胰腺疾病(英文)课件课件
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癌症英文版ppt课件
An adult human body has about 30 trillion cells — 30,000,000,000,00 0!
WHY CANCER IS DANGEROUS?
HOW DOCTORS TREAT CANCER?
The best weapon
to detect it early before spread
癌症英文版
Cancer — a scary word, a scary disease, a callous killer
马三立 （膀胱癌）
陈晓旭 （ breast cancer ）
李钰 （淋巴癌）
Patrick Swayze （胰腺癌）
luciano Pavarotti （胰腺癌）
good news：
•Millions of people with cancer still alive •Technology for cancer treating
Kylie Ann Minogue (breast cancer)
WHAT ISa single disease •includes more than 100 different diseases
WAYS TO PREVENT CANCER?
Don’t smoke! Keep healthy diet. Avoid too much sun.
Getting plenty of sleep and exercise and eating the right foods can help keep you healthy.
•Removed by surgery •Radiation, such as X rays
内科学 胰腺疾病(英文) ppt课件
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The pancreas is routinely divided into the head, the neck,the body and the tail. The pancreas is almost enteraly retroperitoneal and has close relationship with numerous surrounding structures
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3.Etiology
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4. Clinical presentation Most prevalent symptoms: Abdominal pain,nausea,and vomiting Tachycardia and hypotension Low grade fever Jaundice
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(2)Endocrine function Insulin Other: Neuropeptide(VIP, Glucagon galanin, serotonin, Somatastatine amylin ) Pancreatic polypeptide
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Acute pancreatitis
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Infected necrosis
FNA(CT guide) for diagnosis(95%) Surgical intervention (debrided and drainage) Necrosectomy with lavage Prophylactic antibiotics
The pancreas is routinely divided into the head, the neck,the body and the tail. The pancreas is almost enteraly retroperitoneal and has close relationship with numerous surrounding structures
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3.Etiology
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25
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4. Clinical presentation Most prevalent symptoms: Abdominal pain,nausea,and vomiting Tachycardia and hypotension Low grade fever Jaundice
ppt课件
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(2)Endocrine function Insulin Other: Neuropeptide(VIP, Glucagon galanin, serotonin, Somatastatine amylin ) Pancreatic polypeptide
ppt课件
16
Acute pancreatitis
ppt课件
40
Infected necrosis
FNA(CT guide) for diagnosis(95%) Surgical intervention (debrided and drainage) Necrosectomy with lavage Prophylactic antibiotics
胰腺疾病(英文)课件
Routine check-ups can help detect pancreatic diseases in the early stages, allowing for early treatment and better prognosis.
Monitoring changes
Regular follow-up exams can help monitor the progress of pancreatic diseases and adjust treatment plans accordingly.
acute pancreatitis
急性胰腺炎是一种突发的、严重 的胰腺炎症，通常由过量饮酒、 暴饮暴食、胆结石或其他因素引
起。
主要症状包括上腹部剧痛、恶心 、呕吐、发热和黄疸。
严重病例可能导致多器官功能衰 竭和死亡。
chronic pancreatitis
慢性胰腺炎是一种长期慢性的 胰腺炎症，通常由急性胰腺炎 反复发作或长期饮酒引起。
REPORT
CATALOG
DATE
ANALYSIS
SUMMAR Y
01
Байду номын сангаасThe anatomy and physiology of the pancreas
The anatomical structure of the pancreas
The pancreas is a long, narrow organ that lies across the back of the abdominal cavity, behind the
REPORT
CATALOG
DATE
ANALYSIS
SUMMAR Y
Monitoring changes
Regular follow-up exams can help monitor the progress of pancreatic diseases and adjust treatment plans accordingly.
acute pancreatitis
急性胰腺炎是一种突发的、严重 的胰腺炎症，通常由过量饮酒、 暴饮暴食、胆结石或其他因素引
起。
主要症状包括上腹部剧痛、恶心 、呕吐、发热和黄疸。
严重病例可能导致多器官功能衰 竭和死亡。
chronic pancreatitis
慢性胰腺炎是一种长期慢性的 胰腺炎症，通常由急性胰腺炎 反复发作或长期饮酒引起。
REPORT
CATALOG
DATE
ANALYSIS
SUMMAR Y
01
Байду номын сангаасThe anatomy and physiology of the pancreas
The anatomical structure of the pancreas
The pancreas is a long, narrow organ that lies across the back of the abdominal cavity, behind the
REPORT
CATALOG
DATE
ANALYSIS
SUMMAR Y
急性胰腺炎护理查房PPT课件
XXX
新农 合
女 64y
XXX
2床
.
病例汇报- 患者8.27日无明显诱因下出现 右侧腰部及上腹
部腹胀 痛痛无，缓伴解恶，心无呕胸吐闷，心呕悸患吐，物无者为腹病宿胀食腹程，泻呕，C吐腹后部ourse of disease
CT示“急性胰腺炎”，腹部彩超示 “胆囊炎，胆囊 肿大，胰腺体积增大，胰管轻度扩张，就诊于 繁昌县人民医院，予对症治疗后，症状无缓 解，23：20分转入我院行进一步治疗，T： 37.0℃ P：90次/分R：患20者次神/分清B，P精：神14欠0/1佳0，0m绝m对H卧g 床休 视觉模拟疼痛评息分，4分仍，有带明入显胃腹肠胀减腹压痛管，一无根恶。心呕 高血压病史两年吐，，口胃服肠硝减苯压地管平通缓畅释在片位Bi，d，引四流出少 个食染月 、 、前胃补行肠液膝减、关压扩节、容量侧便手抑等黄腰未术制处色部解，胰理液压，其液。体痛小余分，（便患3无泌9腹＋正者.特、0部）常℃仍殊护触反。。有。胃诊跳腹予、患钾，痛部以抗者处左（不禁感血理上＋适钾。腹），置肠2及，并入内.9右大且4鼻营m发空养m烧肠。o患l高甩/营L者，达下养腹予降管胀补，，有患体但行好者温仍早转腹下有期，胀降低体较至热温前正。有缓常解，，腹
—
94.7
98 98.6
—
—
—
—
—
—
6.3
—
—
—
—
—
292.71 — 198.86 —
.
病史汇报-生化检查 Biochemical test
25 20 15 10
5 0
8.28
白细胞
8.29
9.1
白细胞 低值
9.3 高值
.
9.5 中性粒细胞
急性胰腺炎英文版-PPT课件
There has been an increase in the incidence of acute pancreatitis reported worldwide.Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with signifcant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis,recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the gall stone–induced pancreatitis.
急性胰腺炎-最新ppt课件
1、局部并发症: 包括急 性液体积聚、急性坏死 物积聚、胰腺假性囊肿、 胰腺脓肿等 2、全身并发症: 器官功 能衰竭、SIRS、腹腔间 隔室综合征(ACS)、胰性 脑病(PE)。
SAP的特征性体征
Grey-Turner 征
Cullen 征
AP局部并发症
❖ 急性液体积聚 ❖ 胰瘘 （胰腺假性囊肿） ❖ 胸腔积液 ❖ 急性坏死物积聚 ❖ 包裹性坏死 ❖ 胰腺脓肿 ❖ 胃流出道梗阻 ❖ 消化道瘘 ❖ 腹腔出血 ❖ 假性囊肿出血 ❖ 脾静脉或门静脉血栓形成 ❖ 坏死性结肠炎
部分疾病与胰腺分裂有关
急性胰腺炎的发病机制
胰酶自身消化学说
病因 胰蛋白酶激活
胰酶活化释放
淀
粉 酶
舒
缓 素
弹力 蛋白 卵磷脂
酶
磷脂酶A
溶血 卵磷脂
脂 肪 酶
血 血管损害 尿
酶 出血、扩张
增 加
休克、疼痛
胰腺坏死 脂
溶血
肪
坏
腹膜炎 死
多脏器损害
炎症因子和细胞因子学说
腺泡细胞损伤
巨噬细胞、中性 粒细胞激活、迁 移入组织
异常的原因：病理生理变化
炎症或感染 炎症
胰岛素释放减少、胰高血糖素增加、胰腺坏死 胆道梗阻、肝损伤
大量炎性渗出、肝损伤 休克、肾功能不全 成人呼吸窘迫综合征
Ca2+内流入腺泡细胞，胰腺坏死 既是SAP的病因，也可能是后果
肾功能受损、内环境紊乱
反映AP预后不良指标
❖ 72h后的CRP＞150 mg /L ：胰腺组织坏死 ❖ 红细胞压积（HCT）＞44%：胰腺坏死 ❖ 动态测定血清白细胞介素6（IL－6）水平增高提示预后不
胰腺肿大
胰周渗出
胰腺炎PPT课件
少尿、无尿 黄疸加深 上消化道出血 意识障碍，精神异常 体温持续升高或不降 猝死
大量炎性渗出、严重炎症反应及 感染
肠麻痹、腹膜炎、腹腔间隔室 综合征、胰腺出血坏死
肺间质水肿、成人呼吸窘迫综合 征、胸水、严重肠麻痹及腹膜炎 休克、肾功能不全 胆总管下端梗阻、肝损伤 应激性溃疡 胰性脑病 严重炎症反应及感染 严重心律失常
胰腺炎
病因三
胰腺炎
病因四 十二指肠降段疾病
如球后穿透溃疡、临近十二 指肠乳头的憩室炎等可直接波及 胰腺。
胰腺炎
病因五 手术与创伤
腹腔手术特别是胰胆或胃手术、腹部钝挫伤等可 损伤胰腺组织，导致胰腺严重血液循环障碍，均可引 起急性胰腺炎。内镜逆行胰胆管造影术（ERCP）插 管时导致的十二指肠乳头水肿或注射造影剂压力过高 等，也可引发本病。
胰腺炎
临床表现 中度重症急性胰腺炎
临床表现介于轻症与重症之间，在常规治疗基础 上，器官衰竭多在48小时内恢复，恢复期出现胰瘘或 胰周脓肿等局部并发症。
胰腺炎
临床表现
表4-18-1 重症急性胰腺炎的症状、体征及相应的病理生理改变
症状及体征
病理生理改变
低血压、休克 全腹膨隆、张力较高，广泛压痛及 反跳痛，移动性浊音阳性，肠鸣音 少而弱，甚至消失；少数患者可有 Grey-Turner征，Cullen征 呼吸困难
胰腺炎
病因九 其他
急性胰腺炎常见病因分别为：胆源性、酗酒及高脂血 症。而最近的研究显示，近五年来（2010-2015）我 国急性胰腺炎的病因占比，高脂血症（18.2%）已超 过酗酒（13.5%）位居第二，这与国人膳食结构改变 关系重大（1）。
胰腺炎
1.急性水肿型：
病理
较多见，病变可累及
大量炎性渗出、严重炎症反应及 感染
肠麻痹、腹膜炎、腹腔间隔室 综合征、胰腺出血坏死
肺间质水肿、成人呼吸窘迫综合 征、胸水、严重肠麻痹及腹膜炎 休克、肾功能不全 胆总管下端梗阻、肝损伤 应激性溃疡 胰性脑病 严重炎症反应及感染 严重心律失常
胰腺炎
病因三
胰腺炎
病因四 十二指肠降段疾病
如球后穿透溃疡、临近十二 指肠乳头的憩室炎等可直接波及 胰腺。
胰腺炎
病因五 手术与创伤
腹腔手术特别是胰胆或胃手术、腹部钝挫伤等可 损伤胰腺组织，导致胰腺严重血液循环障碍，均可引 起急性胰腺炎。内镜逆行胰胆管造影术（ERCP）插 管时导致的十二指肠乳头水肿或注射造影剂压力过高 等，也可引发本病。
胰腺炎
临床表现 中度重症急性胰腺炎
临床表现介于轻症与重症之间，在常规治疗基础 上，器官衰竭多在48小时内恢复，恢复期出现胰瘘或 胰周脓肿等局部并发症。
胰腺炎
临床表现
表4-18-1 重症急性胰腺炎的症状、体征及相应的病理生理改变
症状及体征
病理生理改变
低血压、休克 全腹膨隆、张力较高，广泛压痛及 反跳痛，移动性浊音阳性，肠鸣音 少而弱，甚至消失；少数患者可有 Grey-Turner征，Cullen征 呼吸困难
胰腺炎
病因九 其他
急性胰腺炎常见病因分别为：胆源性、酗酒及高脂血 症。而最近的研究显示，近五年来（2010-2015）我 国急性胰腺炎的病因占比，高脂血症（18.2%）已超 过酗酒（13.5%）位居第二，这与国人膳食结构改变 关系重大（1）。
胰腺炎
1.急性水肿型：
病理
较多见，病变可累及
胰腺疾病英文课件
Etiology
• • • • Gallstones Sustained alcohol Other In china : biliary tract disease
distal common bile duct stone
stenosis of the papilla of Vater ascarid in biliary duct
• head neck body tail • uncinate process SMV • pancreatic duct
wirsung duct accessory pancreatic duct santorini duct
Arteries
• head & neck
celiac axis, superior mesenteric artery GDA superior & inferior pancreaticoduodenal A superior & inferior pancreatic arteries
• body & tail
splenic & left gastroepiploic arteries
Veins
• • • Superior mesenteric vein Splenic vein Portal vein
Lymph & Nerve
• lymph SPD IPD head SP splenic hilum IP SMA nodes celiac axis nodes tail splenic nodes sympathetic & parasympathetic
islets of Langerhans
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Drug: Azathioprine(硫唑嘌呤) .6-Mercaptopurine(6-巯基嘌呤), Pancreas divisum(胰分裂), Microlithiasis Metabolic cause Infectious causes, ascaris worms蛔虫,HIV----Miscellaneous
area • Grey Turner’ sign:discoloration of flanks
急性胰腺炎
• Laboratory finding
• Amylase and lipase (elevations of amylase are
more sensitive but less specific than lipase in the diagnosis of acute pancreatitis )
急性胰腺炎
• Assessment of severity of acute pancreatitis
Ranson's criteria
On Admission
Age > 55 years WBC > 16,000 /mm³ LDH > 350 IU/L Glucose >11.1mmol/l AST > 250 IU/L
• Gallstones:60%( 35–50% in USA) • Alcohol:14% %(60% in USA) • Duodenal juice countercurrent flow: Sphincter of Oddi
dysfunction • Trauma • Pancreas circulation disorder • Other factors:
急性胰腺炎
• Glasgow Criteria
• Within 48 Hours
• Age &gmm³
• 500 • 400
Urine amylase
• 300 • 200
Blood amylase
• 100
•0
• 0 1H 24H
48H
5DAY
急性胰腺炎
• Serum calcium • Serum glucose • Blood gas analysis • Imunolipase • ALT and AST (gallstone pancreatitis )
急性胰腺炎
• Imaging finding • X-ray • Dilated loop of small bowel (sentinel loop)
• Abrupt cessation of gas in the distal transverse colon (colon cutoff sign)
急性胰腺炎
• Peritoneal irritation sign （Abdominal tenderness， rebound tenderness and rigidity）
• Shifting dullness • Decreased bowel sounds • Cullen’ sign: discoloration of periumbilical
急性胰腺炎
• Pathology • acute edematous
pancreatitis • acute hemorrhagic
necrotizing pancreatitis (acute hemorrhagic pancreatitis, acute necrotizing pancreatitis)
胰腺疾病(英文)课件课件
解剖生理概要
• 解剖
• 头，颈，体，尾，钩突。 • 主胰管 (duct of Wirsung) • 副胰管 (duct of Santorini)
• 胰腺分泌 • 外分泌Exocrine • 内分泌Endocrine
B,A,D,D1,G cell
急性胰c 腺炎
• Causes
• Radioopaque densities (biliary calculi)
• Left-sided pleural effusion • B-US: pancreatic edema, ascites---• CT: Important
•CT is the best diagnostic test for the diagnosis of acute pancreatitis. •Contrast-enhanced CT is excellent for diagnosis of pancreatic necrosis
Within 48 Hours
Hematocrit decrease by >10% Urea nitrogen increase > 5 mg/dl Serum calcium < 1.87 mmol/l Arterial PO²< 8KPa(60 mm Hg) Base deficit > 4 mEq/L Estimated fluid sequestration > 6 L
Edematous
hemorrhagic necrotizing
急性胰腺炎
• Clinical finding • Abdominal pain • Abdominal distention • Nausea and vomiting • Peritonitis • Other:
Respiratory failure, confusion, or coma. Low-grade to moderate fever Tachycardia and hypotension and Shock Mild jaundice, Pleural effusion.
急性胰腺炎
• Pathophysiology • Hypersecretion and obstruction
Self-enzymatic digestion
Enhancement of Vessel permibility Cytokine，infection Decreased arterial perfusion
area • Grey Turner’ sign:discoloration of flanks
急性胰腺炎
• Laboratory finding
• Amylase and lipase (elevations of amylase are
more sensitive but less specific than lipase in the diagnosis of acute pancreatitis )
急性胰腺炎
• Assessment of severity of acute pancreatitis
Ranson's criteria
On Admission
Age > 55 years WBC > 16,000 /mm³ LDH > 350 IU/L Glucose >11.1mmol/l AST > 250 IU/L
• Gallstones:60%( 35–50% in USA) • Alcohol:14% %(60% in USA) • Duodenal juice countercurrent flow: Sphincter of Oddi
dysfunction • Trauma • Pancreas circulation disorder • Other factors:
急性胰腺炎
• Glasgow Criteria
• Within 48 Hours
• Age &gmm³
• 500 • 400
Urine amylase
• 300 • 200
Blood amylase
• 100
•0
• 0 1H 24H
48H
5DAY
急性胰腺炎
• Serum calcium • Serum glucose • Blood gas analysis • Imunolipase • ALT and AST (gallstone pancreatitis )
急性胰腺炎
• Imaging finding • X-ray • Dilated loop of small bowel (sentinel loop)
• Abrupt cessation of gas in the distal transverse colon (colon cutoff sign)
急性胰腺炎
• Peritoneal irritation sign （Abdominal tenderness， rebound tenderness and rigidity）
• Shifting dullness • Decreased bowel sounds • Cullen’ sign: discoloration of periumbilical
急性胰腺炎
• Pathology • acute edematous
pancreatitis • acute hemorrhagic
necrotizing pancreatitis (acute hemorrhagic pancreatitis, acute necrotizing pancreatitis)
胰腺疾病(英文)课件课件
解剖生理概要
• 解剖
• 头，颈，体，尾，钩突。 • 主胰管 (duct of Wirsung) • 副胰管 (duct of Santorini)
• 胰腺分泌 • 外分泌Exocrine • 内分泌Endocrine
B,A,D,D1,G cell
急性胰c 腺炎
• Causes
• Radioopaque densities (biliary calculi)
• Left-sided pleural effusion • B-US: pancreatic edema, ascites---• CT: Important
•CT is the best diagnostic test for the diagnosis of acute pancreatitis. •Contrast-enhanced CT is excellent for diagnosis of pancreatic necrosis
Within 48 Hours
Hematocrit decrease by >10% Urea nitrogen increase > 5 mg/dl Serum calcium < 1.87 mmol/l Arterial PO²< 8KPa(60 mm Hg) Base deficit > 4 mEq/L Estimated fluid sequestration > 6 L
Edematous
hemorrhagic necrotizing
急性胰腺炎
• Clinical finding • Abdominal pain • Abdominal distention • Nausea and vomiting • Peritonitis • Other:
Respiratory failure, confusion, or coma. Low-grade to moderate fever Tachycardia and hypotension and Shock Mild jaundice, Pleural effusion.
急性胰腺炎
• Pathophysiology • Hypersecretion and obstruction
Self-enzymatic digestion
Enhancement of Vessel permibility Cytokine，infection Decreased arterial perfusion