胰腺疾病-外科教学课件.ppt

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胰腺疾病-外科教学课件

Diseases of pancreas DAI Chao-Liu 2nd clinical college of China Medical University Acute pancreatitis Anatomy Head, neck.body, tail, uncinate process, Main pancreatic duct (duct of Wirsung) Dorsal pancreatic duct (duct of Santorini) Pancreatic excretion Exocrine (extra secretion) Endocrine(internal secretion):B,A,D,G cell c Causes Gallstones:60%( 35–50% in USA) Alcohol:!4% Drug: Azathioprine?.6-Mercaptopurine------ Pancreas divisum(胰腺分裂;胰分裂) Microlithiasis Metabolic cause Sphincter of Oddi dysfunction Infectious causes Trauma, ascaris worms,HIV----- Miscellaneous Acute pancreatitis Pathology acute edematous pancreatitis acute hemorrhagic necrotizing pancreatitis (acute hemorrhagic pancreatitis, acute necrotizing pancreatitis) Acute pancreatitis Pathophysiology Hypersecretion and obstruction Self-enzymatic digestiono Lymphatic obstruction Cytokine,infection Decreased arterial perfusion Edematous hemorrhagic necrotizing Acute pancreatitis Clinical finding Abdominal pain Abdominal distention Nausea and vomiting Respiratory failure, confusion, or coma. Low-grade to moderate fever Tachycardia and hypotension Mild jaundice, Pleural effusion. Shock Acute pancreatitis 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 Acute pancreatitis 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 Acute pancreatitis Serum calcium Serum glucose Blood gas analysis CRP(C-reactive protein) Imunolipase, trypsinogen ,and immuno elastase. ALT and AST (gallstone pancreatitis ) Acute pancreatitis Imaging finding X-ray Dilated loop of small bowel (sentinel loop) Abrupt cessation of gas in the di

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