急性胰腺炎 acute pancreatitis.pptx

1、Acute Pancreatitis,PBL-Digestive system,Acute Pancreatitis,AP,Acute pancreatitis is a sudden inflammation of the pancreas. Depending on its severity, it can have severe complications and high mortality despite treatment. While mild cases are often successfully treated with conservative measures, sev

2、ere cases may require admission to the ICU or even surgery (often requiring more than one intervention) to deal with complications of the disease process.,Contents,Predisposing Conditions Pathophysiology Clinical Features Laboratory Diagnosis Diagnostic Imaging Prevention,PREDISPOSING CONDITIONS,Obs

3、tructive Alcohol/other toxins/drugs Metabolic Infectious Vascular Trauma ERCP Postoperative Hereditary/familial/genetic Controversial Miscellaneous Idiopathic,Gallstones Tumors Parasites Duodenal diverticula Annular pancreas Choledochocele Other,PATHOPHYSIOLOGY,gallstones,Obstruction of exit of vate

4、r,Inner pressure in the biliary tract increase,Bile flows retrogradely into pancreatic duct,Acute pancreatitis,Bacterial toxins Free bile acid Unconjugated bilirubin,alcohol,Gastric acid secretion,Edema of duodenal papilla,Sqasm of the sphinctor of oddi,Direct injury to pancreas,Content of protein i

5、n the pancreatic juice increase,Secretin and CCK secretion increase,Blockage to drainage of pancreatic juce,Pancreatic Hyper-tention,Pancreatic juice spillage,Acute pancreatitis,Forrm small protein plugs,PATHOPHYSIOLOGY,The pathophysiology of acute pancreatitis starts with local acinar injury that,

6、if unchecked, leads to local inflammatory complications, a systemic response and sepsis. Pathophysiologic mechanisms include microcirculatory injury, leukocyte chemoattraction, release of pro- and anti-inflammatory cytokines, oxidative stress, leakage of pancreatic fluid into the region of the pancr

7、eas, and bacterial translocation to the pancreas and systemic circulation.,Clinical Features-History,Abdominal pain Nausea and vomiting Overeating/Heave drinking Chronic cholecystitis and cholelithiasis,Clinical Features-Physical Examination,Physical findings vary with the severity of an attack Abdo

8、minal tenderness-left upper quadrant (M-S) Abdominal guarding Abdominal distention Abdominal rigidity Bowel sounds are reduced,Mild Pancreatitis,Clinical Features-Physical Examination,Ecchymosis in one or both flanks-Grey Turners sign Ecchymosis in peirumbilical area-Cullens sign palpable epigastric

9、 mass Heart rate-100 to 150 beats/minute 96 Blood pressure can be higher/lower than normal Temperature-normal-high（within 1 to 3 days） Respiratory rate 24/min Jaundice-persisted for 5 days,Acute hemorrhagic pancreatic,Laboratory Diagnosis,Pancreatic Enzymes-Serum Amylase/Serum Lipase/Other Pancreati

10、c Enzymes Other Blood and Urine Tests Standard Blood Tests,Diagnostic Imaging,Abdominal Plain Film Chest Radiography Abdominal Ultrasonography Endoscopic Ultrasonography Computed Tomography Magnetic Resonance Imaging,Predictors of Severity,Scoring Systems Organ Failure Peritoneal Lavage Laboratory M

11、arkers Computed Tomography Chest Radiography,MAP SAP,APACHE-II Scores,Pathological classification,acute edematous pancreatitis,AEP Abdominal tenderness-left upper quadrant (M-S) Abdominal guarding Abdominal distention Abdominal rigidity Heart rate-100 to 150 beats/minute 96 Blood pressure can be hig

12、her/lower than normal Temperature-normal-high（within 1 to 3 days） Respiratory rate 24/min acute hemorrhagic necrotic pancreatitis,AHNP,Local Complications,Pseudocyst Necrotizing Pancreatitis and Abscess Gastrointestinal Bleeding Splenic Complications Bowel Compression or Fistulization,Systemic Compl

13、ications,Organ Dysfunction Metabolic Disturbances Coagulation Disorders Fat Necrosis Miscellaneous,Prevention,Will it happen again? An attack of acute pancreatitis may be a one-off event. However, if there is an underlying cause, then it may recur unless the cause is corrected. One of the following may be relevant to prevent a recurrence, depending on the cause Alcohol-related concerns An operation to remove your gallbladder is usually advised if a gallstone was the cause. Hyperli