胰腺疾病
胰腺疾病(英文)
1
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
胰腺疾病(英文)
2
胰腺疾病(英文)
Mild jaundice,
Pleural effusion. 胰腺疾病(英文)
8
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
Ranson's criteria
On Admission
Age > 55 years WBC > 16,000 /mm³ LDH > 350 IU/L Glucose >11.1mmol/l AST > 250 IU/L
Within 48 Hours
Hematocrit decrease by >10%
Infectious causes, ascaris worms蛔虫,HIV-----
胰腺疾病(英文)
4
Miscellaneous
胰腺疾病(英文)
5
急性胰腺炎
• Pathology
• acute edematous pancreatitis
• acute hemorrhagic necrotizing pancreatitis
Enhancement of Vessel permibility Cytokine，infection Decreased arterial perfusion
Edematous
hemorrhagic necrotizing
胰腺疾病(英文)
7
急性胰腺炎
• Clinical finding
• Abdominal pain
• 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
• Radioopaque densities (biliary calculi)
• Left-sided pleural effusion
• B-US: pancreatic edema, ascites----
• CT: Important
胰腺疾病(英文)
13
•CT is the best
diagnostic test for
the diagnosis of
acute pancreatitis.
•Contrast-enhanced
CT is excellent for
diagnosis of
pancreatic necrosis
胰腺疾病(英文)
14
急性胰腺炎
• Assessment of severity of acute pancreatitis
(acute hemorrhagic pancreatitis, acute necrotizing pancreatitis)
胰腺疾病(英文)
6
急性胰腺炎
• Pathophysiology • Hypersecretion and obstruction
Self-enzymatic digestion
Urea nitrogen increase > 5 mg/dl
Serum calcium < 1.87 mmol/l
Arterial PO²< 8KPa(60 mm Hg)
Base deficit > 4 mEq/L
3
急性胰c 腺炎
• Causes
• Gallstones:60%( 35–50% in USA)
• Alcohol:14% %(60% in USA)
• Duodenal juice countercurrent flow: Sphincter of Oddi dysfunction
• Trauma
• 500 • 400
Urine amylase
• 300 • 200
Blood amylase
• 100
•0
• 0 1H 24H 胰腺疾病4(英8文H)
5DAY
11
急性胰腺炎
• Serum calcium • Serum glucose • Blood gas analysis • Imunolipase • ALT and AST (gallstone pancreatitis )
胰腺疾病(英文)
9
胰腺疾病(英文)
10
急性胰腺炎
• Laboratory finding
• Amylase and lipase (elevations of amylase are
more sensitive but less specific than lipase in the diagnosis of acute pancreatitis )
• Abdominal distention
• Nausea and vomiting
Байду номын сангаас
• Peritonitis
• Other:
Respiratory failure, confusion, or coma.
Low-grade to moderate fever
Tachycardia and hypotension and Shock
胰腺疾病(英文)
12
急性胰腺炎
• Imaging finding
• X-ray
• Dilated loop of small bowel (sentinel loop)
• Abrupt cessation of gas in the distal transverse colon (colon cutoff sign)