胰腺疾病外科教学课件

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1、DiseasesofpancreasDAIChao-Liu2ndclinicalcollegeofChinaMedicalUniversityAcutepancreatitisAnatomyHead,neck.body,tail,uncinateprocess,Mainpancreaticduct(ductofWirsung)Dorsalpancreaticduct(ductofSantorini)PancreaticexcretionExocrine(extrasecretion)Endocrine（internalsecretion):B,A,D,GcellcCau

2、sesGallstones:60%(35–50%inUSA)Alcohol:!4%Drug:Azathioprine.6-Mercaptopurine------Pancreasdivisum(胰腺分裂;胰分裂)MicrolithiasisMetaboliccauseSphincterofOddidysfunctionInfectiouscausesTrauma,ascarisworms,HIV-----MiscellaneousAcutepancreatitisPathologyacuteedematouspancreatitisacutehemorrhagicnec

3、rotizingpancreatitis(acutehemorrhagicpancreatitis,acutenecrotizingpancreatitis)AcutepancreatitisPathophysiologyHypersecretionandobstructionSelf-enzymaticdigestionoLymphaticobstructionCytokine，infectionDecreasedarterialperfusionEdematoushemorrhagicnecrotizingAcutepancreatitisClinicalfindi

4、ngAbdominalpainAbdominaldistentionNauseaandvomitingRespiratoryfailure,confusion,orcoma.Low-gradetomoderatefeverTachycardiaandhypotensionMildjaundice,Pleuraleffusion.ShockAcutepancreatitisAcutepancreatitisPeritonealirritationsign（Abdominaltenderness，reboundtendernessandrigidity）Shiftingdu

5、llnessDecreasedbowelsoundsCullen’sign:discolorationofperiumbilicalareaGreyTurner’sign:discolorationofflanksLaboratoryfindingAmylaseandlipase(elevationsofamylasearemoresensitivebutlessspecificthanlipaseinthediagnosisofacutepancreatitis)500400300200100001H24H48H5DAYAcutepancreatitisBloodam

6、ylaseUrineamylaseAcutepancreatitisSerumcalciumSerumglucoseBloodgasanalysisCRP(C-reactiveprotein)Imunolipase,trypsinogen,andimmunoelastase.ALTandAST(gallstonepancreatitis)ImagingfindingX-rayDilatedloopofsmallbowel(sentinelloop)Abruptcessationofgasinthedistaltransversecolon(coloncutoffsign

7、)Radioopaquedensities(biliarycalculi)Left-sidedpleuraleffusionB-US:pancreaticedema,ascites----CT:ImportantAcutepancreatitis•CTisthebestdiagnostictestforthediagnosisofacutepancreatitis.•Contrast-enhancedCTisexcellentfordiagnosisofpancreaticnecrosis有力武器AcutepancreatitisAsse