胰腺疾病的诊治.pptVIP

APPROACH TO THE PATIENT WITH PANCREATIC DISEASE  ?GENERAL CONSIDERATIONS ?Inflammatory disease of pancreas: acute/ chronic. acute pancreatitis: frequency: 5000/new cases/yr [USA] mortality rate: 10 % recurrent acute pancreatitis or chronic pancreatitis: Incidence: 8.2 new cases /100,000/year prevalence: 26.4 cases/100,000. prevalence of chronic pancreatitis (autopsy): 0.04 ~ 5 %. Problems in Dx of Pancreatic Disease relative inaccessibility to direct examination and nonspecificity of the abdominal pain usually dependent on elevation of blood [amylase]. Many patients with chronic pancreatitis do not have elevated blood amylase levels. subclinical exocrine dysfunction ( 90 % loss). objective evidence: Some chronic pancreatitis develop ss of pancreatic exocrine insufficiency maldigestion of fat, protein: 90 % of pancreas be damaged. secretin stimulation test (the most sensitive method of assessing pancreatic exocrine function): 60 % of exocrine function lost. Noninvasive, indirect tests (bentiromide, trypsinogen): in obvious (calcification, steatorrhea, DM) than occult disease. clinical manifestations clinical manifestations: Protean hypertriglyceridemia, vit-B12 malabsorption, hypercalcemia, hypocalcemia, hyperglycemia, ascites, pleural effusions, and chronic abdominal pain with normal blood [amylase]. if considers pancreatitis only classic symptoms (i.e., severe, constant epigastric pain that radiates through to the back, along with an elevated blood amylase level): only a minority of patients will be diagnosed correctly. Etiologies: quite varied. frequently secondary to alcohol abuse and biliary tract disease drugs, trauma, virus, metabolic connective tissue disorders. Idiopathic pancreatitis : 30 % (acute), 25 ~ 40 % (chronic) TESTS IN THE DIAGNOSIS OF PANCREATIC DISEASE pancreatic function tests are performed if the diagnosis of pancreatic disease remains a possibility after noninvasive tests [US, CT] and invasive tests [ERCP] have given no