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Vi Poma

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  • ตับอ่อน มีขนาดความยาวประมาณ 6 นิ้ว มีรูปร่างคล้ายปลาดุก เป็นต่อมขนาดใหญ่ ตั้งอยู่ทางด้านหลังของกระเพาะอาหาร ใกล้กับลำไส้เล็กส่วนดูโอดินัม ซึ่งเป็นลำไส้เล็กส่วนต้น
  • endocrine tumor ผู้ป่วยมักมีอาการอันเนื่องมาจากความผิดปกติของฮอร์โมนที่เนื้องอกสร้างขึ้น การจำแนก endocrine tumor ของตับอ่อนจึงอาศัยชนิดของฮอร์โมนที่ตรวจพบในเลือดหรือในเนื้อเยื่อของ tumor เป็นสำคัญ
  • Transcript

    • 1. VIPoma
    • 2. Neck of Pancreas Anatomy of Pancreas
    • 3.  
    • 4.
      • ตับอ่อน มีหน้าที่สำคัญ 2 ประการ คือ
      • 1. ต่อมมีท่อ ( Exocrine) : มีหน้าที่ สร้างน้ำย่อย ที่เรียกว่า “ น้ำย่อยของตับอ่อน ” ( Pancreatic juice ) ประกอบด้วยเอ็นไซม์ ( enzymes ) หลายชนิด ซึ่งมีหน้าที่ ช่วยในการย่อยอาหาร จำพวกแป้ง โปรตีน ไขมัน ให้มีขนาดเล็กลง จนสามารถซึมผ่านผนังของลำไส้เข้าสู่ร่างกายได้
      • 2. ต่อมไร้ท่อ ( Endocrine gland ) : สร้างฮอร์โมน หลายชนิด ซึ่งจะส่งเข้ากระแสเลือดโดยตรง ฮอร์โมนที่สำคัญ ได้แก่ Insulin , Glucagon , Somatostatin , Pancreatic polypeptide
      หน้าที่ของตับอ่อน
    • 5.
      • Non-Endocrine origin
      • - Non functional pancreatic endocrine neoplasms typically present later in the couse of their disease,when their tumors being to cause symptoms related to a mass effect.
      • - No associated evevation in plasma hormone level
      • Endocrine origin
      • - Most pancreatic endocrine neoplasms discovered clinically are functional
      • - Tumors secrete one or more hormonal product into the blood, which leads to a recognizable clinical syndrome
      • - Pancreatic polypeptide (PP) is a product that appears to be a marker for pancreatic endocrine tumors
      Pancreatic Tumor
    • 6. Exocrine Tumor
      • Benign
      • - Serous cystadenoma
      • - Mucinous cystadenoma
      • - Intraductal papillary-mucinous adenoma
      • - Mature teratoma Borderline tumors ( uncertain malignant potential )
      • - Mucinous cystic tumor with moderate dysplasia
      • - Intraductal papillary-mucinous tumor with moderate dysplasia
      • - Solid-pseudopapillary tumor
      • Malignant
      • - Severe ductal dysplasia-carcinoma in situ
      • - Ductal adenocarcinoma:  * Mucinous noncystic carcinoma  * Signet ring cell carcinoma  * Adenosquamous carcinoma  * Undifferentiated (anaplastic) carcinoma  * Mixed ductal-endocrine carcinoma
      • - Osteoclast-like giant cell tumor
      • - Serous cystadenocarcinoma
      • - Mucinous cystadenocarcinoma:  * Noninvasive  * Invasive
      • - Intraductal papillary-mucinous carcinoma:  * Noninvasive  * Invasive (papillary-mucinous carcinoma)
      • - Acinar cell carcinoma:  * Acinar cell cystadenocarcinoma  * Mixed acinar-endocrine carcinoma
      • - Pancreatoblastoma
      • - Solid-pseudopapillary carcinoma
      • - Miscellaneous carcinomas
    • 7. Clinical presentations of pancreatic endocrine tumor Name ( synonym ) Hormone responsible Clinical symptoms Principle of Medical Treatment Insulinoma (insulin-producing tumor) or Beta cell tumor Insulin Whipple triad - Mental confuse, weakness,fatigue and convulsion , palpitation - Fasting hypoglycemia - Relief of hypoglycemic symptoms after glucose administation May require immediate potassium replasement and glucose administration
    • 8. Clinical presentations of pancreatic endocrine tumor Name ( synonym ) Hormone responsible Clinical symptoms Principle of Medical Treatment Gastrinoma (gastrin-producing tumor; ulcerogenic tumor) or G-cell tumors Gastrin Zollinger-Ellison syndrome * Severe gastrointestinal ulcerative disease * Gastric acid hypersecretion * Steatorrhea (fatty diarrhea) 1 . Stabilize hemodynamic and control bleeding from gastrointestinal ulcers 2 . Establish a nonacidic gastric pH with the use of proton pump inhibitors, eg, omeprazole 3 . Administration of the somatostatin analogue octreotide or chemotherapeutic agent
    • 9. Clinical presentations of pancreatic endocrine tumor Name ( synonym ) Hormone responsible Clinical symptoms Principle of Medical Treatment Glucagonoma (glucagon-producing tumor) or Alpha cell tumors Glucagon
      • Glucagonoma syndrome
      • Abnormal glucose tolerance test
      • Normochromic normocytic anemia
      • Skin rash จากการหลั่งฮอร์โมนกลูคากอนมากเกินไป
      Generally have nutritional depletion and often require blood transfusions, total parenteral nutrition, and preoperative control of hyperglycemia
    • 10. Clinical presentations of pancreatic endocrine tumor Name ( synonym ) Hormone responsible Clinical symptoms Principle of Medical Treatment VIPoma (vasoactive intestinal polypeptide) (VIP-producing tumor; diarrheogenic tumor; Verner-Morrison syndrome; pancreatic cholera) VIP
      • WDHA syndrome
      • Watery diarrhea
      • Hypokalemia
      • Achlorhydria
      Primary initial concern in the treatment of a patient who presents first with VIPoma - associated diarrhea is the replacement of volume losses and the correction of acid - base and electrolyte abnormalities
    • 11. Clinical presentations of pancreatic endocrine tumor Name ( synonym ) Hormone responsible Clinical symptoms Principle of Medical Treatment Somatostatinoma (somatostatin-producing tumor) or Delta cell tumors Somatostatin
      • Somatostatinoma syndrome
      • Diabetes mellitus
      • Steatorrhea
      • Cholelithiasis
      • gastric hyposecretion
      Nutritional repletion and control of hyperglycemia are important aspects of good medical care in patients
    • 12.
      • Diagnosis of pancreatic tumors :
      • need imaging studies e.g. ultrasound ,
      • CT scan , MRI
      Investigation
    • 13.
      • Tumors deep in the substance of the pancreatic gland, and therefore close to the main duct, have ill-defined capsules, and tumors larger than 2 cm in diameter should be treated with regional pancreatectomy .
      • Tumors in the body or tail of the pancreas can be managed with distal pancreatectomy
      • Tumors in the neck of the pancreas can now be managed with middle-segment pancreatectomy by oversewing the proximal pancreatic stump and draining the distal pancreatic duct via a pancreaticogastrostomy or pancreaticojejunostomy
      • Lesions in the head or uncinate process of the pancreas can be resected with pancreaticoduodenectomy
      Surgical Treatment