急性胰腺炎的临床处理美国胃肠病学.pptxVIP

华西医院中西医结合科 ;1Center for Pancreatic Care, Southern California Permanente Medical Group, Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California （南加州,凯萨医疗机构） ; and 2 Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts（波士顿，哈佛医学院);Abstract ;Contents;Diagnosis;;;;;间质水肿性胰腺炎;;Figure 2. Pancreatic and peripancreatic necrosis. This image shows an acute necrotic collection involving both the pancreas (large arrow) and peripancreatic tissue. Figure 3. Walled-off pancreatic necrosis is an encapsulated collection of necrosis. This type of collection typically forms 4 to 6 weeks after disease onset. This image shows pancreatic and peripancreatic necrosis.;De?nition of Systemic Complications and Organ Failure;De?nition of Systemic Complications and Organ Failure;De?nition of Severity; Most patients with mild acute pancreatitis do not require pancreatic imaging analysis and are usually discharged within 3 to 5 days of onset of illness . 轻型急性胰腺炎患者无需影像学检查，住院时间通常为3-5天;Roles of Advanced Imaging Techniques;; MRCP has become a useful procedure for identifying retained common bile duct stones. Selective use of MRCP can reduce the need for ERCP for patients with suspected gallstone pancreatitis. MRCP对胆管结石敏感，能够减少因怀疑为胆源性胰腺炎而行ERCP检查。 MRI is helpful in distinguishing walled-off necrosis from a pseudocyst. For example, in walled-off necrosis, there are variable amounts of ?uid and solid debris that can be visualized using T2-weighted imaging. MRI能用于鉴别是包裹性坏死（WON）或是胰腺假性囊肿，因为T2加权像能很直观地看出含有大量渗液体及固体坏死物的包裹性坏死。 Endoscopic ultrasonography is a highly sensitive test for detecting cholelithiasis and choledocholithiasis.19 It could be an alternative to MRCP, which has limited accuracy for detecting smaller gallstones or sludge. 超声内镜对胆石病高度敏感，可以代替对细小结石或淤泥样胆汁不敏感的MRCP检查。 ;;Risk factors;Clinical scor