胃肠道-中英文willard图片见8-chn pancreatitis in dogs

HistorySignalment临床表

饮食情Historyof胰腺炎病 腹HistorySignalment临床表Di胰腺炎病

饮食 腹VmiH胰

History饮史 腹KnowingtheLIMITATIONSofatestorprocedureisoftenmuchmoreimportantthanknowingwhataprocedurecandoPhysicalAnteriorabdominal Profuse 发SQ 皮下脓PhysicalAnteriorabdminal Profuse 发SQ 皮下脓

Physical lIs疸s发皮下脓WHICHCBC(S)IS/AREFROMDOG(S)WITHACUTE000ClinicalAnanorexic,vomitingdogfastinghyperlipidemiaprobablyhasacutepancreatitis ClinicalAnanorexic,vomitingdogwithhyperlipidemiaprobablyhasacute MostdogswithpancreatitisDONOThavefastinghyperlipidemiaClinicalSensitivity~Specificity~

Sensitivity~ ClinicalAmylase/Lipa – cificity~ –

Clinical–Sensitivity~80-敏感性~80-Sig:14yrM(n)ShihTzu14 Abdominal HPI:Pain2daysagoandVomited1PU-PDforlast

Noabnormalities PCV=WBCSegsBands=Lymphs= ets

24%(35-23,300/ul(6,-17,475/ul(4,-0/ul(<4,660/ul(1,-498,000/ul(200,-肌酐Creatinine 0.78mg/dl(<钙Calcium9.7mg/dl(9.3-钠Sodium钾Potassium3.8mEq/L(3.8-ALT=SAP=

2.7gm/dl(2.5-8,258IU/L(<2,354IU/L(<0.3mg/dl(0-AbdU/S:“....enlargedpancreaswithnodules...hepaticmassmostconsistentwithprimarylivertumor” SnapPL: cPL试剂盒检测：YourbestnextstepForgetaboutit(dogisnowRepeatcPLIandultrasoundTxforacutepancreatitis(IVTxwithpancreaticHepatic 肝叶切除 CLINICALLYIMPORTANT胰腺炎和 需重视的胰腺

Sensitivity~ AbdominalSensitivity40%-

Sensitivity~ 敏感性-Abdominalultrasound腹部超声检Sensitivity40%65%敏感40% Becausecliniciansrarelyrepeatthe

Sensitivity~ 敏感性-Abdominalultrasound腹部超声检Sensitivity40%65%敏感40%Findingscanchangewithinhours检查结果数小时内就可能发生变化WHATISTHEBESTWAYTODIAGNOSECANINEACUTEBeBewillingtorepeatAllAllthingsbeingequal,trytoavoidsurgeryBeBewillingtorepeatAllAllthingsbeingequal,trytoavoidsurgeryTHEREALPROBLEMISTHATACUTEPANCREATITISCANPRESENTINSOMANYDIFFERENTWAYSTHATYOUDON’TEVEN ITINITIALLY 7yrMSheltie HPI:Began5weeks

Partialanorexia,vomitsphlegmorbileoncedaily有时厌食 Dogotherwisepretty Nosignificant Sig:9yrM(c)犬

9 Vomitingyellow HPI:Feelingbad12daysago12天前状态不佳Startedvomiting,respondedtofluidtherapy,butbecameillagainwhenstartedfeedingit Dog’seyesturned PCV=BUN葡萄Glucose Potassium=胆固醇Cholesterol=白蛋白Albumin=ALT=SAP

4mg/dl(8-95mg/dl(75-3.6mEq/L(3.8-597mg/dl(120-2.9gm/dl(2.5-1,691IU/L(<3,134IU/L(<4.5mg/dl(0-TAMU 9yrF(s)

9HPI:Vomitingfood/bile6-8Xin2 Diarrheaconstantfor2weeksDecreasedappetitefor10days,anorexiafor5食欲减退10天，厌食5 T=39.2C,HR=TAMUPCVWBCSegs叶状中性粒细Bands

35.5%(35-21,700/ul(6,-15,200/ul(4,-630/ul(<杆状中性粒细Lymphs=1,400/ul(1,-淋巴细 ets=568,000/ul(200,-TAMU钠Sodium152mEq/L(138-钾Potassium4.1mEq/L(3.5-葡萄Glucose107mg/dl(60-白蛋Albumin2.7gm/dl(2.5-123IU/L(<SAP2,174IU/L(<肌 1.3mg/dl(<TAMU“…Smallamountofanechoiceffusionbetweenliverlobesandaroundurinary TAMUAbdominalfluid:WBC=RBC=

Totalprotein 4.6总蛋90%nondegenerate8%macrophages,SterilepancreatitisVersus和SepticAbdominalfluidTP0AbdominalfluidTPgmPANCREATITIS无腹腔积makealittleabdominal产生少量腹腔积Pancreatitiscanpresent胰腺炎可表现acutevomitingwithabdominal急 伴有腹部疼chronic,lowgradevomiting/anorexia慢性轻 /厌食（脓肿icterus(biliarytract黄疸（胆道阻塞ascites(minimal,littleor腹水（少量、无腹水或大量acuteabdomen(looksjustlikesepticSIRS(lookslikesepticshock)RESPONSESYNDROME全身性炎症反应综合 usedtobecalled“Septicshock”曾被称为“败血性休克”RESPONSESYNDROME inadequateperfusionofthebodytissuesbecauseofanexaggeratedinflammatory剧烈的炎症反应导致机体组织灌注不WHATISSUPPOSEDHAPPEN认为会发生什Bacterialtoxin,inflammatoryLymphnodes,hepatic ，肝脏巨噬细Systemic全身循WHATISSUPPOSEDHAPPEN认为会发生什Bacterialtoxin,inflammatoryLymphnodes,hepatic ，肝脏巨噬细Systemic全身循WHATCAN会发生什InflammatoryLymphnodes全身循Mildunevenvasodilatation“HighoutputshockBrightredmucus FastcapillaryrefilltimeBounding

LATE–Severeperipheralvasodilatation+poorcardiaccontractility严重的外周血管扩张“LowoutputshockPalemucusmembranesWeak SlowrefilltimeTHERAPYFOROnlysupportiveand仅用支持疗法和对症治NPO(nothingperos)vsEarlyTHERAPYFOROnlysupportiveand仅用支持疗法和对症治Early 早期饲 Feedsmallamountsofultra-lowfatfoodevenifvomiting即 也饲喂少量超低脂食 Continuefeedingaslongasthepatientdoesnotgetworse只要动物病情没 ，便继续饲THERAPYFOROnlysupportiveand仅用支持疗法和对症治EarlyFluid

Crystalloids

THERAPYFOROnlysupportiveandEarlyFluid

液体疗Crystalloids

Hetastarchisnolongereveryone’sfriend...(JVetEmergCriticalCare25:20-47,羟乙基淀粉不再是所有人最好的朋友THERAPYFOROnlysupportiveandEarlyFluid

液体疗Crystalloids

完全/部分肠外营养支THERAPYFOROnlysupportiveand仅用支持疗法和对症治EarlyFluid

早期饲液体疗Crystalloids

Jejunostomyfeeding空肠造口(PEG-J,NasalJ,regularTHERAPYFOROnlysupportiveandEarlyFluid

液体疗Crystalloids晶体

镇痛THERAPYFOROnlysupportiveandgesicsHydromorphoneor FLKcocktail(CRIoffentanyl, –Butorphanol(moreofa 剂THERAPYFOROnlysupportiveandEarly Fluid Anti-