胰腺疾病英文

Edematous
hemorrhagic necrotizing
急性胰腺炎
• 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.
area • Grey Turner’ sign:discoloration of flanks
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 )
• Acute hemorrhagic necrotizing pancreatitis • Supportive care
• Replacement of fluid and electrolytes • Correction of metabolic abnormalities • Nutritional support • Other measures :nasogastric suction and
• Arterial PaO2 < 60 mm Hg
急性胰腺炎
• APACHE III criteria
• Temperature
• BUN
• Mean blood pressure
• Leukocytes
• Serum Creatinine
• Hematocrit
• Heart rate
• Albumin
antibiotics
• 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
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
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
胰腺疾病
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
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
急性胰腺炎
• Pathophysiology • Hypersecretion and obstruction
Self-enzymatic digestion
Enhancement of Vessel permibility Cytokine，infection Decreased arterial perfusion
• Inefficiency by internal medicine • Complication (pancreatic or/and
peripancreatic Infection and abscess)
• Combined with biliary diseases(Gallstone ASP)
• 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
• Peritoneal irritation sign （Abdominal tenderness， rebound tenderness and rigidity）
• Shifting dullness • Decreased bowel sounds • Cullen’ sign: discoloration of periumbilical
慢性胰腺炎
• Classification • Obstructive chronic pancreatitis • Calcified chronic pancreatitis • Inflammatory chronic pancreatitis • Pathology • pancreatic fibrosis ----
急性胰腺炎
• Glasgow Criteria
• Within 48 Hours
• Age > 55
• WBC > 15,000 /mm³
• LDH > 600 IU/L
• Glucose > 180 mg/dl
• Albumin < 3.2 g/dl
• Calcium < 8 mg/dl
Urea > 45 mg/dl
Within 48 Hours
Hematocrit decrease by >10% Urea nitrogen increase > 5 mg/dl Serum calcium < 1.87 mmol/l Arterial PO²< 8KPa(60 mm Hg) Base deficit > 4 mEq/L Estimated fluid sequestration > 6 L
• Radioopaque densities (biliary calculi)
• Left-sided pleural effusion • B-US: pancreatic edema, ascites---• CT: Important
•CT is the best diagnostic test for the diagnosis of acute pancreatitis. •Contrast-enhanced CT is excellent for diagnosis of pancreatic necrosis
慢性胰腺炎
• Clinical finding and diagnosis • Abdominal pain , distention • Diarrhage • Dyspepsia • Malnutrtion • Diabetes • Narcotic addiction • Jaundice
divisum分裂. • The rationale for endoscopic therapy in
each area is the relief of obstruction to flow of pancreatic juice
慢性胰腺炎
• Causes
• Alcohol • Pancreas divisum • Acute pancreatitis • Hyperparathyroidism • Trauma • Obstructive pancreatitis • Idiopathic chronic pancreatitis • Cystic fibrosis • Hereditary chronic pancreatitis
急性胰腺炎
• Pathology • acute edematous
pancreatitis • acute hemorrhagic
necrotizing pancreatitis (acute hemorrhagic pancreatitis, acute necrotiziessment of severity of acute pancreatitis
Ranson's criteria
On Admission
Age > 55 years WBC > 16,000 /mm³ LDH > 350 IU/L Glucose >11.1mmol/l AST > 250 IU/L
• Respiratory rate
• Bilirubin
• Oxygenation
• Arterial pH
• Serum sodium and potassium
• Serum glucose
• >8 Scores ----SAP
急性胰腺炎
• Diagnosis and differential Diagnosis
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
• 500 • 400
Urine amylase
• 300 • 200
Blood amylase
• 100
•0
• 0 1H 24H
48H
5DAY
急性胰腺炎
• Serum calcium • Serum glucose • Blood gas analysis • Imunolipase • ALT and AST (gallstone pancreatitis )
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)
Clinical finding Amylase CT Abdominal paracentesis
急性胰腺炎
• Treatment
• Acute edematous pancreatitis—internal medicine (Emergency surgery is not indicated in mild acute pancreatitis)