Acute Pancreatitis：急性胰腺炎.ppt

Acute Pancreatitis Rajeev Jain, M.D. December 15, 2003 Normal Anatomy Physiology neutralize chyme digestive enzymes hormones Exocrine Function Enzyme Secretion Enzyme Secretion Digestive Enzymes in the Pancreatic Acinar Cell Normal Enzyme Activation Exocrine Stimulation The more proximal the nutrient infusion…the greater the pancreatic stimulation (dog studies) stomach – maximal stimulation duodenum – intermediate stimulation jejunum – minimal / negligible stimulation Elemental formulas tend to cause less stimulation than standard intact formulas intact protein oligopeptides free amino acids Intravenous nutrients (even lipids) do not appear to stimulate the pancreas Protective Measures COMPARTMENTALIZATION - digestive enzymes are contained within zymogen granules in acinar cells REMOTE ACTIVATION - digestive enzymes are secreted as inactive proenzymes within the pancreas PROTEASE INHIBITORS – trypsin inhibitor is secreted along with the proenzymes to suppress any premature enzyme activation AUTO “SHUT-OFF” – trypsin destroys trypsin in high concentrations Acute PancreatitisDefinition Acute inflammatory process involving the pancreas Usually painful and self-limited Isolated event or a recurring illness Pancreatic function and morphology return to normal after (or between) attacks Acute PancreatitisEtiology Acute PancreatitisAssociated Conditions Cholelithiasis Ethanol abuse Idiopathic Medications Hyperlipidemia ERCP Trauma Pancreas divisum Hereditary Hypercalcemia Viral infections Mumps Coxsackievirus End-stage renal failure Penetrating peptic ulcer Acute PancreatitisCausative Drugs AIDS therapy: didanosine, pentamidine Anti-inflammatory: sulindac, salicylates Antimicrobials: metronidazole, sulfonamides, tetracycline, nitrofurantoin Diuretics: furosemide, thiazides IBD: sulfasalazine, mesalamine Immunosuppressives: azathioprine, 6-mercaptopurine Neuropsychiatric: valproic acid Other: calcium, estrogen, tamoxifen, ACE-I Adjusted ORs for Pancreatitis Pancreas