胆道胰腺疾病介绍课件.pptVIP

胆胰恶性肿瘤与黄疸;胆胰恶性疾病——keypoint;关于胆胰恶性疾病;胆胰恶性疾病的诊断思路;胆胰恶性疾病的诊断思路;

;

;ClinicalClassificationofHyperbilirubinemia;PredominantUnconjugatedHyperbilirubinemia;3.Decreasedconjugation:duetodefect

orabsenceofUDP-glucuronyltransferase

orothercauses

?Neonataljaundice

?Hepatocellulardisease:e.g.,post-hepatitic

hyperbilirubinemia

?Drugs:chloramphenicol,etc.

?Crigller-Najjarsyndrome,Gilbertsyndrome;1.Intrahepaticcholestasis

?Cholestatichepatitis:viral,alcoholic,auto-

immunehepatitis

?Drug-induced:androgens,estrogens,cyclo-

sporins,thiouracils,phenothiazines,captopril

?Pregnancy

?SepsiswithGramnegativeorganisms

?Primarybiliarycirrhosis(PBC)

?Inheritary:Dubin-Johnson,Rotorsyndromes

;2.Extrahepaticbiliaryobstruction

?Gallstones

?Tumors:pancreatic,bileduct,ampulaof

Vater

?Bileductcompression:chronicpancreatitis,

lymphnodes

?Post-operativebiliarystricture

?Primarysclerosingcholangitis(PSC)

?Congenitalbiliaryatresia;Duetohepatocellulardiseaseordamage

?Hepatitis:viral,alcoholic,autoimmune

?Cirrhosis,Wilson’sdisease

?Sepsis

?Congestiveheartfailure,Budd-Chiari

syndrome

?Drug-inducedhepaticinjury:alcohol,

rifampin,cimetidine,sulfonamide,

colchicine,verapramil,etc.;Decreasedbileacidexcretion

?Pruritus

??Absorptionoffatfat-solublevitamins

?Coagulopathy:duetoVitKdeficiency

??Calciumabsorptionandosteoporosis

Hypercholesterolemia,xanthoma

Increasedsynthesisandsecretionofcanalicularenzymes:ALP,GGT;Renalfailure

Pigmentgallstones

Increasedpostoperativemortalityandmorbidity

Kernicterusininfants

Decreasedcardiovascularresponsetovasopressors

;Distinguishbetweenhepatocellularandcholestaticjaundice

HepatocellularDis.Cholestasis

Bilirubin