上海交通大学医学院外科学各论(英文)课件第十三章 胰腺疾病.ppt

上海交通大学医学院外科学各论(英文)课件第十三章 胰腺疾病.ppt

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上海交通大学医学院外科学各论(英文)课件第十三章 胰腺疾病

Anatomy of pancreas Pancreatitis Pancreatic pseudocyst Pancreatic cancer Anatomy Location: retroperitoneal head neck body tail uncinate process SMV pancreatic duct Arteries head & neck celiac axis, superior mesenteric artery GDA superior & inferior pancreaticoduodenal A superior & inferior pancreatic arteries body & tail splenic & left gastroepiploic arteries Veins Superior mesenteric vein Splenic vein Portal vein Lymph & Nerve lymph SPD SP splenic hilum IPD IP head SMA nodes celiac axis nodes tail splenic nodes nerve sympathetic & parasympathetic Histoloy & physiology Exocrine acinar cell digestive enzymes ductal cell bicarbonate secretion of control vagal & CCK Histoloy & physiology Endocrine islets of Langerhans βcell 50% insulin αcell 20% glucagon δ cell 5% somatostatin nonβcell vasoactive intestinal peptide nonβcell gastrin nonβcell pancreatic polypeptide(PP) Acute Pancreatitis Definition Acute pancreatitis (AP) is an acute inflammatory process of the pancreas, with variable involvement of other regional tissue or remote organ systems.The disease includes a broad spectrum of pancreatic disease, which varies from mild parenchymal edema to severe hemorrhagic pancreatitis associated with subsequent gangrene and necrosis.. The clinical presentation Pain of abdomen is diffuse Hypotension Metabolic derangements Sepsis Fluid sequenstration Multiple organ failure Death Etiology Gallstones Sustained alcohol Other In china : biliary tract disease distal common bile duct stone stenosis of the papilla of Vater ascarid in biliary duct Pathogenesis A complicated pathophysiologic process Enzyme autoactivation and self-digestion True mechanism remains unknown Pancreatic self-protective mechanism Mucopolysaccharide on pancreatic duct epithelia Proenzyme Pancreatin inhibitor Acinus metabolism activity Anti-reflux mechanism: oddi’s sphincter

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