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4--inh exocrine 5--counterregulate insulin 6--dec insulin/somato/exocrine, inc glucagon 7--dec insulin *normal pancreas 20% = can survive Heterotopic pancreas -abnormal location of pancreatic tissue -exocrine+endocrine -stomach/duodenum/meckel -submucosal lesion, yellow, central umbilical -Sx in symptom/incidental finding Annular pancreas -congenital anomaly -band of ventral pancreas -duodenal obstruction - infant 40yr -1st choiceduodenoduodenostomy -not reect bandpancreatic fistula
2.biochemical marker Assess severity--mild or severe -CRP -uri trypsinogen activate peptide--TAP 3.CT -gold std for assess severity CT severity index Barthaza A=normal B=pancreatic enlarge C=pancreatic inflammation D=1 collection E=>=2 collection Necrosis No <30% 30-50% >50% CTSI 0-3 4-6 7-10 c/p 8% 35% 92% mortality 3% 6% 27%
point 0 1 2 3 4 0 2 4 6
Sterile necrosis 3 degree aggressive 1.no systemic c/p -as mild pancreatitis 2.systemic c/p, suspect infection -FNA confirm 3.very ill, hi APACHE/Ranson -aggressive debridement Pancreatic abscess -2-6 wk -external drainage Biliary pancreatitis 1.Urgent intervention -48-72hr 2.Delayed intervention ->72hr, but in hospitalization favor 1 as 2 cholecystectomy + CBD clearance (in obstructive pancreatitis) hi risk--ERCP 3.obstruction persist>24hr -emer ERCP+EST+remove stone routine ERCP--not use suspect persist CBD stone--imaging
-without LPJ
4.denervation procedure -symptomatic relies -poor candidate for resect/drainage -Neurolytic tx--neural ablation -Direct infiltraton of celiac GG -Operative celiac gangliectomy -Transhiatal splanchniectomy -Transthorasic splanchniectomy -Videoscopic transthorasicsplanchniectomy