单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,编辑ppt,*,胰腺疾病,编辑ppt,胰腺疾病编辑ppt,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,编辑ppt,解剖生理概要解剖编辑ppt,2,编辑ppt,编辑ppt,3,c,Causes,Gallstones:60%(,35,50%in USA),Alcohol:14%(60,%in USA),Duodenal juice countercurrent flow:Sphincter of Oddi dysfunction,Trauma,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,Infectious causes,ascaris worms,蛔虫,HIV-,Miscellaneous,急性胰腺炎,编辑ppt,cCauses急性胰腺炎编辑ppt,4,编辑ppt,编辑ppt,5,Pathology,acute edematous pancreatitis,acute hemorrhagic necrotizing pancreatitis,(acute hemorrhagic pancreatitis,acute necrotizing pancreatitis),急性胰腺炎,编辑ppt,Pathology急性胰腺炎编辑ppt,6,Pathophysiology,Hypersecretion and obstruction,Self-enzymatic digestion,Enhancement of Vessel permibility C,ytokine,，,infection,Decreased arterial perfusion,Edematous hemorrhagic necrotizing,急性胰腺炎,编辑ppt,Pathophysiology 急性胰腺炎编辑ppt,7,Clinical finding,Abdominal pain,Abdominal distention,Nausea and vomiting,Peritonitis,Other:,Respiratory failure,confusion,or coma.,Low-grade to moderate fever,Tachycardia and hypotension and Shock,Mild jaundice,Pleural effusion,.,急性胰腺炎,编辑ppt,Clinical finding急性胰腺炎编辑ppt,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,编辑ppt,急性胰腺炎Peritoneal irritation sig,9,编辑ppt,编辑ppt,10,Laboratory finding,Amylase and lipase,(,elevations of amylase are more sensitive but less specific than lipase in the diagnosis of acute pancreatitis),500,400,300,200,100,0,0 1H 24H 48H 5DAY,急性胰腺炎,Blood amylase,Urine amylase,编辑ppt,Laboratory finding急性胰腺炎Blood a,11,急性胰腺炎,Serum calcium,Serum glucose,Blood gas analysis,Imunolipase,ALT and AST(gallstone pancreatitis),编辑ppt,急性胰腺炎Serum calcium 编辑ppt,12,Imaging finding,X-ray,Dilated loop of small bowel(sentinel loop),Abrupt cessation of gas in the distal transverse colon(colon cutoff sign),Radioopaque densities(biliary calculi),Left-sided pleural effusion,B-US:,pancreatic edema,ascites-,CT:,Important,急性胰腺炎,编辑ppt,Imaging finding 急性胰腺炎编辑ppt,13,CT,is the best diagnostic test for the diagnosis of acute pancreatitis.,Contrast-enhanced CT,is excellent for diagnosis of pancreatic necrosis,有力武器,编辑ppt,CT is the best diagnostic tes,14,急性胰腺炎,Assessment of severity of acute pancreatitis,Ransons criteria,On Admission Within 48 Hours,Age 55 years Hematocrit decrease by 10%,WBC 16,000/mm,Urea nitrogen increase 5 mg/dl,LDH 350 IU/L Serum calcium 11.1mmol/l Arterial PO,250 IU/L Base deficit 4 mEq/L,Estimated fluid sequestration 6 L,编辑ppt,急性胰腺炎Assessment of severity of,15,急性胰腺炎,Glasgow Criteria,Within 48 Hours,Age 55,WBC 15,000/mm,LDH 600 IU/L,Glucose 180 mg/dl,Albumin 3.2 g/dl,Calcium 45 mg/dl,Arterial PaO,2,8 Scores-SAP,编辑ppt,急性胰腺炎APACHE III criteria编辑ppt,17,Diagnosis and differential Diagnosis,Acute edematous pancreatitis and acute hemorrhagic necrotizing pancreatitis,Other diseases,Acute appendtitis,Ileus,Perforated gastroduodenal ulcer,Biliary disease,Ruptured hepatoma,急性胰腺炎,Clinical finding,Amylase,CT,Abdominal paracentesis,编辑ppt,Diagnosis and differential Dia,18,急性胰腺炎,Treatment,Acute edematous pancreatitis,internal medicine(,Emergency surgery is not indicated in mild acute pancreatitis),Acute hemorrhagic necrotizing pancreatitis,Supportive care,Replacement of fluid and electrolytes,Correction of metabolic abnormalities,Nutritional support,Other measures:nasogastric suction and antibiotics,编辑ppt,急性胰腺炎Treatment编辑ppt,19,Agents to inhibit pancreatic secretion,Have not been found to be useful in altering the course in acute pancreatitis,Somatostatin(sandostatin stilamin),Protease inhibitors(trasylol,抑肽酶,),Surgical therapy,Inefficiency by internal medicine,Complication(pancreatic or/and peripancreatic,Infection and abscess),Combined with biliary diseases(Gallstone ASP),编辑ppt,Agents to inhibit pancreatic s,20,Surgical approach,Resection of necrotic tissue and peritoneal lavage,severe,progressive necrotizing pancreatitis or pancreatic abscess.,Cholecystectomy,recurrent acute pancreatitis and microlithiasis,.,Surgical sphincteroplasty of the pancreatic sphincter,pancreatic sphincter dysfunction,outcome is the same as for the endoscopic pancreatic sphincterotomy,more invasive,requiring laparotomy and duodenotomy,编辑ppt,Surgical approach 编辑ppt,21,急性胰腺炎,Endoscopic therapy,1)acute gallstone pancreatitis,2)recurrent pancreatitis due to pancreatic sphincter dysfunction,3)recurrent pancreatitis due to pancreas divisum,分裂,.,The rationale for endoscopic therapy in each area is the relief of obstruction to flow of pancreatic juice,编辑ppt,急性胰腺炎Endoscopic therapy编辑ppt,22,编辑ppt,编辑ppt,23,编辑ppt,编辑ppt,24,编辑ppt,编辑ppt,25,慢性胰腺炎,Causes,Alcohol,Pancreas divisum,Acute pancreatitis,Hyperparathyroidism,Trauma,Obstructive pancreatitis,Idiopathic chronic pancreatiti