Pancreatic stone disease

Introduction to pancreatic stone disease Pancreatic stone disease is a rare disease, which has been reported to account for 0.09% to 0.13% of autopsy materials, and has increased in recent years. It can be the cause of chronic pancreatitis and the end result of the development of chronic pancreatitis. basic knowledge The proportion of illness: 0.006%-0.007% Susceptible people: no special people Mode of infection: non-infectious Complications: chronic pancreatitis pancreatic pseudocysts diabetes peptic ulcer liver disease pancreatic cancer

The cause of pancreatic stone disease

(1) Causes of the disease

The main causes of pancreatic stone disease are:

1. Alcohol abuse is the most important factor, accounting for 75%.

2. Recurrent pancreatitis.

3. Malnutrition.

4. Other causes such as biliary tract disease, hyperparathyroidism, genetic factors and pancreatic parasitic diseases.

5. The reason is unknown.

(two) pathogenesis

Alcohol can stimulate the secretion of pancreatic juice and pancreatic enzyme, wherein pancreatic enzyme secretion is greater than water secretion, high concentration of pancreatic enzyme can destroy pancreatic duct epithelial cells, causing an increase in protein and calcium concentration in pancreatic juice, including lactoferrin and pancreatic protein ( PSP) plays an important role in the formation of stones. They can bind to albumin and form a huge protein polymer to precipitate. As the disease progresses, calcium carbonate is added to it, causing typical calcification and gradually forming stones. In short, Pancreatic juice stasis and changes in its composition are important causes of pancreatic stone formation.

Pancreatic stone disease prevention

Changing bad habits (alcoholism) to actively and effectively treat primary diseases (biliary diseases, hyperthyroidism, parasites, etc.) is the key to preventing this disease.

Pancreatic stone complications Complications chronic pancreatitis pancreatic pseudocyst diabetes peptic ulcer liver disease pancreatic cancer

1. Benign complications Pancreatic stone disease can cause chronic inflammatory changes in pancreatic tissue, producing chronic pancreatitis and pancreatic pseudocysts. Diabetes can occur when inflammation involves islet cells, and other complications include peptic ulcer and liver disease.

2. Malignant complications are mainly pancreatic cancer. The incidence rate is generally between 3.6% and 16.7%. It is believed that pancreatic stone disease can cause chronic inflammation and cystic fibrosis in pancreatic tissue. The genes of pancreatic cells are mutated and eventually become cancerous. From the age of good hair, patients with pancreatic disease and pancreatic cancer are mostly 30 to 40 years old, while pancreatic cancer is mostly 50 to 60 years old. The former is earlier than the latter. 20 years old.

Symptoms of pancreatic stone disease Common symptoms Abdominal pain Abdominal discomfort Dull pain Pancreatic duct obstruction Persistent pain Edema cyst Cystic mass jaundice

1. Abdominal pain is the most common, accounting for about 62%. The pain is located in the upper abdomen or the left upper abdomen. Most of them are recurrent persistent pain. A few are dull pain, which can be radiated to the back, shoulder and left rib. It has a certain relationship with eating. The severity, interval of attack and duration are quite different. Some patients have severe pain and frequent episodes, which affect work and life. Some patients only have occasional discomfort in the upper abdomen. The pain is due to stones blocking the pancreatic duct and the pancreatic juice can not be discharged. Increased tube pressure, or caused by Oddi sphincter edema, inflammation in the stimulation of nerve endings is also one of the causes of pain.

2. steatorrhea and malnutrition Because pancreatic duct obstructs the pancreatic duct, and the destruction of pancreatic tissue, resulting in insufficient pancreatic exocrine function, the light can be expressed as the number of stools, increased stool volume, severely visible oily stool on the surface of the stool, long-term fat Diarrhea can cause malabsorption of nutrients, leading to malnutrition and weight loss. The degree of exocrine dysfunction is related to the cause, location of stones and distribution of stones. The incidence of alcohol and stones distributed in the head of the pancreas or whole pancreas is higher. Heavier, stones distributed in the tail of the pancreas are less damaged and lighter.

3. Astragalus and pancreatic stones are blocked in the ampulla, or the chronic inflammatory mass of the pancreatic head is compressed at the lower end of the common bile duct, or Oddi sphincter edema can cause jaundice.

4. Diabetic dominant diabetes accounted for 32%, impaired glucose tolerance accounted for 68%, due to islet cell destruction, decreased insulin secretion, and some people believe that insulin, glucagon and growth hormone secretion are reduced, this Diabetes is more difficult to control with drugs.

5. Abdominal signs are not obvious, occasionally moderate tenderness in the upper abdomen or left upper abdomen, no rebound pain, in the formation of complicated pseudocysts, can be abdomen and cystic mass in the abdomen.

Examination of pancreatic stone disease

Urinary amylase can be elevated, and those with fatty diarrhea can observe the amount of fat droplets and undigested muscle fibers in the feces, blood ALT, AST, mild abnormalities, albumin decline, cholesterol, triglyceride drop, and jaundice. Total bilirubin and combined bilirubin, alkaline phosphatase can be elevated, blood sugar is elevated in diabetic patients, and some people have detected the increase of blood lactoferrin by radioimmunoassay, which is the unique manifestation of pancreatic stone disease. The law is the best way to diagnose.

Imaging examination is the main method for the diagnosis of pancreatic stone disease.

1. Abdominal plain film because the pancreatic stone contains more calcium, it can not pass X-ray, and it shows opaque positive stones on the abdominal plain film. There are mainly three types:

(1) Diffuse type: It is a loose miliary stone.

(2) Isolated type: one or several block stones.

(3) Mixed type: it is a miliary, soy-like or massive stone.

The pancreatic stone disease caused by alcoholism is more common with diffuse stones. The other causes of pancreatic stone disease are more common in isolated and mixed stones. The stones are distributed on both sides of the spine, and the second lumbar vertebrae to the eleventh thoracic vertebrae, if it is a single Stones or small stones, easy to overlap with the spine, then you need to add lateral slices, early stone components are mainly protein, abdominal plain film is negative, ERCP is helpful for diagnosis.

2.B super can accurately observe the shape of the pancreas, the light clusters of the stones and the dilated pancreatic duct, and make a diagnosis of the size, number and location of the stones. It is currently the preferred method of examination.

3. CT pancreatic stones appear as small spots, strips, astigmatous shadows ranging from stellate to coarse plaque, which can be localized or diffusely distributed. It can determine the number, size and position of the stones in the pancreatic duct, and can also observe the pancreas. Morphology, size and extent of pancreatic duct expansion.

4. ERCP can clearly observe the number, size, location and diameter of the pancreatic duct, whether there is stenosis or dilation, especially helpful for negative stones, but ERCP can only show changes in the pancreatic duct, calcification in the pancreatic parenchyma (false Sexual stones) help is not great, and ERCP can still induce pancreatitis, pay attention when applied.

5. The diagnostic value of MRI is similar to that of CT, but the findings of calcification and calculi are better than MRI. MRI is not easy to find when the stone is less than 5mm.

Diagnosis and diagnosis of pancreatic stone disease

According to the clinical manifestations, supplemented by imaging examination, a clear diagnosis can be made. In particular, the diagnostic rate of pancreatic stone disease is very high. Currently, B-ultrasound and abdominal plain film are the preferred methods. CT, MRI and CT are needed when needed. ERCP check.

Pancreatic stone disease needs to be diagnosed with the following diseases: cholelithiasis, urinary calculi, retroperitoneal and mesenteric lymph node calcification, calcium deposition after tuberculous peritonitis, and retention of sputum in the digestive tract, especially in the sputum, in the onset of abdominal pain, Need to be differentiated from peritoneal organ perforation, mesenteric artery embolization, intestinal obstruction and coronary embolism.

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