胰腺疾病(英文)演示

胰腺疾病(英文)課件課件當(dāng)前1頁(yè)，總共47頁(yè)。

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(nèi)分泌EndocrineB,A,D,D1,Gcell當(dāng)前2頁(yè)，總共47頁(yè)。當(dāng)前3頁(yè)，總共47頁(yè)。cCausesGallstones:60%(35–50%inUSA)Alcohol:14%%(60%inUSA)Duodenaljuicecountercurrentflow:SphincterofOddidysfunctionTraumaPancreascirculationdisorderOtherfactors:Drug:Azathioprine(硫唑嘌呤)

.6-Mercaptopurine(6-巰基嘌呤),Pancreasdivisum(胰分裂),MicrolithiasisMetaboliccauseInfectiouscauses,ascarisworms蛔蟲(chóng),HIV-----Miscellaneous急性胰腺炎當(dāng)前4頁(yè)，總共47頁(yè)。當(dāng)前5頁(yè)，總共47頁(yè)。Pathologyacuteedematouspancreatitisacutehemorrhagicnecrotizingpancreatitis

(acutehemorrhagicpancreatitis,acutenecrotizingpancreatitis)急性胰腺炎當(dāng)前6頁(yè)，總共47頁(yè)。PathophysiologyHypersecretionandobstruction

Self-enzymaticdigestion

EnhancementofVesselpermibilityCytokine，infection

DecreasedarterialperfusionEdematoushemorrhagicnecrotizing急性胰腺炎當(dāng)前7頁(yè)，總共47頁(yè)。ClinicalfindingAbdominalpainAbdominaldistentionNauseaandvomitingPeritonitisOther:Respiratoryfailure,confusion,orcoma.Low-gradetomoderatefeverTachycardiaandhypotensionandShockMildjaundice,Pleuraleffusion.急性胰腺炎當(dāng)前8頁(yè)，總共47頁(yè)。急性胰腺炎Peritonealirritationsign（Abdominaltenderness，reboundtendernessandrigidity）ShiftingdullnessDecreasedbowelsoundsCullen’sign:discolorationofperiumbilicalareaGreyTurner’sign:discolorationofflanks當(dāng)前9頁(yè)，總共47頁(yè)。當(dāng)前10頁(yè)，總共47頁(yè)。LaboratoryfindingAmylaseandlipase(elevationsofamylasearemoresensitivebutlessspecificthanlipaseinthediagnosisofacutepancreatitis)500400300200100001H24H48H5DAY急性胰腺炎BloodamylaseUrineamylase當(dāng)前11頁(yè)，總共47頁(yè)。急性胰腺炎Serumcalcium

Serumglucose

BloodgasanalysisImunolipaseALTandAST(gallstonepancreatitis)當(dāng)前12頁(yè)，總共47頁(yè)。ImagingfindingX-ray

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

Left-sidedpleuraleffusionB-US:pancreaticedema,ascites----CT:Important急性胰腺炎當(dāng)前13頁(yè)，總共47頁(yè)。?CTisthebestdiagnostictestforthediagnosisofacutepancreatitis.?Contrast-enhancedCTisexcellentfordiagnosisofpancreaticnecrosis有力武器當(dāng)前14頁(yè)，總共47頁(yè)。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當(dāng)前15頁(yè)，總共47頁(yè)。急性胰腺炎GlasgowCriteriaWithin48HoursAge>55WBC>15,000/mm3LDH>600IU/LGlucose>180mg/dlAlbumin<3.2g/dlCalcium<8mg/dlUrea>45mg/dlArterialPaO2<60mmHg當(dāng)前16頁(yè)，總共47頁(yè)。急性胰腺炎APACHEIIIcriteriaTemperature?BUNMeanbloodpressure?LeukocytesSerumCreatinine?HematocritHeartrate?AlbuminRespiratoryrate?BilirubinOxygenationArterialpHSerumsodiumandpotassiumSerumglucose>8Scores----SAP當(dāng)前17頁(yè)，總共47頁(yè)。DiagnosisanddifferentialDiagnosisAcuteedematouspancreatitisandacutehemorrhagicnecrotizingpancreatitisOtherdiseasesAcuteappendtitisIleusPerforatedgastroduodenalulcerBiliarydiseaseRupturedhepatoma急性胰腺炎ClinicalfindingAmylaseCTAbdominalparacentesis當(dāng)前18頁(yè)，總共47頁(yè)。急性胰腺炎TreatmentAcuteedematouspancreatitis—internalmedicine(Emergencysurgeryisnotindicatedinmildacutepancreatitis)AcutehemorrhagicnecrotizingpancreatitisSupportivecareReplacementoffluidandelectrolytesCorrectionofmetabolicabnormalitiesNutritionalsupportOthermeasures:nasogastricsuctionandantibiotics當(dāng)前19頁(yè)，總共47頁(yè)。AgentstoinhibitpancreaticsecretionHavenotbeenfoundtobeusefulinalteringthecourseinacutepancreatitis

Somatostatin(sandostatinstilamin)Proteaseinhibitors(trasylol抑肽酶)SurgicaltherapyInefficiencybyinternalmedicineComplication(pancreaticor/andperipancreaticInfectionandabscess)Combinedwithbiliarydiseases(GallstoneASP)當(dāng)前20頁(yè)，總共47頁(yè)。SurgicalapproachResectionofnecrotictissueandperitoneallavage

severe,progressivenecrotizingpancreatitisorpancreaticabscess.

Cholecystectomy

recurrentacutepancreatitisandmicrolithiasis.

Surgicalsphincteroplastyofthepancreaticsphincter

pancreaticsphincterdysfunctionoutcomeisthesameasfortheendoscopicpancreaticsphincterotomymoreinvasiverequiringlaparotomyandduodenotomy當(dāng)前21頁(yè)，總共47頁(yè)。急性胰腺炎Endoscopictherapy

1)acutegallstonepancreatitis2)recurrentpancreatitisduetopancreaticsphincterdysfunction,3)recurrentpancreatitisduetopancreasdivisum分裂.Therationaleforendoscopictherapyineachareaisthereliefofobstructiontoflowofpancreaticjuice當(dāng)前22頁(yè)，總共47頁(yè)。當(dāng)前23頁(yè)，總共47頁(yè)。當(dāng)前24頁(yè)，總共47頁(yè)。當(dāng)前25頁(yè)，總共47頁(yè)。慢性胰腺炎Causes

AlcoholPancreasdivisumAcutepancreatitisHyperparathyroidismTraumaObstructivepancreatitisIdiopathicchronicpancreatitisCysticfibrosisHereditarychronicpancreatitis當(dāng)前26頁(yè)，總共47頁(yè)。慢性胰腺炎ClassificationObstructivechronicpancreatitisCalcifiedchronicpancreatitisInflammatorychronicpancreatitisPathologypancreaticfibrosis----當(dāng)前27頁(yè)，總共47頁(yè)。慢性胰腺炎ClinicalfindinganddiagnosisAbdominalpain,distentionDiarrhageDyspepsiaMalnutrtionDiabetesNarcoticaddictionJaundice當(dāng)前28頁(yè)，總共47頁(yè)。BiochemicalmeasurementsIsoamylase,lipasetrypsin,andelastase彈性蛋白酶QuantitativemeasurementoffecalfatglucosetolerancetestSecretinstimulationtestPlasmacholecystokinin(CCK)(maybeelevated)Bentiromide(苯酪肽)test（與糜蛋白酶反應(yīng)）慢性胰腺炎當(dāng)前29頁(yè)，總共47頁(yè)。當(dāng)前30頁(yè)，總共47頁(yè)。慢性胰腺炎ImagingfindingPlainabdominalfilmTransabdominalultrasoundCTMRCPEndoscopicdiagnosisprocedures(ERCP,EUS)當(dāng)前31頁(yè)，總共47頁(yè)。當(dāng)前32頁(yè)，總共47頁(yè)。當(dāng)前33頁(yè)，總共47頁(yè)。慢性胰腺炎MedicaltherapyAlcoholandcigaretteavoidanceAnalgesics鎮(zhèn)痛EnzymetherapyTreatmentofmalnutrition

SurgicaltherapyBiliaryObstruction,pancreaticpseudocysts,combinedwithbiliarydiseases,intractabepain,Celiacnerveblock（難處理）Therapeuticendoscopy當(dāng)前34頁(yè)，總共47頁(yè)。當(dāng)前35頁(yè)，總共47頁(yè)。當(dāng)前36頁(yè)，總共47頁(yè)。當(dāng)前37頁(yè)，總共47頁(yè)。當(dāng)前38頁(yè)，總共47頁(yè)。當(dāng)前39頁(yè)，總共47頁(yè)。當(dāng)前40頁(yè)，總共47頁(yè)。胰腺腫瘤PancreaticcarcinomaArisefromacinar腺泡orductcellsEarlydiagnosisverydifficulty,prognosispoorObstructivejaundice(permanent):mainsymptomAbdominalpainDiabetesWeakness,emaciation(消瘦)Stools:acholic無(wú)膽汁

Gallbladder:DistendedAbdominalmass當(dāng)前41頁(yè)，總共47頁(yè)。DiagnosisofpancreaticcarcinomaLaboratorytest:AKP,r-GT,LDH;CEA,POA胰胚抗原,PCCA胰癌相關(guān)抗原,CA19-9ImagingfindingUS,CT(CTA),MRCPERCP,PTC&PTCDPET(正電子發(fā)射斷層掃描)Biopsy(FNA)andcytology胰腺腫瘤當(dāng)前42頁(yè)，總共47頁(yè)。TreatmentofpancreaticcarcinomaRadicaloperation

Pancreatoduodenectomy----tumo