_pancreatitis慢性胰腺炎课件

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1、CHRONICPANCREATITISA49-year-oldmanwasadmittedwithanine-monthhistoryofintermittentattacksofepigastricpain,jaundiceandfever.Theseattacksusuallylastuptoseveraldaysassociatedwithnauseaandvomiting.HewaswellinbetweenattacksandhadnolossofweightWhatisyournextstep?LabResultsAP=1017GGT=269AST=

2、103ALT=186TB=2(DB=1.1)Alb=3.2Lipase=33(upto244duringattacks)Amylase=44Hb=12WBC=5.7Plts=223Na=141K=4.2Ur=15Cr=0.9Ca=8.9FBS:178Whatarearrows?PancreaticcalcificationTransabdominalUS:NogallstonesormassinheadofpancreasCTscan:Theextrahepaticbileductwasmildlydilatedand"generouspancreas"was

3、notedbuttherewasnomass.EndoscopicUltrasoundDiffusehypoechoicenlargementofpancreas.Fineneedleaspirateofthepancreaswasnegativefortumor.ERCPTherewasalongsegmentofextrahepaticbiliarystricture.Thepancreaticductwasnormalinsizebutirregular.Brushings,biopsiesandbileaspiratewerenegativefortum

4、orThepatientunderwentWhipple'soperationHistologyofthepancreasshowedchronicpancreatitis,nomalignancyTwopresentation:EpisodesofacuteinflammationinapreviouslyinjuredpancreasChronicdamagewithpersistentpainormalabsorptionEtiology:sameasacutepancreatitis“pancreatitisassociatedwithgallst

5、onespredaminantlyacuteorrelapsing-acute”MoreidiopathictypesMostcommoncause:Inadults:alcoholintakeInchildren:cysticfibrosisIdiopathicchronicpancreatitisistheleadingcauseofnonalcoholicchronicpancreatitisPATHOPHYSIOLOGYTheeventsthatinitiateaninflamatoryprocessarestillnotwellunderstoodIn

6、thealcohol-induced:suggestedthattheprimarydefectmaybetheprecipitationofprotein(inspissatedenzyme)Infact,shownthatalcoholhasdirecttoxiceffectonthepancreasClinicalfeaturesabdominalpain:maybecontinuous,intermittentorabsentPatternisoftenatypicalRUQorLUQofthebackDiffusethroughoutupperabdo

7、menMaybereferredtotheanteriorchestorflankTypicalform:Persistent,deep-seated,UnresponsivetoantacidsWorsenedbyalcoholintakeoraheavymeal(especiallyfattyfoods)OftenneednarcoticsPancreaticinsufficiencyWeightlossFatmalabsorption:Steatorrhea:15%ofpatientspresentwithsteatorrheaandnopainPancr

8、eaticdiabete