胰腺疾病(英文)演示

胰腺疾病(英文)課件課件本文檔共47頁；當前第1頁；編輯于星期一\0點14分

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本文檔共47頁；當前第2頁；編輯于星期一\0點14分本文檔共47頁；當前第3頁；編輯于星期一\0點14分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,HIV-----Miscellaneous急性胰腺炎本文檔共47頁；當前第4頁；編輯于星期一\0點14分本文檔共47頁；當前第5頁；編輯于星期一\0點14分Pathologyacuteedematouspancreatitisacutehemorrhagicnecrotizingpancreatitis

(acutehemorrhagicpancreatitis,acutenecrotizingpancreatitis)急性胰腺炎本文檔共47頁；當前第6頁；編輯于星期一\0點14分PathophysiologyHypersecretionandobstruction

Self-enzymaticdigestion

EnhancementofVesselpermibilityCytokine，infection

DecreasedarterialperfusionEdematoushemorrhagicnecrotizing急性胰腺炎本文檔共47頁；當前第7頁；編輯于星期一\0點14分ClinicalfindingAbdominalpainAbdominaldistentionNauseaandvomitingPeritonitisOther:Respiratoryfailure,confusion,orcoma.Low-gradetomoderatefeverTachycardiaandhypotensionandShockMildjaundice,Pleuraleffusion.急性胰腺炎本文檔共47頁；當前第8頁；編輯于星期一\0點14分急性胰腺炎Peritonealirritationsign（Abdominaltenderness，reboundtendernessandrigidity）ShiftingdullnessDecreasedbowelsoundsCullen’sign:discolorationofperiumbilicalareaGreyTurner’sign:discolorationofflanks本文檔共47頁；當前第9頁；編輯于星期一\0點14分本文檔共47頁；當前第10頁；編輯于星期一\0點14分LaboratoryfindingAmylaseandlipase(elevationsofamylasearemoresensitivebutlessspecificthanlipaseinthediagnosisofacutepancreatitis)500400300200100001H24H48H5DAY急性胰腺炎BloodamylaseUrineamylase本文檔共47頁；當前第11頁；編輯于星期一\0點14分急性胰腺炎Serumcalcium

Serumglucose

BloodgasanalysisImunolipaseALTandAST(gallstonepancreatitis)本文檔共47頁；當前第12頁；編輯于星期一\0點14分ImagingfindingX-ray

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

Left-sidedpleuraleffusionB-US:pancreaticedema,ascites----CT:Important急性胰腺炎本文檔共47頁；當前第13頁；編輯于星期一\0點14分?CTisthebestdiagnostictestforthediagnosisofacutepancreatitis.?Contrast-enhancedCTisexcellentfordiagnosisofpancreaticnecrosis有力武器本文檔共47頁；當前第14頁；編輯于星期一\0點14分急性胰腺炎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本文檔共47頁；當前第15頁；編輯于星期一\0點14分急性胰腺炎GlasgowCriteriaWithin48HoursAge>55WBC>15,000/mm3LDH>600IU/LGlucose>180mg/dlAlbumin<3.2g/dlCalcium<8mg/dlUrea>45mg/dlArterialPaO2<60mmHg本文檔共47頁；當前第16頁；編輯于星期一\0點14分急性胰腺炎APACHEIIIcriteriaTemperature?BUNMeanbloodpressure?LeukocytesSerumCreatinine?HematocritHeartrate?AlbuminRespiratoryrate?BilirubinOxygenationArterialpHSerumsodiumandpotassiumSerumglucose>8Scores----SAP本文檔共47頁；當前第17頁；編輯于星期一\0點14分DiagnosisanddifferentialDiagnosisAcuteedematouspancreatitisandacutehemorrhagicnecrotizingpancreatitisOtherdiseasesAcuteappendtitisIleusPerforatedgastroduodenalulcerBiliarydiseaseRupturedhepatoma急性胰腺炎ClinicalfindingAmylaseCTAbdominalparacentesis本文檔共47頁；當前第18頁；編輯于星期一\0點14分急性胰腺炎TreatmentAcuteedematouspancreatitis—internalmedicine(Emergencysurgeryisnotindicatedinmildacutepancreatitis)AcutehemorrhagicnecrotizingpancreatitisSupportivecareReplacementoffluidandelectrolytesCorrectionofmetabolicabnormalitiesNutritionalsupportOthermeasures:nasogastricsuctionandantibiotics本文檔共47頁；當前第19頁；編輯于星期一\0點14分AgentstoinhibitpancreaticsecretionHavenotbeenfoundtobeusefulinalteringthecourseinacutepancreatitis

Somatostatin(sandostatinstilamin)Proteaseinhibitors(trasylol抑肽酶)SurgicaltherapyInefficiencybyinternalmedicineComplication(pancreaticor/andperipancreaticInfectionandabscess)Combinedwithbiliarydiseases(GallstoneASP)本文檔共47頁；當前第20頁；編輯于星期一\0點14分SurgicalapproachResectionofnecrotictissueandperitoneallavage

severe,progressivenecrotizingpancreatitisorpancreaticabscess.

Cholecystectomy

recurrentacutepancreatitisandmicrolithiasis.

Surgicalsphincteroplastyofthepancreaticsphincter

pancreaticsphincterdysfunctionoutcomeisthesameasfortheendoscopicpancreaticsphincterotomymoreinvasiverequiringlaparotomyandduodenotomy本文檔共47頁；當前第21頁；編輯于星期一\0點14分急性胰腺炎Endoscopictherapy

1)acutegallstonepancreatitis2)recurrentpancreatitisduetopancreaticsphincterdysfunction,3)recurrentpancreatitisduetopancreasdivisum分裂.Therationaleforendoscopictherapyineachareaisthereliefofobstructiontoflowofpancreaticjuice本文檔共47頁；當前第22頁；編輯于星期一\0點14分本文檔共47頁；當前第23頁；編輯于星期一\0點14分本文檔共47頁；當前第24頁；編輯于星期一\0點14分本文檔共47頁；當前第25頁；編輯于星期一\0點14分慢性胰腺炎Causes

AlcoholPancreasdivisumAcutepancreatitisHyperparathyroidismTraumaObstructivepancreatitisIdiopathicchronicpancreatitisCysticfibrosisHereditarychronicpancreatitis本文檔共47頁；當前第26頁；編輯于星期一\0點14分慢性胰腺炎ClassificationObstructivechronicpancreatitisCalcifiedchronicpancreatitisInflammatorychronicpancreatitisPathologypancreaticfibrosis----本文檔共47頁；當前第27頁；編輯于星期一\0點14分慢性胰腺炎ClinicalfindinganddiagnosisAbdominalpain,distentionDiarrhageDyspepsiaMalnutrtionDiabetesNarcoticaddictionJaundice本文檔共47頁；當前第28頁；編輯于星期一\0點14分BiochemicalmeasurementsIsoamylase,lipasetrypsin,andelastase彈性蛋白酶QuantitativemeasurementoffecalfatglucosetolerancetestSecretinstimulationtestPlasmacholecystokinin(CCK)(maybeelevated)Bentiromide(苯酪肽)test（與糜蛋白酶反應）慢性胰腺炎本文檔共47頁；當前第29頁；編輯于星期一\0點14分本文檔共47頁；當前第30頁；編輯于星期一\0點14分慢性胰腺炎ImagingfindingPlainabdominalfilmTransabdominalultrasoundCTMRCPEndoscopicdiagnosisprocedures(ERCP,EUS)本文檔共47頁；當前第31頁；編輯于星期一\0點14分本文檔共47頁；當前第32頁；編輯于星期一\0點14分本文檔共47頁；當前第33頁；編輯于星期一\0點14分慢性胰腺炎MedicaltherapyAlcoholandcigaretteavoidanceAnalgesics鎮(zhèn)痛EnzymetherapyTreatmentofmalnutrition

SurgicaltherapyBiliaryObstruction,pancreaticpseudocysts,combinedwithbiliarydiseases,intractabepain,Celiacnerveblock（難處理）Therapeuticendoscopy本文檔共47頁；當前第34頁；編輯于星期一\0點14分本文檔共47頁；當前第35頁；編輯于星期一\0點14分本文檔共47頁；當前第36頁；編輯于星期一\0點14分本文檔共47頁；當前第37頁；編輯于星期一\0點14分本文檔共47頁；當前第38頁；編輯于星期一\0點14分本文檔共47頁；當前第39頁；編輯于星期一\0點14分本文檔共47頁；當前第40頁；編輯于星期一\0點14分胰腺腫瘤PancreaticcarcinomaArisefromacinar腺泡orductcellsEarlydiagnosisverydifficulty,prognosispoorObstructivejaundice(permanent):mainsymptomAbdominalpainDiabetesWeakness,emaciation(消瘦)Stools:acholic無膽汁

Gallbladder:DistendedAbdominalmass本文檔共47頁；當前第41頁；編輯于星期一\0點14分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胰腺腫瘤本文檔共47頁；當前第42頁；編輯于星期一\0點14分TreatmentofpancreaticcarcinomaRadicaloperation

Pancreatoduodenectomy----tumorin