胰腺疾病(英文)課件

胰腺疾病1精選可編輯ppt

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,Gcell2精選可編輯ppt3精選可編輯pptcCausesGallstones: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,HIV-----Miscellaneous急性胰腺炎4精選可編輯ppt5精選可編輯pptPathologyacuteedematouspancreatitisacutehemorrhagicnecrotizingpancreatitis

(acutehemorrhagicpancreatitis,acutenecrotizingpancreatitis)急性胰腺炎6精選可編輯pptPathophysiologyHypersecretionandobstruction

Self-enzymaticdigestion

EnhancementofVesselpermibilityCytokine，infection

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

Serumglucose

BloodgasanalysisImunolipaseALTandAST(gallstonepancreatitis)12精選可編輯pptImagingfindingX-ray

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

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

Somatostatin(sandostatinstilamin)Proteaseinhibitors(trasylol抑肽酶)SurgicaltherapyInefficiencybyinternalmedicineComplication(pancreaticor/andperipancreaticInfectionandabscess)Combinedwithbiliarydiseases(GallstoneASP)20精選可編輯pptSurgicalapproachResectionofnecrotictissueandperitoneallavage

severe,progressivenecrotizingpancreatitisorpancreaticabscess.

Cholecystectomy

recurrentacutepancreatitisandmicrolithiasis.

Surgicalsphincteroplastyofthepancreaticsphincter

pancreaticsphincterdysfunctionoutcomeisthesameasfortheendoscopicpancreaticsphincterotomymoreinvasiverequiringlaparotomyandduodenotomy21精選可編輯ppt急性胰腺炎Endoscopictherapy

1)acutegallstonepancreatitis2)recurrentpancreatitisduetopancreaticsphincterdysfunction,3)recurrentpancreatitisduetopancreasdivisum分裂.Therationaleforendoscopictherapyineachareaisthereliefofobstructiontoflowofpancreaticjuice22精選可編輯ppt23精選可編輯ppt24精選可編輯ppt25精選可編輯ppt慢性胰腺炎Causes

AlcoholPancreasdivisumAcutepancreatitisHyperparathyroidismTraumaObstructivepancreatitisIdiopathicchronicpancreatitisCysticfibrosisHereditarychronicpancreatitis26精選可編輯ppt慢性胰腺炎ClassificationObstructivechronicpancreatitisCalcifiedchronicpancreatitisInflammatorychronicpancreatitisPathologypancreaticfibrosis----27精選可編輯ppt慢性胰腺炎ClinicalfindinganddiagnosisAbdominalpain,distentionDiarrhageDyspepsiaMalnutrtionDiabetesNarcoticaddictionJaundice28精選可編輯pptBiochemicalmeasurementsIsoamylase,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29精選可編輯ppt30精選可編輯ppt慢性胰腺炎ImagingfindingPlainabdominalfilmTransabdominalultrasoundCTMRCPEndoscopicdiagnosisprocedures(ERCP,EUS)31精選可編輯ppt32精選可編輯ppt33精選可編輯ppt慢性胰腺炎MedicaltherapyAlcoholandcigaretteavoidanceAnalgesics鎮(zhèn)痛EnzymetherapyTreatmentofmalnutrition

SurgicaltherapyBiliaryObstruction,pancreaticpseudocysts,combinedwithbiliarydiseases,intractabepain,Celiacnerveblock（難處理）Therapeuticendoscopy34精選可編輯ppt35精選可編輯ppt36精選可編輯ppt37精選可編輯ppt38精選可編輯ppt39精選可編輯ppt40精選可編輯ppt胰腺腫瘤PancreaticcarcinomaArisefromacinar腺泡orductcellsEarlydiagnosisverydifficulty,prognosispoorObstructivejaundice(permanent):mainsymptomAbdominalpainDiabetesWeakness,emaciation(消瘦)Stools:acholic無膽汁

Gallbladder:DistendedAbdominalmass41精選可編輯pptDiagnosisofpancreaticcarcinomaLaboratorytest: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42精選可編輯pptTreatmentofpancreaticcarcinomaRadicaloperation

Pancreatoduodenectomy----tumorinpancreatichead

Resectionofpan