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1、DiseasesofpancreasDAIChao-Liu2ndclinicalcollegeofChinaMedicalUniversityAcutepancreatitisAnatomyHead,neck.body,tail,uncinateprocess,Mainpancreaticduct(ductofWirsung)Dorsalpancreaticduct(ductofSantorini)PancreaticexcretionExocrine(extrasecretion)Endocrin
2、e(internalsecretion):B,A,D,GcellcCausesGallstones:60%(35–50%inUSA)Alcohol:!4%Drug:Azathioprine.6-Mercaptopurine------Pancreasdivisum(胰腺分裂;胰分裂)MicrolithiasisMetaboliccauseSphincterofOddidysfunctionInfectiouscausesTrauma,ascarisworms,HIV-----Miscellaneou
3、sAcutepancreatitisPathologyacuteedematouspancreatitisacutehemorrhagicnecrotizingpancreatitis(acutehemorrhagicpancreatitis,acutenecrotizingpancreatitis)AcutepancreatitisPathophysiologyHypersecretionandobstructionSelf-enzymaticdigestionoLymphaticobstruct
4、ionCytokine,infectionDecreasedarterialperfusionEdematoushemorrhagicnecrotizingAcutepancreatitisClinicalfindingAbdominalpainAbdominaldistentionNauseaandvomitingRespiratoryfailure,confusion,orcoma.Low-gradetomoderatefeverTachycardiaandhypotensionMildjaun
5、dice,Pleuraleffusion.ShockAcutepancreatitisAcutepancreatitisPeritonealirritationsign(Abdominaltenderness,reboundtendernessandrigidity)ShiftingdullnessDecreasedbowelsoundsCullen’sign:discolorationofperiumbilicalareaGreyTurner’sign:discolorationofflanksL
6、aboratoryfindingAmylaseandlipase(elevationsofamylasearemoresensitivebutlessspecificthanlipaseinthediagnosisofacutepancreatitis)500400300200100001H24H48H5DAYAcutepancreatitisBloodamylaseUrineamylaseAcutepancreatitisSerumcalciumSerumglucoseBloodgasanalys
7、isCRP(C-reactiveprotein)Imunolipase,trypsinogen,andimmunoelastase.ALTandAST(gallstonepancreatitis)ImagingfindingX-rayDilatedloopofsmallbowel(sentinelloop)Abruptcessationofgasinthedistaltransversecolon(coloncutoffsign)Radioopaquedensities(biliarycalculi
8、)Left-sidedpleuraleffusionB-US:pancreaticedema,ascites----CT:ImportantAcutepancreatitis•CTisthebestdiagnostictestforthediagnosisofacutepancreatitis.•Contrast-enhancedCTisexcellentfordiagnosisofpancreaticnecrosis有力武器AcutepancreatitisAsse