin<3.8mmol/L(50mg%)recurrentacutepancreatitisandmicrolithiasis.Pancreatoduodenectomytumorinpancreatichead急性胰腺炎GlasgowCriteriaWithin48HoursAge>55WBC>15,000/mm3LDH>600IU/LGlucose>180mg/dlAlbumin<3.2g/dlCalcium<8mg/dlUrea>45mg/dlArterialPaO2<60mmHgResectionofpancreaticbodya急性胰腺炎APACHEIIIcriteriaTemperature?BUNMeanbloodpressure?LeukocytesSerumCreatinine?HematocritHeartrate?AlbuminRespiratoryrate?BilirubinOxygenationArterialpHSerumsodiumandpotassiumSerumglucose>8ScoresSAP急性胰腺炎APACHEIIIcriteriaDiagnosisanddifferentialDiagnosisAcuteedematouspancreatitisandacutehemorrhagicnecrotizingpancreatitisOtherdiseasesAcuteappendtitisIleusPerforatedgastroduodenalulcerBiliarydiseaseRupturedhepatoma急性胰腺炎ClinicalfindingAmylaseCTAbdominalparacentesisDiagnosisanddifferentialDia急性胰腺炎TreatmentAcuteedematouspancreatitis—internalmedicine(Emergencysurgeryisnotindicatedinmildacutepancreatitis)AcutehemorrhagicnecrotizingpancreatitisSupportivecareReplacementoffluidandelectrolytesCorrectionofmetabolicabnormalitiesNutritionalsupportOthermeasures:nasogastricsuctionandantibiotics急性胰腺炎TreatmentAgentstoinhibitpancreaticsecretionHavenotbeenfoundtobeusefulinalteringthecourseinacutepancreatitisSomatostatin(sandostatinstilamin)Proteaseinhibitors(trasylol抑肽酶)SurgicaltherapyInefficiencybyinternalmedicineComplication(pancreaticor/andperipancreaticInfectionandabscess)Combinedwithbiliarydiseases(GallstoneASP)AgentstoinhibitpancreaticsSurgicalapproachResectionofnecrotictissueandperitoneallavagesevere,progressivenecrotizingpancreatitisorpancreaticabscess.Cholecystectomyrecurrentacutepancreatitisandmicrolithiasis.SurgicalsphincteroplastyofthepancreaticsphincterpancreaticsphincterdysfunctionoutcomeisthesameasfortheendoscopicpancreaticsphincterotomymoreinvasiverequiringlaparotomyandduodenotomySurgicalapproach急性胰腺炎Endoscopictherapy

1)acutegallstonepancreatitis2)recurrentpancreatitisduetopancreaticsphincterdysfunction,3)recurrentpancreatitisduetopancreasdivisum分裂.Therationaleforendoscopictherapyineachareaisthereliefofobstructiontoflowofpancreaticjuice急性胰腺炎Endoscopictherapy胰腺疾病英文示范課件胰腺疾病英文示范課件胰腺疾病英文示范課件慢性胰腺炎CausesAlcoholPancreasdivisumAcutepancreatitisHyperparathyroidismTraumaObstructivepancreatitisIdiopathicchronicpancreatitisCysticfibrosisHereditarychronicpancreatitis慢性胰腺炎Causes慢性胰腺炎ClassificationObstructivechronicpancreatitisCalcifiedchronicpancreatitisInflammatorychronicpancreatitisPathologypancreaticfibrosis慢性胰腺炎Classification慢性胰腺炎ClinicalfindinganddiagnosisAbdominalpain,distentionDiarrhageDyspepsiaMalnutrtionDiabetesNarcoticaddictionJaundice慢性胰腺炎ClinicalfindinganddiagSerumCreatinine?HematocritAge>55yearsHematocritdecreaseby>10%NauseaandvomitingClinicalfindinganddiagnosisObstructivepancreatitisAST>250IU/LBasedeficit>4mEq/LNauseaandvomitingLDH>600IU/LArterialpHEndoscopictherapyNutritionalsupportPleuraleffusion.TachycardiaandhypotensionandShockResectionofnecrotictissueandperitoneallavagesevere,progressivenecrotizingpancreatitisorpancreaticabscess.SerumsodiumandpotassiumLowgradetomoderatefeverComplication(pancreaticor/andperipancreaticInfectionandabscess)ArterialpHTemperature?BUNHypersecretionandobstruction頭，頸，體，尾，鉤突。BiochemicalmeasurementsIsoamylase,lipasetrypsin,andelastase彈性蛋白酶QuantitativemeasurementoffecalfatglucosetolerancetestSecretinstimulationtestPlasmacholecystokinin(CCK)(maybeelevated)Bentiromide(苯酪肽)test（與糜蛋白酶反應）慢性胰腺炎SerumCreatinine胰腺疾病英文示范課件慢性胰腺炎ImagingfindingPlainabdominalfilmTransabdominalultrasoundCTMRCPEndoscopicdiagnosisprocedures(ERCP,EUS)慢性胰腺炎Imagingfinding胰腺疾病英文示范課件胰腺疾病英文示范課件慢性胰腺炎MedicaltherapyAlcoholandcigaretteavoidanceAnalgesics鎮(zhèn)痛EnzymetherapyTreatmentofmalnutritionSurgicaltherapyBiliaryObstruction,pancreaticpseudocysts,combinedwithbiliarydiseases,intractabepain,Celiacnerveblock（難處理）Therapeuticendoscopy慢性胰腺炎Medicaltherapy胰腺疾病英文示范課件胰腺疾病英文示范課件胰腺疾病英文示范課件胰腺疾病英文示范課件胰腺疾病英文示范課件SecretinstimulationtestWBC>15,000/mm3Within48HoursClinicalfindinganddiagnosisVaterampullaSymptom:obstructivejaundiceVaterampullaSurgicalapproachMeanbloodpressure?LeukocytesSelfenzymaticdigestionCT:ImportantCholecystectomyrequiringlaparotomyandduodenotomyAbdominalpainNutritionalsupportResectionofpancreaticbodyandtailtumorinpancreaticbodyortailGreyTurner’sign:discolorationofflanksTreatmentofpancreaticcarcinomaSecretinstimulationtest胰腺腫瘤PancreaticcarcinomaArisefromacinar腺泡orductcellsEarlydiagnosisverydifficulty,prognosispoorObstructivejaundice(permanent):mainsymptomAbdominalpainDiabetesWeakness,emaciation(消瘦)Stools:acholic無膽汁

Gallbladder:DistendedAbdominalmass胰腺腫瘤PancreaticcarcinomaDiagnosisofpancreaticcarcinomaLaboratorytest:AKP,rGT,LDH;CEA,POA胰胚抗原,PCCA胰癌相關抗原,CA199ImagingfindingUS,CT(CTA),MRCPERCP,PTC&PTCDPET(正電子發(fā)射斷層掃描)Biopsy(FNA)andcytology胰腺腫瘤DiagnosisofpancreaticcarcinTreatmentofpancreaticcarcinomaRadicaloperationPancreatoduodenectomytumorinpancreaticheadResectionofpancreaticbodyandtailtumorinpancreaticbodyortailPalliativeoperation:torelievejaundiceBiotherapy胰腺腫瘤TreatmentofpancreaticcarcinSPNSPN胰腺密度胰腺腫瘤密度低于胰腺密度胰腺密度胰腺腫瘤密度低于胰腺密度Pancreaticendocrineneoplasm(PEN)InsulinomaArisefromBcellSymptoms:whipple’striad1Spontaneoushypoglycemiaaccompaniedbycentralnervoussystem,psychiatric,orvasomotorsymptoms2Repeatedbloodsugarlevelsbelow2.8mmol/L(50mg%)3ReliefofsymptomsbyoralorintravenousadministrationofglucoseDiagnosis:symptomandIRI/G>0.3,Bus,CT,MRI,EndoUS,Angiography,PTPSTreatment:operation(resection)胰腺腫瘤Pancreaticendocrineneoplasm(Arisefrom:PapillaofduodenumVaterampullaDistalCBDSymptom:obstructivejaundiceDiagnosisTreatment:similartopancreaticcarcinoma壺腹周圍癌Arisefrom:壺腹周圍癌胰腺疾病英文胰腺疾病英文48

解剖生理概要解剖頭，頸，體，尾，鉤突。

主胰管

(ductofWirsung)副胰管

(ductofSantorini)

胰腺分泌外分泌Exocrine內分泌EndocrineB,A,D,D1,Gcell解剖生理概要解剖胰腺疾病英文示范課件cCausesGallstones:60%(35–50%inUSA)Alcohol:14%%(60%inUSA)Duodenaljuicecountercurrentflow:SphincterofOddidysfunctionTraumaPancreascirculationdisorderOtherfactors:Drug:Azathioprine(硫唑嘌呤)

.6Mercaptopurine(6巰基嘌呤),Pancreasdivisum(胰分裂),MicrolithiasisMetaboliccauseInfectiouscauses,ascarisworms蛔蟲,HIVMiscellaneous急性胰腺炎cCauses急性胰腺炎胰腺疾病英文示范課件Pathologyacuteedematouspancreatitisacutehemorrhagicnecrotizingpancreatitis(acutehemorrhagicpancreatitis,acutenecrotizingpancreatitis)急性胰腺炎Pathology急性胰腺炎PathophysiologyHypersecretionandobstruction

Selfenzymaticdigestion

EnhancementofVesselpermibilityCytokine，infectionDecreasedarterialperfusionEdematoushemorrhagicnecrotizing急性胰腺炎Pathophysiology急性胰腺炎ClinicalfindingAbdominalpainAbdominaldistentionNauseaandvomitingPeritonitisOther:Respiratoryfailure,confusion,orcoma.LowgradetomoderatefeverTachycardiaandhypotensionandShockMildjaundice,Pleuraleffusion.急性胰腺炎Clinicalfinding急性胰腺炎急性胰腺炎Peritonealirritationsign（Abdominaltenderness，reboundtendernessandrigidity）ShiftingdullnessDecreasedbowelsoundsCullen’sign:discolorationofperiumbilicalareaGreyTurner’sign:discolorationofflanks急性胰腺炎Peritonealirritationsig胰腺疾病英文示范課件LaboratoryfindingAmylaseandlipase(elevationsofamylasearemoresensitivebutlessspecificthanlipaseinthediagnosisofacutepancreatitis)500400300200100001H24H48H5DAY急性胰腺炎BloodamylaseUrineamylaseLaboratoryfinding急性胰腺炎Blooda急性胰腺炎SerumcalciumSerumglucoseBloodgasanalysisImunolipaseALTandAST(gallstonepancreatitis)急性胰腺炎SerumcalciumImagingfindingXrayDilatedloopofsmallbowel(sentinelloop)Abruptcessationofgasinthedistaltransversecolon(coloncutoffsign)Radioopaquedensities(biliarycalculi)LeftsidedpleuraleffusionBUS:pancreaticedema,ascitesCT:Important急性胰腺炎Imagingfinding急性胰腺炎?CTisthebestdiagnostictestforthediagnosisofacutepancreatitis.?Contrast-enhancedCTisexcellentfordiagnosisofpancreaticnecrosis有力武器?CTisthebestdiagnostictes急性胰腺炎AssessmentofseverityofacutepancreatitisRanson'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急性胰腺炎AssessmentofseverityofResectionofpancreaticbodyandtailtumorinpancreaticbodyortailBiliaryObstruction,pancreaticpseudocysts,combinedwithbiliarydiseases,intractabepain,InflammatorychronicpancreatitisUS,CT(CTA),MRCP8mmol/L(50mg%)Resectionofnecrotictissueandperitoneallavagesevere,progressivenecrotizingpancreatitisorpancreaticabscess.VaterampullaCalcifiedchronicpancreatitisacuteedematouspancreatitisOtherdiseasesTransabdominalultrasoundSurgicalsphincteroplastyofthepancreaticsphincterLDH>600IU/L1)acutegallstonepancreatitisPlainabdominalfilmacutehemorrhagicnecrotizingpancreatitisAlbumin<3.8mmol/L(50mg%)recurrentacutepancreatitisandmicrolithiasis.Pancreatoduodenectomytumorinpancreatichead急性胰腺炎GlasgowCriteriaWithin48HoursAge>55WBC>15,000/mm3LDH>600IU/LGlucose>180mg/dlAlbumin<3.2g/dlCalcium<8mg/dlUrea>45mg/dlArterialPaO2<60mmHgResectionofpancreaticbodya急性胰腺炎APACHEIIIcriteriaTemperature?BUNMeanbloodpressure?LeukocytesSerumCreatinine?HematocritHeartrate?AlbuminRespiratoryrate?BilirubinOxygenationArterialpHSerumsodiumandpotassiumSerumglucose>8ScoresSAP急性胰腺炎APACHEIIIcriteriaDiagnosisanddifferentialDiagnosisAcuteedematouspancreatitisandacutehemorrhagicnecrotizingpancreatitisOtherdiseasesAcuteappendtitisIleusPerforatedgastroduodenalulcerBiliarydiseaseRupturedhepatoma急性胰腺炎ClinicalfindingAmylaseCTAbdominalparacentesisDiagnosisanddifferentialDia急性胰腺炎TreatmentAcuteedematouspancreatitis—internalmedicine(Emergencysurgeryisnotindicatedinmildacutepancreatitis)AcutehemorrhagicnecrotizingpancreatitisSupportivecareReplacementoffluidandelectrolytesCorrectionofmetabolicabnormalitiesNutritionalsupportOthermeasures:nasogastricsuctionandantibiotics急性胰腺炎TreatmentAgentstoinhibitpancreaticsecretionHavenotbeenfoundtobeusefulinalteringthecourseinacutepancreatitisSomatostatin(sandostatinstilamin)Proteaseinhibitors(trasylol抑肽酶)SurgicaltherapyInefficiencybyinternalmedicineComplication(pancreaticor/andperipancreaticInfectionandabscess)Combinedwithbiliarydiseases(GallstoneASP)AgentstoinhibitpancreaticsSurgicalapproachResectionofnecrotictissueandperitoneallavagesevere,progressivenecrotizingpancreatitisorpancreaticabscess.Cholecystectomyrecurrentacutepancreatitisandmicrolithiasis.SurgicalsphincteroplastyofthepancreaticsphincterpancreaticsphincterdysfunctionoutcomeisthesameasfortheendoscopicpancreaticsphincterotomymoreinvasiverequiringlaparotomyandduodenotomySurgicalapproach急性胰腺炎Endoscopictherapy

1)acutegallstonepancreatitis2)recurrentpancreatitisduetopancreaticsphincterdysfunction,3)recurrentpancreatitisduetopancreasdivisum分裂.Therationaleforendoscopictherapyineachareaisthereliefofobstructiontoflowofpancreaticjuice急性胰腺炎Endoscopictherapy胰腺疾病英文示范課件胰腺疾病英文示范課件胰腺疾病英文示范課件慢性胰腺炎CausesAlcoholPancreasdivisumAcutepancreatitisHyperparathyroidismTraumaObstructivepancreatitisIdiopathicchronicpancreatitisCysticfibrosisHereditarychronicpancreatitis慢性胰腺炎Causes慢性胰腺炎ClassificationObstructivechronicpancreatitisCalcifiedchronicpancreatitisInflammatorychronicpancreatitisPathologypancreaticfibrosis慢性胰腺炎Classification慢性胰腺炎ClinicalfindinganddiagnosisAbdominalpain,distentionDiarrhageDyspepsiaMalnutrtionDiabetesNarcoticaddictionJaundice慢性胰腺炎ClinicalfindinganddiagSerumCreatinine?HematocritAge>55yearsHematocritdecreaseby>10%NauseaandvomitingClinicalfindinganddiagnosisObstructivepancreatitisAST>250IU/LBasedeficit>4mEq/LNauseaandvomitingLDH>600IU/LArterialpHEndoscopictherapyNutritionalsupportPleuraleffusion.TachycardiaandhypotensionandShockResectionofnecrotictissueandperitoneallavagesevere,progressivenecrotizingpancreatitisorpancreaticabscess.SerumsodiumandpotassiumLowgradetomoderatefeverComplication(pancreaticor/andperipancreaticInfectionandabscess)ArterialpHTemperature?BUNHypersecretionandobstruction頭，頸，體，尾，鉤突。BiochemicalmeasurementsIsoamylase,lipasetrypsin,andelastase彈性蛋白酶QuantitativemeasurementoffecalfatglucosetolerancetestSecretinstimulationtestPlasmacholecystokinin(CCK)(maybeelevated)Bentiromide(苯酪肽)test（與糜蛋白酶反應）慢性胰腺炎SerumCreatinine胰腺疾病英文示范課件慢性胰腺炎ImagingfindingPlainabdominalfilmTransabdominalultrasoundCTMRCPEndoscopicdiagnosisprocedures(ERCP,EUS)慢性胰腺炎Imagingfinding胰腺疾病英文示范課件胰腺疾病英文示范課件慢性胰腺炎MedicaltherapyAlcoholandcigaretteavoidanceAnalgesics鎮(zhèn)痛EnzymetherapyTreatmentofmalnutritionSurgicaltherapyBiliaryObstruction,pancreaticpseudocysts,combinedwithbiliarydiseases,intractabepain,Celiacnerveblock