精品PPT课件 浏览免费 下载后可以编辑修改。 http:/www.docin.com/jn-lxh http:/www.doc88.com/lianer2012 http:/www.baidu.com/ http:/www.google.com/ http:/ www.sogou.com /Pancreas 胰腺疾病 Department of Surgery Ma Qingyong Anatomy The pancreas lies within the retroperitoneum in the upper abdomen, lying in front of the second lumber vertebra and ending in the splenic hilum. The gland can be divided into four portions- head, neck, body, and tail. uncinate process AnatomyThe main pancreatic duct (the duct of Wirsung, 23 mm in diameter) courses along the gland from the tail to the head and joins the common bile duct just before entering the duodenum at the ampulla of Vater (85%). The accessory pancreatic duct (the duct of Santorini) enters the duodenum 22.5 cm proximal to the Vater. the duct of WirsungSantoriniampulla of Vateruncinate process AnatomyBlood supply The superior pancreaticoduodenal artery arises from the gastroduedenal artery, runs parallel to the duodenum, and eventually meets the inferior pancreaticoduodenal artery, a branch of the superior mesenteric artery, to form an arcade. The splenic artery provides tributaries that supply the body and tail of the pancreas. pancreatic magna Asuperior mesenteric arterysplenic arteryarcadesuperior pancreaticoduodenal arteryinferior pancreaticoduodenal arterydorsal pancreatic Apancreatic magna Asuperior mesenteric VPhysiologyExocrine Function The external secretion consists of a clear, alkaline (pH 7.08.3) solution of 7501000 ml/d containing digestive enzymes. Secretion is stimulated by the hormones secretin and cholecystokinin (CCK) and by parasympathetic vagal discharge. Secretin and CCK are synthesized, store, and released from duodenal mucosal cells in response to specific stimuli. Acid in the lumen of the duodenum causes the release of secretin, and luminal digestion products of fat and protein cause the release of CCK.PhysiologyExocrine Function enzymes synthesized, stored (as zymogen granules), and released by the acinar cells of the gland, in response to CCK and vagal stinulation. Pancreatic enzymes are proteolytic, lipolytic, and emylolytic. Lipase and amylase are stored and secreted in active forms. The prolytic enzymes are secreted as inactive precursors and activated by the duodenal enzyme enterokinase. Other enzymes include ribonucleases and phospholipase A. PhysiologyEndocrine FunctionInsulin (51 amino acid residues, formed in the beta cells via the precursor proinsulin) glucagons (29 amino acids, formed in the cells)pancreatic polypeptide and somatostatin are produced by the islets of Langerhans. Acute Pancreatitis急性胰腺炎 Acute pancreatitis is one of following five acute abdomen Acute pancreatitis, Acute appendicitis, Intestinal obstruction, Performed gatroduodenal ulcer Cholecystitis or cholelithiasis). Etiology Most cases of pancreatitis are caused by gallstone disease or alcoholism; a few result from hypercalcemia, trauma, hyperlipidemia, and genetic predisposition; and the remainder are idiopathic.EtiologyBiliary pancreatitis: About 4060% of cases of pancreatitis are associated with gallstone disease, which, if untreated, usually gives rise to additional acute attacks. Bile refluxpancreatic ductactivate enzymes. Obstruction increased duct pressure damage pancreatic acinus distroy gland. EtiologyAlcoholic Pancreatitis: Alcohol stimulates gastric acid secretion which increases CCK-PZ (cholecystokin and pancreozymin) excretion in duodenum and then increases pancreatic secretion. Make the sphincter spasm and edema Increase duct pressure. Direct toxic to pancreas EtiologyInfection: e.g. hepatitis virus, parotitis virus and typhoid bacillus.Trauma and operation, endoscopy (iatrogenic Pancreatitis): following common bile duct exploration, especially if sphincterotomy was performed. 1). Use of a common duct T tube with a long arm passing through of sphincter of Oddi, 2). Dilation of the sphincter to 57 mm during common duct exploration. EtiologyHypercalcemia: hyperparahtyroidism and other disorders accompanied by hypercalcemia are occasionally complicated by acute pancreatitis, it is thought that the increased calcium concentrations in pancreatic juice that result from hypercalcemia may prematurely activate proteases, they may also facilitate precipitation of calculi in the duct. EtiologyHyperlipidemia: pancreatitis seems to be a direct consequence of the metabolic abnormality. during an acute attack usually associated with mormal serum amylase levels, because the lipid interferes with the chemical determination for amylase; urinary output of amylase may still be high. EtiologyDrug-induced pancreatitis: corticosteroids, estrogen-containing contraceptives, azathioprine, thiazide diuretics, and tetracyclines. Pancreatitis associated with use of estrogens is usually the result of drug-induced hypertriglyceridemia. Etiology Idiopathic pancreatit