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VIPoma
Neck of Pancreas   Anatomy of Pancreas
 
<ul><li>ตับอ่อน มีหน้าที่สำคัญ  2  ประการ คือ   </li></ul><ul><li>1. ต่อมมีท่อ ( Exocrine)  :  มีหน้าที่ สร้างน้ำย่อย ที่เ...
<ul><li>Non-Endocrine origin </li></ul><ul><li>-  Non functional pancreatic endocrine neoplasms typically present later in...
Exocrine Tumor <ul><li>Benign </li></ul><ul><li>-  Serous cystadenoma </li></ul><ul><li>- Mucinous cystadenoma </li></ul><...
Clinical presentations of pancreatic endocrine tumor Name  ( synonym ) Hormone responsible Clinical symptoms Principle of ...
Clinical presentations of pancreatic endocrine tumor Name  ( synonym ) Hormone responsible Clinical symptoms Principle of ...
Clinical presentations of pancreatic endocrine tumor Name  ( synonym ) Hormone responsible Clinical symptoms Principle of ...
Clinical presentations of pancreatic endocrine tumor Name  ( synonym ) Hormone responsible Clinical symptoms Principle of ...
Clinical presentations of pancreatic endocrine tumor Name  ( synonym ) Hormone responsible Clinical symptoms Principle of ...
<ul><li>Diagnosis of pancreatic tumors :  </li></ul><ul><li>need imaging studies e.g. ultrasound ,  </li></ul><ul><li>CT s...
<ul><li>Tumors deep in the substance of the pancreatic gland, and therefore close to the main duct, have ill-defined capsu...
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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 of "Vi Poma"

    1. 1. VIPoma
    2. 2. Neck of Pancreas Anatomy of Pancreas
    3. 4. <ul><li>ตับอ่อน มีหน้าที่สำคัญ 2 ประการ คือ </li></ul><ul><li>1. ต่อมมีท่อ ( Exocrine) : มีหน้าที่ สร้างน้ำย่อย ที่เรียกว่า “ น้ำย่อยของตับอ่อน ” ( Pancreatic juice ) ประกอบด้วยเอ็นไซม์ ( enzymes ) หลายชนิด ซึ่งมีหน้าที่ ช่วยในการย่อยอาหาร จำพวกแป้ง โปรตีน ไขมัน ให้มีขนาดเล็กลง จนสามารถซึมผ่านผนังของลำไส้เข้าสู่ร่างกายได้ </li></ul><ul><li>2. ต่อมไร้ท่อ ( Endocrine gland ) : สร้างฮอร์โมน หลายชนิด ซึ่งจะส่งเข้ากระแสเลือดโดยตรง ฮอร์โมนที่สำคัญ ได้แก่ Insulin , Glucagon , Somatostatin , Pancreatic polypeptide </li></ul>หน้าที่ของตับอ่อน
    4. 5. <ul><li>Non-Endocrine origin </li></ul><ul><li>- 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. </li></ul><ul><li>- No associated evevation in plasma hormone level </li></ul><ul><li>Endocrine origin </li></ul><ul><li>- Most pancreatic endocrine neoplasms discovered clinically are functional </li></ul><ul><li>- Tumors secrete one or more hormonal product into the blood, which leads to a recognizable clinical syndrome </li></ul><ul><li>- Pancreatic polypeptide (PP) is a product that appears to be a marker for pancreatic endocrine tumors </li></ul>Pancreatic Tumor
    5. 6. Exocrine Tumor <ul><li>Benign </li></ul><ul><li>- Serous cystadenoma </li></ul><ul><li>- Mucinous cystadenoma </li></ul><ul><li>- Intraductal papillary-mucinous adenoma </li></ul><ul><li>- Mature teratoma Borderline tumors ( uncertain malignant potential ) </li></ul><ul><li>- Mucinous cystic tumor with moderate dysplasia </li></ul><ul><li>- Intraductal papillary-mucinous tumor with moderate dysplasia </li></ul><ul><li>- Solid-pseudopapillary tumor </li></ul><ul><li>Malignant </li></ul><ul><li>- Severe ductal dysplasia-carcinoma in situ </li></ul><ul><li>- Ductal adenocarcinoma:  * Mucinous noncystic carcinoma  * Signet ring cell carcinoma  * Adenosquamous carcinoma  * Undifferentiated (anaplastic) carcinoma  * Mixed ductal-endocrine carcinoma </li></ul><ul><li>- Osteoclast-like giant cell tumor </li></ul><ul><li>- Serous cystadenocarcinoma </li></ul><ul><li>- Mucinous cystadenocarcinoma:  * Noninvasive  * Invasive </li></ul><ul><li>- Intraductal papillary-mucinous carcinoma:  * Noninvasive  * Invasive (papillary-mucinous carcinoma) </li></ul><ul><li>- Acinar cell carcinoma:  * Acinar cell cystadenocarcinoma  * Mixed acinar-endocrine carcinoma </li></ul><ul><li>- Pancreatoblastoma </li></ul><ul><li>- Solid-pseudopapillary carcinoma </li></ul><ul><li>- Miscellaneous carcinomas </li></ul>
    6. 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
    7. 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
    8. 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 <ul><li>Glucagonoma syndrome </li></ul><ul><li>Abnormal glucose tolerance test </li></ul><ul><li>Normochromic normocytic anemia </li></ul><ul><li>Skin rash จากการหลั่งฮอร์โมนกลูคากอนมากเกินไป </li></ul>Generally have nutritional depletion and often require blood transfusions, total parenteral nutrition, and preoperative control of hyperglycemia
    9. 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 <ul><li>WDHA syndrome </li></ul><ul><li>Watery diarrhea </li></ul><ul><li>Hypokalemia </li></ul><ul><li>Achlorhydria </li></ul>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
    10. 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 <ul><li>Somatostatinoma syndrome </li></ul><ul><li>Diabetes mellitus </li></ul><ul><li>Steatorrhea </li></ul><ul><li>Cholelithiasis </li></ul><ul><li>gastric hyposecretion </li></ul>Nutritional repletion and control of hyperglycemia are important aspects of good medical care in patients
    11. 12. <ul><li>Diagnosis of pancreatic tumors : </li></ul><ul><li>need imaging studies e.g. ultrasound , </li></ul><ul><li>CT scan , MRI </li></ul>Investigation
    12. 13. <ul><li>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 . </li></ul><ul><li>Tumors in the body or tail of the pancreas can be managed with distal pancreatectomy </li></ul><ul><li>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 </li></ul><ul><li>Lesions in the head or uncinate process of the pancreas can be resected with pancreaticoduodenectomy </li></ul>Surgical Treatment
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