pancreatitis
Introduction
Introduction to pancreatic stone disease Pancreatic stone disease is also called pancreatic stone. In recent years, due to the increasing incidence of chronic pancreatitis and the increase of various imaging methods, the rate of examination of pancreatic stones has also increased. Domestic and foreign reports of pancreatic stone disease have been detected. The rate is different. The etiology of pancreatic stones has not been fully understood so far. The results of a large number of data show that pancreatic stone disease is related to drinking, and that drinking time is long and the amount is large, which is easy to form pancreatic stones. The age of onset is 30-50 years old. The average daily drinking amount is 100g, and the fat intake is 90g. In addition, pancreatic stone disease has been reported in relation to family history. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: Diabetes Pancreatic cancer Cardiomyopathy Obstructive arteriosclerosis Retinopathy Peptic ulcer Portal hypertension
Cause
Cause of pancreatic stone disease
The etiology of pancreatic stones has not been fully understood so far. The results of a large number of data show that pancreatic stone disease is related to drinking, long-term drinking time, and large cases are easy to form pancreatic stones. The age of onset is 30-50 years old. The average daily drinking amount is 100g, and the fat intake is 90g. This village reported 45 cases of pancreatic stones, of which 43 cases have been drinking for more than 10 years. In addition, pancreatic stone disease has been reported in family history. Japan has reported more than 10 families suffering from this disease, others such as biliary tract disease, hyperparathyroidism, and related to it, long-term lack of protein can also cause cell degeneration of the pancreas, fibrosis and similar changes with pancreatic stone disease.
Long-term alcoholism increases the concentration of protein in the pancreatic juice, forming protein deposits. The protein plugs precipitated in the pancreatic duct are calcified to form stones. In the blood of normal people and patients with chronic pancreatitis, there is a pancreatic protein (Pancreatic), PSP. By binding to block the activity of calcium carbonate, thereby inhibiting the precipitation of calcium carbonate, PSP secretion is reduced when factors such as long-term alcoholism or malnutrition, and the supersaturated calcium carbonate in the pancreatic juice is no longer inhibited by it to form a crystalline precipitate. Crystallization precipitates on the network structure of exfoliated epithelial cells, mucosa, pancreatic enzymes and non-enzymatic trypsin, etc., combined with the high potential activity of these crystal surfaces and the large surface area of network-like structures, some metal ions are deposited on the network by absorption. After a certain period of deposition, stones are formed. The pancreatic stones contain about 955 calcium carbonate, and the surface layer still contains calcium, chromium and magnesium.
Prevention
Pancreatic stone disease prevention
Pancreatic stone disease is related to drinking. Drinking time is long. If the amount is large, it is easy to form pancreatic stones. Therefore, drinking should be reduced and bad living habits should be changed.
Complication
Pancreatic stone complications Complications Diabetic Pancreatic cancer Cardiomyopathy Obstructive arteriosclerosis Retinopathy Peptic ulcer Portal hypertension
Pancreatic damage caused by pancreatic stones is more obvious, so it is easy to cause a series of complications, such as diabetes, pancreatic cancer, etc. The most common complications are as follows.
1. Benign complications of pancreatic stones : Diabetes is the most common, as well as myocardial lesions due to diabetes, kidney disease, retinopathy, occlusive atherosclerosis, etc., sometimes liver lesions and peptic ulcers.
2. Pancreatic stone pancreatic lesions affect the symptoms of surrounding organs : pancreatic enlargement or fibrotic induration compresses the common bile duct, splenic vein, or leads to spleen-portal thrombosis and secondary portal hypertension, which may be regional hypertension. It can be systemic, depending on the extent to which thrombosis is affected.
3. Malignant complications : The malignant complications of pancreatic stone disease are the pancreas itself, and the other is a malignant tumor other than the pancreas. The relationship between pancreatic stone disease and pancreatic cancer is very close. Generally, pancreatic cancer occurs first and then pancreatic cancer. Most of the patients with pancreatic cancer are large stones, about half of which are pancreatic heads. The incidence of pancreatic cancer is different. The European and American literature records 3.6 to 25%. Japanese small mouth Shoufu reported cases of pancreatic stones complicated with pancreatic cancer in 31 cases. (accounting for 14.8%), the general report in Japan is 5.3% to 10%.
Symptom
Symptoms of pancreatic stone disease Common symptoms Abdominal pain, weight loss, severe pain, jaundice, severe pain, bloating, fatty diarrhea, pancreatic fibrosis, diabetes
The diagnosis of pancreatic stone disease is not too difficult. According to the history of long-term alcohol abuse, abdominal pain, and some diabetes with different degrees, preliminary judgment can be made, and then the experimental examination, X-ray film, ultrasound, CT and ERCP examination can be made. A deterministic diagnosis can then be made.
The symptoms of pancreatic stone disease can be divided into early and late manifestations.
Early symptoms
Abdominal pain: It is the most common symptom, ranging in severity, mainly due to pancreatic duct obstruction and pancreatic fibrosis. It is often manifested as upper abdominal pain. If it is alcoholic pancreatic stone disease, it often shows severe pain and repeated episodes. The time is longer, the cause is unknown, the pain is less, most of them are pain in the upper abdomen, dull pain.
Weight loss, steatorrhea: due to the reduction of pancreatic exocrine function caused by calculous chronic pancreatitis, the condition of steatorrhea is different depending on the condition of pancreas damage.
Astragalus: About one-fourth of patients can have jaundice, which is caused by fibrosis of the patient. The hard pancreatic head is pressed against the lower end of the common bile duct. The jaundice can be continuous or intermittent, and the latter is more common.
2. Late symptoms
The late symptoms of pancreatic stone disease are mainly caused by complications caused by progressive chronic damage of the pancreas.
Examine
Pancreatic stone examination
1. Experimental examination
Detection of serum GPT, GOT, cholesterol, triglycerides, etc., may have mild abnormalities, a small number of patients with AKP can be elevated.
In order to identify the presence or absence of pancreatic cancer, carcinoembryonic antigen (CEA) should be detected. The carcinoembryonic antigen staining of pancreatic cancer tissue is moderately positive, and the pancreatic duct epithelial cells are mild and moderately positive.
2. X-ray film
Pancreatic stone disease can display 3 types on X-ray film:
Diffuse type: There are some stones of different sizes, scattered in the pancreas.
Isolated: one or more massive stones, mostly in the main pancreatic duct.
Hybrid type: Miliary stones and massive stones coexist on the same X-ray film.
Pancreatic stones often have the largest number of pancreatic heads, fewer tails, and the body is centered. The larger stones are more obstructive to the main pancreatic duct, and most of them are accompanied by pancreatic duct obstruction. Complications are also common.
3. Ultrasound and CT examination
The sensitivity of pancreatic stones is more than 90%. If the positive rate of CT is higher than that of CT, the diagnosis of pancreatic cancer by CT can increase the positive detection rate. When pancreatic stone disease and pancreatic cancer are present, the pancreas has calcification and pseudocyst. The pancreatic duct is dilated, the shape of the pancreas is irregular, the localized pancreas is enlarged, and the peripancreatic fat disappears.
Diagnosis
Diagnosis and diagnosis of pancreatic stone disease
diagnosis
The diagnosis of pancreatic stone disease is not too difficult. According to the history of long-term alcohol abuse, abdominal pain, and some degrees of diabetes, preliminary judgments can be made, followed by laboratory examination, X-ray film, ultrasound, CT and ERCP. A deterministic diagnosis can then be made.
Differential diagnosis
Pancreatic stone disease should be mainly differentiated from pancreatic cancer.
