Pancreatic diseases

　　First, biliary diseases

　　1. The most common cause: bile reflux.

　　2. The common channel theory.

　　3. Since most people's common bile duct and main pancreatic duct converge before entering the duodenal papilla, gallstones, cholangitis, biliary roundworms, and other conditions can cause bile to reflux into the pancreatic duct and activate pancreatic enzymes, leading to poor drainage of pancreatic enzymes in the pancreatic duct, reflux of pancreatic juice, and damage to pancreatic tissue.

　　Second, alcoholism and overeating

　　1. It is a major cause of pancreatitis in the Western world.

　　2. Alcohol and overeating can stimulate the excessive secretion of pancreatic juice, leading to spasms of the Oddi's sphincter and obstruction of the pancreatic duct, resulting in poor drainage of pancreatic juice, reflux, and damage to pancreatic tissue after excessive drinking.

　　3. Alcohol also has a direct toxic effect on the pancreas.

　　Third, duodenal juice reflux

　　Factors that increase the intraduodenal pressure can cause duodenal juice to reflux into the pancreatic duct, activate various pancreatic enzymes, and lead to pancreatic autodigestion.

　　1. Penetrating duodenal ulcer.

　　2. Duodenal diverticulum.

　　3. Ring pancreas.

　　4. Inflammatory stricture of the duodenum.

　　5. Postoperative obstruction of the alimentary limb after subtotal gastrectomy.

　　Fourth, injury

　　After upper abdominal surgery or trauma, procedures such as endoscopic retrograde cholangiopancreatography and duodenal papillotomy can trigger pancreatitis.

　　Fifth, pancreatic circulation disorders

　　Low blood pressure, cardiopulmonary bypass, arterial embolism, vasculitis, increased blood viscosity, and other factors can cause pancreatic blood flow disorders leading to pancreatitis.

　　Sixth, other

　　1. Pancreatic calculi caused by hyperparathyroidism or other hypercalcemia.

　　2. Diabetic pancreatic vascular diseases.

　　3. Emotional excitement can lead to dysfunction of the Oddi's sphincter, affecting the normal drainage of pancreatic juice and bile.

　　4. Certain drugs such as diuretics, estrogens, and immunosuppressants can also induce pancreatitis.

　　5. Some patients with pancreatitis have a family history, which is an autosomal dominant inheritance, onset in childhood, often accompanied by pancreatic calculi.

　　6. Infections such as mumps virus, hepatitis virus, and Salmonella typhi may affect the pancreas.

　　The main complications of pancreatic diseases include: pseudocysts, biliary or duodenal obstruction, and formation of splenic vein thrombosis. These complications seriously threaten patients' health, so it is necessary to seek timely treatment as soon as symptoms are detected.

　　First, the main manifestations of acute pancreatitis are

　　1. Abdominal pain is the main clinical symptom, with severe pain. It starts in the upper middle abdomen, can also be more pronounced in the upper right or left abdomen, and radiates to the back; if the entire pancreas is involved, it presents as a belt-like pain radiating to the lower back and back. Alcoholic pancreatitis often develops within 12-48 hours after drinking, presenting with abdominal pain. Biliary pancreatitis often presents with abdominal pain after a heavy meal.

　　2. Nausea and vomiting often occur with abdominal pain: vomiting is severe and frequent. The vomit contains the contents of the stomach and duodenum, and occasionally coffee-like contents.

　　3. Abdominal distension: In the early stage, it is due to reflexive ileus, and in severe cases, it may be caused by stimulation from retroperitoneal cellulitis. The upper segment of the small intestine and transverse colon adjacent to the pancreas may become paralyzed and dilated. Abdominal distension is mainly in the upper abdomen. Abdominal distension is more obvious when there is ascites: the patient stops defecating and passing gas. Bowel sounds are weakened or disappear.

　　4. Signs of peritonitis: In cases of edematous pancreatitis, tenderness is limited to the upper abdomen, and there is often no obvious muscle tension. In hemorrhagic necrotic pancreatitis, tenderness is marked, and there is muscle tension and rebound pain. The range is wide or extends to the entire abdomen.

　　5. Other symptoms: Initially, it often presents with moderate fever, around 38℃. Those with cholangitis may have chills and high fever. High fever is one of the main symptoms when pancreatic necrosis is accompanied by infection. Jaundice may be seen in biliary pancreatitis or due to compression of the common bile duct by edematous pancreas head.

　　6. Chronic pancreatitis: It is mainly characterized by persistent dull or mild pain in the upper abdomen, or slightly to the left. The pain may be severe during attacks, worsen at night, and may radiate to the lumbar or left shoulder. Chronic pancreatitis may form pancreatic masses, resembling pancreatic cancer. Deep pancreatic tumors that compress the pancreatic duct can cause chronic inflammation of the surrounding pancreatic tissue, and when a biopsy of the pancreatic surface tissue is taken, it is often misdiagnosed as chronic pancreatitis. Biopsy of deep tissue by puncture during surgery or using ERCP before surgery can make the diagnosis.

　　7. Symptoms of pancreatic cancer include: Early pancreatic cancer, due to the small size of the lesion and its localization within the pancreas, may present with no symptoms. As the condition progresses, the tumor gradually increases in size, involves the gallbladder, pancreatic duct, and peripancreatic tissue, and symptoms such as upper abdominal discomfort and dull pain, jaundice, weight loss, loss of appetite, dyspepsia, and fever may appear. Among these, jaundice is the most prominent, obstructive jaundice is the most prominent manifestation of pancreatic head cancer, with an incidence of over 90%. Early in the body and tail of the pancreas may not have jaundice. Jaundice usually presents as persistent and progressively deepening. Complete obstruction may cause the feces to turn clay-colored, the skin yellowing may appear brown or bronze, accompanied by itching. Persistent upper abdominal pain and weight loss with a history of biliary tract disease and long-term alcohol consumption should raise suspicion of pancreatic disease. It should be determined after combining laboratory tests and imaging examinations. After diagnosis, treatment should be initiated promptly, and the main treatment modality is surgery,

　　8. Insulinoma: It has typical clinical manifestations, transient hypoglycemia, and symptoms disappear immediately after oral or intravenous administration of glucose.

　　Two, high-risk populations prone to pancreatic cancer: 1. Those with familial adenomatous polyposis and concurrent pancreatic cancer are higher than the normal population.

　　1. Intraductal papillary mucinous neoplasms also belong to precancerous conditions.

　　2. Individuals with a family history of pancreatic cancer, some believe that genetic factors account for 5% to 10% of the incidence of pancreatic cancer.

　　3. Patients over 40 years of age with non-specific upper abdominal symptoms.

　　4. High-risk factors for pancreatic cancer include smoking, excessive alcohol consumption, and long-term exposure to harmful chemicals.

　　5. The incidence of pancreatic cancer is increased by 1.5 to 5 times in patients who have undergone a subtotal gastrectomy, especially in those with more than 20 years postoperatively.

　　6. It is currently believed that chronic pancreatitis is an important precancerous condition in some patients, especially in chronic familial pancreatitis and chronic calcifying pancreatitis.

　　7, Diabetic patients with sudden onset, especially atypical diabetes, aged over 60, without family history, without obesity, and quickly forming insulin resistance. 40% of patients with pancreatic cancer have diabetes at the time of diagnosis.

　　1, Cultivate an optimistic and optimistic personality, learn to regulate emotions, be magnanimous and generous, smile frequently, and ensure mental health. That is the best 'antibody'. In addition, adjust the dietary structure, do not eat burned and charred food, try to eat less high animal protein, high fat, high oil, and high-salt food.

　　2, Do not smoke or drink excessively, live a regular life, and exercise appropriately. In addition, also do a good job in the prevention and treatment of related diseases such as diabetes, chronic pancreatitis, and bile duct diseases. People who have long-term contact with harmful chemicals should do a good job of occupational protection.

　　3, 'Three parts of medicine, seven parts of adjustment', pay more attention to diet in terms of diet. After the illness, the intake of food should be light, easy to digest, and rich in nutrition; increase dietary fiber, carotene, vitamin E, and necessary minerals in the diet, control the intake of salt, reasonable allocation, and avoid overeating and overdrinking.

　　4, In addition, be careful to avoid the following foods: avoid foods with strong刺激性; avoid certain trigger foods and unrefrigerated foods; patients with hypertension and diabetes should pay special attention to special dietary taboos; avoid foods that should not be taken with certain medications such as ginseng, radish, blood tonics, tea, etc.

　　1, X-ray examination (gastrointestinal barium meal X-ray examination, which can check whether the adjacent organs of the pancreas are compressed and deformed).

　　2, Ultrasound examination.

　　3, Fiberoptic endoscopic examination.

　　4, CT or MRI examination.

　　5, Laboratory examination, including serum amylase, blood glucose, serum bilirubin, serum alanine aminotransferase, transpeptidase, hemoglobin.

　　6, Immunological examination, including cancer胚抗原 determination (CEA), pancreas cancer胚抗原 (POA) determination, CAl9—9 determination, etc. You have discomfort in the left upper abdomen recently, but this symptom alone cannot diagnose pancreatic disease. The visceral organs in the left upper abdomen include: the left part of the stomach, spleen, pancreas, sigmoid colon, etc.

　　1, Fist of Buddha porridge:Fist of Buddha 15 grams, glutinous rice 50 grams. Boil the Fist of Buddha juice and remove the residue, add glutinous rice and an appropriate amount of water to cook porridge, add an appropriate amount of rock sugar when it is about to be cooked, and eat it when the porridge is done. It has the effect of: relieving pain, invigorating the spleen and stomach.

　　2, Cassia and Licorice:Cassia twig 20 grams, Bai Shao 40 grams, Licorice 12 grams, ginger 20 grams, 12 dates, boil the water and remove the residue, then add 100 grams of glutinous rice, cook into porridge, and take in divided doses. It can strengthen the spleen and stomach.

　　3, Pork pancreas powder:Dry the pork pancreas with low heat and grind it into powder, encapsulate it, and take it in divided doses daily. It contains various pancreatic enzymes and can act as a substitute therapy, effective for patients with indigestion and steatorrhea.

　　4, Hawthorn and荷叶 tea:Hawthorn 30 grams;荷叶 12 grams. Add two herbs and 2 bowls of clear water, boil to 1 bowl, remove the residue and take in divided doses. It can raise the clearness and promote digestion, aid digestion, and can be used to treat chronic pancreatitis with poor digestion.

　　5, Decoction of海带:Kelp 20 grams, Cassia seed 10 grams. Boil the above two ingredients in 2 bowls of water, boil to 1 bowl, take it all at once, and take it twice a day. It is beneficial for the alleviation of chronic pancreatitis.

　　6. Dried ginger porridge:Dried ginger 3 grams, galangal 3 grams, glutinous rice 50 grams. First, boil dried ginger and galangal in water, remove the dregs and take the juice, then add the washed glutinous rice and cook into porridge, and eat it in several servings. It has the effect of invigorating the spleen and warming the stomach.

　　1. Surgical treatment for pancreatic cancer is the best treatment method for pancreatic cancer, mainly suitable for early-stage patients. Radical resection surgery is the main method of treatment for this disease. Most of the tumors are located in the lateral part of the pancreatic head and have no direct relationship with the pancreatic duct and duodenal wall. It is reported that about 80% of patients can undergo complete tumor resection, and if it can be implemented, it often has a good therapeutic effect. According to the location, size, local infiltration, and distant metastasis of the tumor, pancreaticoduodenectomy, distal pancreatectomy, and simple tumor resection can be performed.

　　2. After the surgery for pancreatic cancer, auxiliary chemotherapy can be used, mainly with gemcitabine as the main drug, combined with other drugs, which can extend the survival period. Before chemotherapy, the treatment purpose must be explained to the patient, and patients receiving chemotherapy must be closely followed up, including physical examinations, abdominal, chest imaging, and blood CA19-9 tests.

　　3. Indications: Auxiliary chemotherapy after radical surgery; pancreatic cancer with metastasis; locally progressive pancreatic cancer that cannot be removed, or recurrence and metastasis after surgery or other treatment

　　4. Radiotherapy is a commonly used treatment method for cancer in medicine, and pancreatic cancer is no exception. Radiotherapy can be chosen if the tumor cannot be removed, the lesions have metastasized, or the tumor lesions need to be reduced before surgery. However, the treatment is not accurate enough with ordinary radiotherapy, the treatment time is long, the patient is very painful, and there are many side effects, and some patients' bodies cannot bear it. The CyberKnife, on the other hand, is a modern radiotherapy developed on the basis of traditional radiotherapy. It incorporates a real-time image tracking system and a synchronized breathing system, significantly improving the accuracy of treatment and reducing side effects. Moreover, in the treatment of brain tumors, it does not require a head frame, there are no blind spots in the radiation, and the treatment time is greatly shortened, generally requiring only 1-5 sessions, and the entire treatment can be completed in 1-7 days.

　　5. Defects: The treatment effect is not significant for tumors larger than 6 centimeters. If the tumor is large, it is best to undergo surgery first to reduce the area of the tumor mass.