Pancreatic stone obstruction

Introduction 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. Clinical symptoms of abdominal pain are the most common, accounting for about 62%. The pain is located in the middle upper abdomen or the left upper abdomen, mostly recurrent persistent pain, a small amount of dull pain, can be radiated to the back, shoulders, left rib margin, and has a certain relationship with eating. Causes steatorrhea and malnutrition, jaundice, diabetes, etc. Due to the obstruction of the pancreatic duct by pancreatic stones and the destruction of pancreatic tissue, the pancreatic exocrine function is insufficient, resulting in steatorrhea and malnutrition.

Cause

The cause of pancreatic stone obstruction:

The main causes of pancreatic stone disease are:

1. Alcohol: It 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.

an examination

Related inspection

CT examination of the pancreas Ultrasound diagnosis of pancreatic disease Retrograde cholangiopancreatography (ERCP) MRI examination of pancreatic exocrine function in liver, gallbladder, pancreas and spleen

Examination and diagnosis of pancreatic stone obstruction:

1. Abdominal pain: the most common, accounting for about 62%. The pain is located in the middle upper abdomen or the left upper abdomen, mostly recurrent persistent pain, a small amount of dull pain, can be radiated to the back, shoulders, left rib margin, and has a certain relationship with eating. The severity, interval and duration of the difference are quite different. Some patients have severe pain and frequent episodes, which affect work and life. Some patients have occasional discomfort in the upper abdomen. The pain is caused by the stone blocking the pancreatic duct, the pancreatic juice can not be discharged, the pancreatic duct pressure is increased, or it is caused by Oddi sphincter edema. In the case of chronic pancreatitis, inflammation stimulates nerve endings and is one of the causes of pain.

2. steatorrhea and malnutrition: due to pancreatic duct obstruction of the pancreatic duct, coupled with destruction of pancreatic tissue, resulting in insufficient pancreatic exocrine function. The lighter can be expressed as the number of stools and the amount of stool is increased. In severe cases, there is oil on the surface of the stool. Long-term steatorrhea can cause nutrient absorption disorders, leading to malnutrition and weight loss. The degree of exocrine dysfunction is related to the etiology, the location of stones and the distribution of stones. The incidence of alcoholism and stones distributed in the body of the pancreatic head or whole pancreas is higher and the degree is heavier. The distribution of stones in the tail of the pancreas is less damage. light.

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

4. Diabetes: Dominant diabetes accounts for 32%, and impaired glucose tolerance accounts for 68%. It is caused by the destruction of islet cells and the decrease of insulin secretion. It is also thought to be caused by the decrease of insulin, glucagon and growth hormone secretion. This type of diabetes is more difficult to control with drugs.

5. Abdominal signs: not obvious, occasionally mild tenderness in the upper abdomen or left upper abdomen, no rebound pain. In the formation of complicated pseudocysts, cystic masses in the abdomen can be found.

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

Laboratory tests: Urine amylase can be elevated. Patients with steatorrhea observed a large amount of fat droplets and undigested muscle fibers in the stool. Blood ALT, AST, mild abnormalities, albumin decreased, cholesterol, decanoyl glycerol decreased. In patients with jaundice, total bilirubin and combined bilirubin and alkaline phosphatase can be elevated. People with diabetes have elevated blood sugar. Some people have found that the increase of blood lactoferrin is a characteristic manifestation of pancreatic stone disease by radioimmunoassay, and it is considered that this method is the best method for diagnosis.

Other examination imaging examinations are the main method of 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 blocky 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, between the second lumbar vertebrae and the eleventh thoracic vertebrae. If it is a single stone or small stone, it is easy to overlap with the spine. At this time, it is necessary to add a lateral slice. The early stone components are mainly protein, and the abdominal plain film is negative. At this time, ERCP is helpful for diagnosis.

2. B-ultrasound: It is the preferred method of examination to observe the shape of the pancreas, the light clusters of the stones and the dilated pancreatic ducts, and to diagnose the size, number and location of the stones.

3. CT: Pancreatic stones appear as small dots, strips, stellate to coarse plaques, which can be localized or diffusely distributed. It determines the number and size of stones and their location within the pancreatic duct, as well as the morphology, size, and extent of pancreatic duct expansion.

4. ERCP: The number, size, location and diameter of the pancreatic duct can be clearly observed, and the presence or absence of stenosis or dilatation is particularly helpful for negative stones. However, ERCP can only show changes in the pancreatic duct, and it does not help the calcification of the pancreatic parenchyma (pseudo stones). And ERCP can still induce pancreatitis, pay attention when applied.

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

complication:

1. Benign complications: Pancreatic stone disease can cause chronic inflammatory changes in pancreatic tissue, resulting in chronic pancreatitis and pancreatic pseudocyst. Diabetes can develop when inflammation involves islet cells. Other complications include peptic ulcer and liver disease.

2. Malignant complications: mainly pancreatic cancer. The incidence rate is generally between 3.6% and 16.7%. Some people think that pancreatic stone disease can cause chronic inflammation and cyst fibrosis in pancreatic tissue. The long-term effects of the latter two can cause mutations in the genes of pancreatic cells and eventually cancer. From the age of good hair, patients with pancreatic stone disease and pancreatic cancer are mostly 30 to 40 years old, while pancreatic cancer is mostly 50 to 60 years old. The former is 20 years earlier than the latter.

Differential diagnosis

Symptoms of confusing pancreatic stone obstruction:

Islet cell destruction: Diabetes mellitus is a metabolic disorder caused by a decrease in the biological effect of insulin deficiency and (and) insulin. It is a common disease characterized by persistent elevated blood glucose and the presence of diabetes. The incidence rate is 1%. ~2%. Diabetes refers to primary diabetes, which can be divided into insulin-dependent diabetes mellitus (type I diabetes) and non-insulin-dependent diabetes mellitus (type II diabetes) according to its etiology, pathogenesis, pathology, clinical manifestations and prognosis. ).

Insulin-dependent diabetes mellitus can occur at any age, but it usually occurs in children or adolescents. It accounts for less than five percent of all diabetes, but its impact on life is far greater than that of common non-insulin-dependent diabetes. The exact cause of insulin-dependent diabetes is not very clear. It is more certain that the body's immune system is out of order and is against the tissues of the body. The body's immune system creates certain substances that fight insulin in the pancreas. When these cells are destroyed, they cannot secrete insulin.

Pancreatic fibrosis: Chronic pancreatitis is a persistent, permanent damage to pancreatic tissue and function due to various factors. Different degrees of acinar atrophy, pancreatic duct deformation, fibrosis and calcification in the pancreas, and varying degrees of pancreatic exocrine and endocrine dysfunction, clinical manifestations of abdominal pain, diarrhea or steatorrhea, weight loss and malnutrition and other pancreatic insufficiency Symptoms. Typical chronic pancreatitis is rare in China, and it is difficult to diagnose.

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