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FIZIOLOGIE
- chemotripsina
-carboxipeptidaza
- hiperparatiroidism
- hipertrigliceridemia
TOXIC-METABOLIC Alcool
Fumat
Hipercalcemia
Hiperlipidemia
IDIOPATIC Tropical
GENETIC Pancreatita ereditara- trypsinogen cationic
Mutatia CFTR
Mutatia SPINK1
Boala vasculara/Ischemie
Postiradiere
Obstructie ductala(tumorala)
FIZIOPATOLOGIE
- creste conc proteine totale in suc pancreatic → precipitare proteine → congl proteice/ calculi
- acizi grasi etil esterici si specii reactive oxigen → activare anormala enz pancreatice in ductele acinare
• IPOTEZA NECROZEI SI FIBROZEI- inflamatie cronica → elib mediatori inflamatori → acitivare cel pancreatice
stelate → fibroza pancreatica
• FORME GENETICE
2. PRSS1 (cationic trypsinogen gene)- tripsinogen activat la tripsina → alte proenzime → pancreatita ereditara
3. SPINK1 (serine protease inhibitor kazal tip 1)- in PC idiopatica la copii, pancreatita ereditara, pancreatita
tropicala
TIPURI DE PANCREATITA CRONICA
- raspunde corticoterapie
- adulti tineri
- calculi mari intraductali (90% caz), dilatatia imp ductului pancreatic principal, atrofia
glandei
- gena tripsinogen
MANIFESTARI CLINICE
EXAMEN OBIECTIV
• 1. Teste directe- test stimulare secretie pancreatica dupa inj secretina sau colecistokinina fol sonda
oroduodenala sau EDS, lichidul colectat este mas HCO3 (stimularea secretina) sau lipaza
sau tripsina (stimularea colecistokinina), scade secretia
- testul benzoil-tirozil-p-aminobenzoic
- chemotripsina fecala
- ecografia transabdominala
- ex computer tomograf
- ERCP+ citologie
PARACLINIC
- calcificari pancreatice
- atrofia parenchimului
- gold standard
• Rx abdominala simpla- calcificari in 65% cazuri
COMPLICATII
• Pseudoanevrisme
• Diabet zaharat
• Dependenta de narcotice
TRATAMENT
TRATAMENT FARMACOLOGIC
Analgezia: AINS si opioide -IPP si enzime pancreatice (25.000-30.000 U lipaza/masa)
-controlul glicemiei
TRATAMENT CHIRURGICAL
CANCER PANCREATIC
- varsta avansata
- pancreatita ereditara
- MANIFESTARI CLINICE:
- durere (post), scadere greutate, icter
• Icter 56%
• Greata 51%
• Icter 55%
• Hepatomegalie 39%
• Casexie 13%
• Ascita 5%
EX PARACLINIC-STADIALIZARE
• Laparoscopia expl
• Biopsia
TRATAMENT
• REZECTIE:- curativ doar in 10- 25 % cazuri
- Gemzar + Paclitaxel
- Gemzar + Erlotinib
NEOPLASME CHISTICE
- CT
- RMN
- ecoendoscopia
- CEA