Serum glucose
急性胰腺炎
Diagnosis
and Clinical findis
Amylase
Acute pancreatitis
edematous and acute
CT
hemorrhagic pancreatitis
急性胰腺炎
Assessment of severity of acute pancreatitis
Ranson's criteria
On Admission
Within 48 Hours
Age > 55 years
Hematocrit decrease by >10%
WBC > 16,000 /mm³ Urea nitrogen increase > 5 mg/dl
Drug: Azathioprine(硫唑嘌呤) .6-Mercaptopurine(6-巯基嘌呤), Pancreas divisum(胰分裂),
急性胰腺炎
Pathology
acute
edematous
pancreatitis
acute hemorrhagic necrotizing pancreatitis
Dilated loop of small bowel (sentinel loop) Abrupt cessation of gas in the distal transverse colon (colon cutoff sign) Radioopaque densities (biliary calculi)
急性胰腺炎
Clinical finding Abdominal pain Abdominal distention Nausea and vomiting Peritonitis Other:
Respiratory failure, confusion, or coma. Low-grade to moderate fever
500
Urine amylase
400
Blood amylase
300
200
100
急性胰腺炎
Serum calcium Serum glucose Blood gas analysis Imunolipase ALT and AST (gallstone pancreatitis )
急性胰腺炎
Imaging finding X-ray
胰腺疾病
解剖生理概要
解剖
头，颈，体，尾，钩突。 主胰管 (duct of Wirsung) 副胰管 (duct of Santorini)
胰腺分泌 外分泌Exocrine 内分泌Endocrine B,A,D,D1,G cell
c
急性胰腺炎
Causes
Gallstones:60%( 35–50% in USA) Alcohol:14% %(60% in USA) Duodenal juice countercurrent flow: Sphincter of Oddi dysfunction Trauma Pancreas circulation disorder Other factors:
LDH > 350 IU/L
Serum calcium < 1.87 mmol/l
Glucose >11.1mmol/l Arterial PO²< 8KPa(60 mm Hg)
AST > 250 IU/L
Base deficit > 4 mEq/L
急性胰腺炎
Glasgow Criteria Within 48 Hours
急性胰腺炎
Laboratory finding
Amylase and lipase (elevations of amylase are
more sensitive but less specific than lipase in the
diagnosis of acute pancreatitis )
Mean blood pressure
• Leukocytes
Serum Creatinine
• Hematocrit
Heart rate
• Albumin
Respiratory rate
• Bilirubin
Oxygenation
Arterial pH
Serum sodium and potassium
急性胰腺炎
Peritoneal irritation sign （ Abdominal tenderness ， rebound tenderness and rigidity） Shifting dullness Decreased bowel sounds Cullen’ sign: discoloration of periumbilical area Grey Turner’ sign:discoloration of flanks
Age > 55 WBC > 15,000 /mm³ LDH > 600 IU/L Glucose > 180 mg/dl Albumin < 3.2 g/dl Calcium < 8 mg/dl
Urea > 45 mg/dl
急性胰腺炎
APACHE III criteria
Temperature
• BUN
(acute hemorrhagic pancreatitis, acute necrotizing
急性胰腺炎
Pathophysiology Hypersecretion and obstruction
Self-enzymatic digestion
Enhancement of Vessel permibility Cytokine，infection Decreased arterial perfusion
Left-sided pleural effusion
•CT is the best diagnostic test for the diagnosis of acute pancreatitis. •Contrast-enhanced CT is excellent for diagnosis of pancreatic necrosis