Acute pancreatitis is activated when the trypsin reasons summarized as follows.
1. Duodenal obstruction caused ampulla of bile reflux (biliary reflux) of the common bile duct and pancreatic duct openings in the duodenum ampulla, the bile reflux can enter pancreatic duct (totaling Road said), there will be no activity of pancreatic protease activator% trypsin and then induced the aforementioned series of pancreatic enzyme reaction caused the hemorrhage and necrosis. Duodenal obstruction caused by a number of factors ampulla gallstone, roundworm, over eating and drinking-induced spastic sphincter ampulla and duodenal papilla edema. After two kinds of reasons may also enter the pancreatic duodenal fluid within.
2. Hyperparathyroidism pancreatic secretion of pancreatic juice to the pressure increased over eating and drinking, the alcohol and acid stimulated duodenal to promote secretion of pancreatic juice of secretin increased, thereby promoting increased secretion of pancreatic juice, causing increased pressure within the pancreatic duct. Weight may lead to pancreatic acinar small catheter and rupture, release of endogenous live, activated trypsinogen, so as to the cause pancreatic tissue hemorrhage and necrosis.
In acute pancreatitis on the actual incidence is likely to be such a combination of two factors, namely pancreatic secretion hyperthyroidism and incomplete occlusion coexist. In recent years, and noted that the bacterial infection can damage bile duct surface coating of mucus barrier, biliary tract infection stressed the importance of the本病发生on.
(1) acute pancreatitis
Acute pancreatitis is pancreatic trypsin digestion and its surrounding tissues caused by acute inflammation manifested mainly as a pancreatic inflammatory edema, hemorrhage and necrosis, is also known as acute hemorrhagic pancreatic necrosis (acute hemorrhagic necrosis of pancreas), occurs in the in males, there are over eating and drinking before the attack or the history of biliary tract diseases. Clinical manifestations of a sudden attack of severe upper abdominal pain and shock.
Lesions
Performance by different diseases, the disease can be divided into acute edema (or interstitial) pancreatitis and acute hemorrhagic pancreatitis II.
1. Acute edema (interstitial) pancreatitis see more about acute pancreatitis all cases the 3 / 4 or more. More pancreatic lesions limited to tail. The pancreatic lesions enlarged stiffen, interstitial edema and congestive neutrophil and mononuclear cell infiltration. Sometimes limitations of fat necrosis may occur, but no bleeding. Better prognosis of this type, often after treatment lesions and dissipated in the short term recovery. A few cases may change as acute hemorrhagic pancreatitis.
2. Acute hemorrhagic pancreatitis rare. The rapid onset of this type, severity and prognosis of serious than edema. The pancreatic lesions with extensive necrosis and hemorrhage features with slight inflammatory response.
Naked eye view enlarged pancreas, soft, bleeding, fuzzy-leaf structure. Pancreas, omentum and mesentery and other places scattered in the muddy yellow-white spots, or in small block of fat necrosis lesions. Necrotic foci due to pancreatic juice overflow, which will be neutral fat lipase decomposed into glycerol and fatty acids, while the latter is in the tissue fluid combination of calcium into the insoluble calcium soap formed.
Microscope, a large pancreatic tissue coagulation necrosis, cell structure unclear, mesenchymal small vessel wall also necrosis, which is caused pancreatic bleeding reasons. In the pancreatic tissue necrosis around the foreseeable neutral and monocyte infiltration. Patients such as through the acute stage, inflammatory exudation and necrosis were gradually being absorbed, partial recovery occurred fibrosis and chronic pancreatitis or change.
Clinicopathological links
1. Patients often a shock shock symptoms. The shock can cause a variety of reasons, such as pancreatic juice spills due to stimulate the peritoneum caused severe pain; pancreatic tissue and abdominal hemorrhage; tissue necrosis, protein decomposition caused by the body poisoning. No serious shock timely rescue can be lethal.
2. Acute peritonitis due to pancreatic necrosis and pancreatic juice spills, and often cause acute peritonitis.
3. Pancreatic necrosis of the change, due to pancreatic juice spills, which contained a large number amylase and lipase can be and discharged from the urine. Patients with clinical examination and the common urinary amylase and lipase levels increased, which will enable diagnosis.
4. Changes in serum ionized calcium in the blood, potassium, sodium levels drop. The reasons for the decline calcium, in recent years, studies of acute pancreatitis that pancreatic alpha cells stimulated, secreted glucagon (glucagon), which enables calcitonin thyroid secretion, inhibit intracellular free calcium from bone, causing pancreatitis while consumption of fat necrosis due to the lack of calcium and a calcium supplement reduced. Serum potassium, sodium decline may cause persistent vomiting.
(2) chronic pancreatitis
Chronic pancreatitis is due to recurrent acute pancreatitis caused by a chronic progressive destruction of pancreatic diseases. Some cases of the acute phase not obvious, symptoms occult, which is a chronic when found. Clinical accompanied biliary system disorders, patients, abdominal pain, diarrhea and fat, and sometimes complicated by diabetes. Chronic alcoholism, the disease often caused.
Lesions
Naked eye view, the pancreas was nodular, quality hard. Section Visibility pancreatic interstitial fibrous tissue hyperplasia and pancreatic duct expansion, a pipe occasionally stone formation. Sometimes real visible pancreatic necrosis, liquefied necrotic tissue after being surrounded by fibrous tissue formation false cyst. Endoscopic, and that pancreatic acinar lobular surrounding fibrous tissue hyperplasia or intergovernmental extensive fibrosis, and acinar pancreatic tissue atrophy, disappeared, have interstitial lymphocytes, plasma cell infiltration.

Research has shown that smokers of the dangers of smoking and its proportional to the degree. To quit smoking 10 to 15 people, the risk of life-long non-smokers with similar. Suction cigar, cigarette, pipe and chewing tobacco are in danger of respect no difference.
The geographical distribution of pancreatic cancer research, such as studies on migrants, fully shows that environmental factors, such as diet and carcinogenic effects. Animal experiments proved with pancreatic cancer development. Other cards such as meat and high fever diet, especially high-carbohydrate, dairy products and marine food is also relevant factors. The structure of the high-fiber diet, fruit and fresh vegetables fewer people suffering from pancreatic cancer. Although caffeine drink alcoholic beverages is growing is considered a risk factor, but there are many studies do not support this point of view.

Similarly, many studies do not support diabetes and the relationship between pancreatic cancer, although some forward-looking studies have shown that people suffering from diabetes the risk of pancreatic cancer than others or four times higher. Pancreatic cancer has been found in recent years confirm there are several months before onset diabetes, found that doctors may advise against non-diabetic middle-aged family history of early pancreatic cancer patients to consider the possibility.

And pancreatic cancer is related to occupational chemicals and metal contacts work, researchers think that with β - naphthylamine and benzene-related work in the factories of men suffering from pancreatic cancer have a high risk.

Pancreatic cancer genetic factors have not been clearly confirmed, but there are also families incidence report. Recent studies that have close relatives in the malignant pancreatic tumor prevalence higher risk.

Under 40 years of age were suffering from pancreatic cancer rarely, the average age was 63 years old sick, men slightly higher than women. Pancreatic cancer mortality and incidence rates almost unanimously, the five-year survival rate is very low, and almost all have undergone surgery. Not for treatment of pancreatic cancer patient’s survival period of about four months, receiving bypass surgery for patients survival time of about seven months, after surgery patients generally survive 16 months. According to the latest statistics, 20 percent of patients survive a period of 1 year, 3% of the patients survival period is five years.

Using rats (Diazo acetyl serine), the Syrian hamster (N-nitroso bis [2 - oxygen propane] amine or amine BOP), and guinea pigs (methyl-nitrosourea) reproduction of rodents Tooth animal pancreatic cancer model has been successful. Nitroso complexes Rodent is the most effective carcinogens. Foods containing large number of saturated fat can promote formation of cancer in rats. Cholecystokinin (CCK) or its analogues bombesin peptide cholecystokinin (cerulein) can stimulate secretion in vitro and in vivo experimental animal pancreatic growth. Speculate may be precisely because of the release of CCK, diet rich in soy powder and trypsin inhibitor can be formed to cancer in rats. CCK promote pancreatic juice and intestinal peptide together can stimulate the carcinogenic substances led to pancreatic cancer. Recent experiments will be an artificial pancreas CCK receptor antagonist in the formation of new biological before implantation in rats that can stop Diazo acetyl serine role. This, however, the use of antagonists in clinical needs further study. Lovastatin (Lovastatin) - A cholesterol-lowering drugs, in vitro experiments can inhibit the growth of pancreatic cancer.

      Pancreatic carcinoma patients can have on the digestive system disease symptoms, such as nausea, lack of appetite, dislike oils, fats, such as symptoms of diarrhea, eating high-fat and high-protein diet, symptoms increase. When the diagnosis of pancreatic cancer and did not have the above symptoms, they should heighten their vigilance and early treatment. As for pancreatic cancer diagnosed, the more attention should meal. Dine to have regularity day three meals to five meals, eat snacks, this would prompt the pancreatic secretion of pancreatic juice constantly, add to the burden of pancreatic function. Meals must be reasonable mix, pay attention to carbohydrate, fat and protein percentage, we should take the main carbohydrate, fat and protein to the appropriate amount to eat to the digestion and absorption of protein, such as lean meat, eggs and fish, it is necessary to adopt reasonable cooking methods to cook, stewing, boil, steam, wandering, boil for a short time and so on, do not use fried, fried, stir-way, and prevent food grease so much that excessive secretion of pancreatic pancreas. , Advanced pancreatic cancer, the symptoms, left upper abdominal pain increased, and obviously suffering from weight loss, patients usually oral diet has no guarantee that the body needs, we will have to through intravenous nutrition, to improve the nutritional status of whole body. The opportunity has not been lost surgery patients should try to take a positive approach, through surgery for removal of lesions. After the operation patients according to the situation and surgical diseases of the situation, to determine what the diet. In general, three days after surgery fasting cut water, mainly through intravenous nutrition and the surrounding central venous nutrition to maintain the body’s physiological needs. When the exhaust, may appropriate ate the whole flow of fresh oil as, fruit water or vegetable to stimulate the gastrointestinal tract, gastrointestinal tract gradually adapted itself to be, under condition to be low-fat or low-fat half - Pu Fresh. If the purposes of the jejunostomy, can be given through the fistula homogenate meals, we should pay attention to giving absorption of food, such as steamed bread, eggs, lean meat, chicken (boneless), fish (to thorns), Cucumber, tomato, rape, spinach, soybean products, and so on, these dishes, reuse organizations broken up-smash, smash the particles according to the appropriate nasal feeding tube diameter sizes to determine, not a word to small coarse to prevent fistula the all Cypriots.

     Although pancreatic cancer is the number one killer, but its difficult early diagnosis and daunting. Beijing Union Medical College Hospital Medicine has just completed digest an important research allows people to fear diminished. The study results show that the joint stool K-ras oncogene and tumor suppressor gene p53 mutation detection, as well as tumor markers CA19-9 test, it is possible early detection of pancreatic cancer. In the recently held directly under the Ministry of Health (tube) units clinical disciplines in the assessment of key projects inspection, the assessment of the study was highly appraised by experts.
     In recent years, the global incidence of pancreatic cancer are increasing year by year. Over the years both at home and abroad no breakthrough in the diagnosis. In patients attending 3 / 4 is already late, the five-year survival rate of less than 5%. If input in the early diagnosis and treatment, the five-year survival rate of 20% to 50%. Therefore, the study of new screening and diagnostic means to improve the early detection rate of pancreatic cancer is the key to conquest.
     With the support of funds from 1997, the Beijing Union Medical College Hospital digestive medicine to land Star team, headed by Professor Early diagnosis of pancreatic cancer a comprehensive and in-depth exploration. Their study found that the duodenal cholangiopancreatography has the highest sensitivity and accuracy of the diagnosis; pancreatic cancer multiple oncogenes or tumor suppressor gene and protein anomalies very prominent. In the K-ras, P53 and P16 are two or more abnormal gene for 18 percent to 47 percent, while the absence of such chronic pancreatitis; stool DNA extraction through an improved method will be significantly higher than that reported in literature abroad PCR expansion by success rate. On this basis, the combined application of manure K-ras mutations and P53 mutation detection, diagnosis of pancreatic cancer sensitivity of up to 93.2%, if the above two with the detection of a tumor marker CA19-9 joint testing, diagnostic specificity of up to 85% to 100%; confirmed by surgery and pathology of T1 (tumor confined to the pancreas, there is no lymph node metastases) patients with pancreatic juice and feces K-ras mutation rate and P53 mutation rate and T2 more than similar patients . The aforementioned study, they concluded, the joint stool K-ras, p53 mutation detection and CA19-9 test, it is possible in the early detection of pancreatic cancer.
     It is learned that the experts will carry out the next stage of pancreatic cancer in the high-risk population (aged 45 and above, the new, diabetes, chronic pancreatitis, smoking, family history of cancer) for epidemiological investigation and follow-up to verify their screening method introduced .

     The treatment of this disease should be based on the severity of disease, be selected, in principle, light non-surgical therapy can be used to deal with medical mainly on heavy gallstone pancreatitis and secondary lesions, such as pancreatic abscess, pancreatic cysts, and other pseudo be positive support and surgical treatment to save lives.
     (1) Non-Surgical Treatment
     1. Spasmolysis analgesics (1) pethidine, atropine injection. When severe abdominal pain to be in the application. It is not appropriate use of morphine analgesia alone, the sphincter of Oddi spasm their lead, its combination of atropine may confrontation caused cramps, yielded a good result. (2) Acupuncture Treatment: Body Acupuncture from Yang Ling-chuen, Zusanli, customs within the next giant imaginary, in, etc.. Ear acupuncture from pancreas, biliary District. (3) does not ease the pain, can be 0.1% Merino Qazi by 300 to 500 ml, intravenous drip.
     2. Control diet and gastrointestinal decompression light can flow into a small amount of light juice,fat, irritating food, are required to strictly ban severe diet to reduce or inhibit secretion of pancreatic juice. Illness Shigeatsu or abdominal distension obviously, should visit gastrointestinal decompression may be out of gastric, duodenal stimulation to reduce gastric acid produced in promoting pancreatic juice, cholecystokinin, to reduce the secretion of pancreatic juice, and prevention and treatment of paralytic ileus. Infusion should be fasting period, the added calories, nutrition support. The maintenance of water and electrolyte balance, correct hypocalcemia, low magnesium, acidosis and high blood sugar, etc.. If necessary, given total parenteral nutrition (TPN) to maintain electrolyte and hot water supply cards. Advantages of pancreatic juice can reduce the secretion of digestive tract to rest, compensatory body catabolism.
     3. Antibiotics commonly used penicillin, streptomycin and gentamicin, ampicillin, methyl benzyl penicillin, Pioneer Adriamycin, for the control of anaerobic infections, can be used metronidazole. Because pancreatic hemorrhage and necrosis, the protein product of decomposition is the multiplication of bacteria often a good medium, it was particularly severe in the case as soon as possible and they can play a secondary infection prevention and the prevention of complications.
     4. Trypsin inhibitor used: ① aprotinin (Trasylol), and with anti-vascular ease of pancreatic role. The first volume of 200,000 μ, after 200,000 μ / 6 hours, vein. Or 200,000 μ, 2 times / day, intravenous, linked on the 5th. ② 5 - FU for the cytotoxic drug, can inhibit DNA and RNA synthesis, secretion of trypsin reduction of trypsin and phosphoric acid lipase were inhibited A daily 100 ~ 500 mg intravenous, or 250 mg in 5% glucose the infusion of 500 ml, 24 hours can repeat.
     5. Give anticholinergic drug atropine 654-2, scopolamine, Propofol the digoxin to inhibit secretion of pancreatic juice, preferably early repeatedly application. Acid at the same time should be given for a cyanide microphones listening Chat 200 mg, four times / day, aluminum hydroxide gel, and sodium bicarbonate in the gastric acid to oral, inhibit secretion of pancreatic juice. Glucagon inhibited pancreatic exocrine on a certain role, can also be used.
     6. Hormones can cause their application generally do not advocate the use of acute pancreatitis. But with severe pancreatitis shock; obvious symptoms of poisoning, suspected sepsis, or illness suddenly worsened serious breathing difficulties, particularly in adult respiratory distress syndrome; or some tight on the gland cortical dysfunction, should be hydrogen test 500 to 1000 mg, or dexamethasone 20 ~ 40 mg, static, linked 3, suspended by reductions to. Reduce the inflammatory response, reducing capillary permeability and edema.
     7. Treatment: ① Qing Yi Tang No.1: apply to edema pancreatitis, especially suitable for liver Qi stagnation, spleen and stomach hot and humid. Prescription components: Bupleurum 15 g, 9 g, the Hu-Lien 9 g, Hang Shao 15 g, costas 9 g, Yuan Hu 9 g, Health Jun 15 g, mirabilite 9 g  . One day, the fried, served at the second. ② Qing Yi Tang II: apply biliary ascariasis pancreatitis can be Shugan Qi, flooding lumbricoid the lumbricoid. Prescription components: Bupleurum 15 g, baicalin 9 g, Forsythia 9 g, costas 9 g, betel 30 g, the gentlemanly 30 g, hard-dong Paper 30 g, Asarum 3 g, mirabilite 9 g . One day, two fried, served at the second. This applies to the majority of acute pancreatitis, with clinical disease can be modified, TGA, plus two flowers, Forsythia, damp heat of re-plus Chen,  Gentiana. Vomiting-plus Ruddle. Fresh and Semen Raphani plot, coke 0.53, pain Muneko, Yuan Hu cable, plus chest full Magnolol, Zhishi, pain and Gualou, Xiebai, shielding, etc..
     8. Anti-shock: heavy, often a shock early stage, mainly because of the influx of humoral extravasation can cycle of loss 40 percent, it appeared hemorrhagic shock, is the cause of early death, so based on central venous pressure, blood pressure, urine output , hematocrit and electrolyte monitoring, supply balanced salt solution, plasma, fresh whole blood, human albumin, plasma, such as dextran incremental agents and electrolyte solution, in order to restore effective circulating volume and electrolyte balance, it is also necessary to maintain acid alkali balance improvement in the situation, after excluding heart failure induced hypotension, it can boost the application of vasoactive drugs, dopamine is preferred. Furthermore, it should be given broad-spectrum antibiotics and hormones to improve the ability to mobilize the body stress effect. At the same time the protection of renal function, diuretic use, if necessary, to peritoneal dialysis. Respiratory failure, arterial blood gas analysis should be high-flow oxygen, when necessary, will tracheotomy and positive pressure breathing. If cardiac dysfunction should promptly gave tonic. The rescue, should be collaboration with the College of Physicians can be successful.

     In patients with previous history of the statistics, diabetes, gallstones, and peptic ulcer were 20.1%, 7.3%, 7.2% ranked top three. While pancreatic cancer has been considered to be the main incentive for chronic pancreatitis only 3.4 percent. For this result, the presence of many doctors expressed surprise.
     In the treatment of pancreatic cancer, 39.4 percent took resection (1988 compared to an increase of 0.6 percentage points), 33.2% by the non-removal treatment, 21.1 percent were conservative surgery (year-on-year decrease 8.2 percentage points) , 3.5% only implemented a laparotomy (year-on-year decrease of 5.6 percentage points). Because worsening of the illness which has been introduced to the increase in the number of patients is likely to cause a rise in the proportion of non-surgical causes.
     On surgery, 10 years ago, accounted for more than half of the pancreatic duodenal surgery has dropped significantly to 37.9% (year-on-year drop of 20.8 percentage points). In its place is a brand-new pyloric ring pancreatic duodenal surgery. This technique has gradually risen to 26.2 percent, which increasingly see that people tend to choose the importance of improving the QOL in patients with surgical method.

1. The incidence of pancreatic cancer in recent years have significantly increased trend.
2. Pancreatic cancer early without typical clinical manifestations, abdominal pain need to identify many diseases, so prone to misdiagnosis and mistreatment, the misdiagnosis rate in the 35.5% to 87.5%, and often misdiagnosed as cholecystitis ﹑ ﹑ gastrointestinal diseases, such as hepatitis ﹑ pancreatitis.
3. Misprision of pancreatic cancer clinical manifestations, it is not easy early detection, 80% of the patients already advanced when diagnosed, the low rate of surgical resection, about 5% to 15%.
4. Pancreatic cancer can be divided into parts by the anatomy of pancreatic cancer ﹑ ﹑ pancreatic carcinoma of the pancreas tail cancer, the most common pancreatic cancer.
5. CA19-9 is the most hopeful signs in the early diagnosis of pancreatic cancer, the diagnosis rate of 90%.
6. Pancreatic cancer tumors are not sensitive to radiation, local radiotherapy, will enable 30% to 50% of the patients pain relief, and to some extent may inhibit tumor development.
7.70 percent of pancreatic cancer patients increased serum CEA, CEA can be used for pancreatic cancer after surgery before ﹑ the dynamic follow-up regularly on the CEA forecast of cancer recurrence be a valuable reference.
8. Weight loss ﹑ abdominal back pain ﹑ three major symptoms of jaundice is pancreatic cancer, pancreatic cancer can be oppressive violations of celiac plexus led to violent persistent abdominal pain.
9. Chemotherapy no significant effect on pancreatic cancer, coupled with the lower rate of surgical resection, effective pancreatic cancer-specific anti-cancer therapy is the main treatment, the system effective anticancer drug treatment plant activity will be part of pancreatic cancer patients with long-term survival of .
10 clinicians should strictly control pancreatic cancer surgery and chemotherapy indications indications.
11. Pancreatic cancer apparent abdominal back pain are mostly cancer pain, cancer treatment is effective analgesic premise.