胰腺疾病 中山大学 内科学课件.pptVIP

PANCREAS The chapter includes: Summary of anatomy physiology Acute pancreatitis Chronic pancreatitis Pancreatic cyst Pancreatic cancer / Periampullary carcinoma Pancreatic endocrine tumors Location region Anatomy physiology Blood supply Venous lymph drainage Lymph drainage by multiple node groups, mainly celiac nodes sup. mesenteric nodes Ducts:the duct of Wirsung/ main ductthe duct of Santorini/ accessory duct Physiology exocrine pancreas: pancreatic juice, 750-1500ml/d --- bicarbonate digestive enzymes/proenzymes endocrine pancreas: 1.7-2.0 millions of islets --- 4 major cell types some minor types A cells – glucagons B cells – insulin D cells – somatostatin PP cells – pancreatic polypeptide G cells – gastrin D1 – vasoactive intestinal polypeptide Acute pancraetitis Causes Biliary tract stones Ethanol abuse Hyperlipidemia Dietary factors Trauma, Surgery, ERCP Infection Drugs: thiazide diuretics, oral contraceptives Metabolic abnormalities Biliary tract stones Bile reflux theory --- Common channel theory Ethanol abuse Increasing ductal pressure Increasing pancreatic enzyme secretion Direct injury to pancreatic acinar cells SIRS systemic inflammatory response syndrome MODS multiple organ dysfunction syndrome Presentation acute abdominal pain nausea, vomiting abdominal distension / abdominal compartment syndrome (ACS) fever / hyperthermia jaundice shock, MODS Presentation Grey Turner sign – flank bluish ecchymoses Cullen sign – umbilical bluish ecchymoses ARDS acute respiratory distress syndrome SIRS systemic inflammatory response syndrome MODS multiple organ dysfunction syndrome Laboratory Serum amylase and lipase levels Serum calcium blood glucose arterial blood gas white blood cell count Imaging studies Chest/abdominal radiographs Ultrasound CT MRI MRCP Admission Age 55 yr WBC16000/mm3 Glucose 200 mg/dL LDH350 IU/L AST250 IU/L Initial 48 hrs Hct fall 10% BUN elevat