胰腺疾病-外科教学课件演示文稿.pptVIP

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 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 ?CT is the best diagnostic test for the diagnosis of acute pancreatitis. ?Contrast-enhanced CT is excellent for diagnosis of pancreatic necrosis Acute pancreatitis Assessment of severity of acute pancreatitis Ransons criteria On Admission Within 48 Hours Age 55 years Hematocrit decrease by 10% WBC 16,000 mm3 Urea nitrogen increase 5 mg/dl LDH 350 IU/L Serum calcium 8 mg/dl Glucose 200 mg/dl Arterial PO2 60 mm Hg AST 250 IU/L