tailieunhanh - The Pancreas: An Integrated Textbook of Basic Science, Medicine, and Surgery_2

At the beginning of the 21st century, medicine is increasingly based on understanding the functions of genes and the molecular mechanisms of diseases. In pancreatology, the understanding of functions and dysfunctions of the exocrine and endocrine pancreas is derived from molecular biological data on the actions of compounds in subcellular compartments and intracellular transcription pathways. In clinical medicine new and improved technical devices enable the gastroenterologist and the gastrointestinal surgeon to identify lesions by highresolution imaging techniques, imaging of metabolic processes, and intrapancreatic ductal investigations. Decision making is increasingly based on the evidence of data from clinical trials on treatment modalities of pancreatic lesions | 49 Endoscopic retrograde cholangiopanpneatogppphy magnetic resonancecColpnnCopancreatography and enOoccopicultrpnounP in chronic pancreatitio Andrew s. Rose and Irving Waxman Introduction Chronic pancreatitis is an inflammatory disorder of the pancreas that leadstociangesinthe structure of the gland ultimately resulting in impairment of its endocrine and exocrine functions 1 . Asoppo sedtoacute pancreatitis where injut to the gland is transtent ths morphologic and funcrioeal changes associated wirhchronicuancreatitis ere irreaeesiblc 1-3 . Because civaeiat ions in eeeeentesien the true prevalence of chronic pencrcatitie has bean ditfiaalr So stuOy although most ostrme-et raugd frern 0S4 so 5 1 . Ttd vaei -OUS causes of chronicpanceeetisisare rhsciissed re Odtaliin Chapters 39-43. While the gords c t rae- -t arnenotiseS oesanicpaecre-atitis is histologic- rotC en ipvosive aopenaoh is not feerib-e fee most patients. Asrunh rOediognosis of chronic pancreatitis is typically made by osher Ses tc ot nancedotiasrructereand dimCi tion 4 . Endutcopie reteogrode opdicnaidnan -9eutography ERCP magardc nx oeiiA - choianRiupaenrenroienehy MRCP and teUorcopiauitraeonnd EUSj erethoeelmaging modalities which ovpr the parr Suc Ìo heco ễ pì 0si oUcnned both the diagnostic and sSe thetapelJtie arclotac se dhroeic pancreatitis. ThistCapthr RiscutteotUeroin nSecehofthdre modalities in thsnidgnoris os opronicppahedatititl Diagnosis In patients with advanced disease the diagnosis of chronic pancreatitis canbemadebn virtually any available test obviating the need for invasive testing 4 5 . Although a history of alcohol abuse aid innatrardisg ep . pern eoupeed with the finding of uconreotic 11008 01 0 e dheminai radiography ispcthognhmealc ot dhromeuciccrertisiSi shit The Pancreas An Integrated Textbook of Basic Scitece Medicme tá Surgery condEditien Edited by H. G. Begts A . L. Wirstaw M. w. ì1 . R. a. Kriortk M. M. ae- ch r- h o lemt K. Shiratori D. c. Wdite r ted B. M. std tots .