04.19 胰腺炎.pptVIP

ACUTE PANCREATITIS Jie Liu Definition (1) Definition (2) Etiology（1） Pathogenesis （1） conversion of trypsinogen to trypsin within acinar cells Pathogenesis （2） Injury by activated enzymes Pathology（1） Edematous Necrotizing Pathology（2） Edematous Pathology（3） Necrotizing Pathology（4） Necrotizing Site Nausea and Vomiting Bloating and constipation Fever Hypotension and shock Abdominal tenderness , guarding, rebounding tenderness, bowel sound extravasation of hemorrhagic pancreatic exudate Local Laboratory diagnosis (1-1) rises within 6 to 12 hours of onset peek: 48hr remains elevated for 3 to 5 days（75%） normal value 40~80U , ≥ 500 U (somogy ) sensitivity:92%，specificity:92% Laboratory diagnosis (1-2) Laboratory diagnosis (2) PLA2, trypsin, carboxylester lipase, carboxypeptidase A, colipase, elastase, and ribonuclease Pancreatic associated peptide (PAP), Pancreatic specified peptide (PSP), TAP, CRP, IL-6 Laboratory diagnosis (3) used during the first 24 hours of hospitalization less accessible and more expensive than CT as good as CT in detecting necrosis and fluid collections a better method to detect choledocholithiasis and ductal disruption Diagnosis（1） Clinical features + signs + amylase + BUS / CT Diagnosis（2） CT Grading System of Balthazar CTSI = Balthazar Grade Score Plus Necrosis Score Differential Diagnosis Biliary pain/acute holecystitis ? Perforated hollow viscus ?? Mesenteric ischemia or infarction ?? Closed-loop intestinal obstruction ?? Inferior wall myocardial infarction ?? Dissecting aortic aneurysm ?? Ruptured ectopic pregnancy Treatment ( 1 ) Fluid resuscitation 5 to 10 liters /day for the first several days isotonic saline dextran :hematocrit value of around 30% When hematocrit decreases to around 25% : packed red blood cells should be infused Treatment ( 3 ) Treatment ( 4 ) majority of organisms : gram-negative aerobic or anaerobic species Treatment ( 5 ) MAP :