area • Grey Turner’ sign:discoloration of flanks
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 )
• 500 • 400
Urine amylase
• 300 • 200
Blood amylase
• 100
•0
• 0 1H 24H
48H
5DAY
急性胰腺炎
• Serum calcium • Serum glucose • Blood gas analysis • Imunolipase • ALT and AST (gallstone pancreatitis )
急性胰腺炎
• Glasgow Criteria
• Within 48 Hours
• Age > 55
• WBC > 15,000 /mm³
急性胰腺炎
• Pathophysiology • Hypersecretion and obstruction
Self-enzymatic digestion
Enhancement of Vessel permibility Cytokine，infection Decreased arterial perfusion
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
急性胰c 腺炎
• Causes
• Gallstones:60%( 35–50% in USA) • Alcohol:14% %(60% in USA) • Duodenal juice countercurrent flow: Sphincter of Oddi
急性胰腺炎
• Assessment of severity of acute pancreatitis
Ranson's criteria
On Admission
Age > 55 years WBC > 16,000 /mm³ LDH > 350 IU/L Glucose >11.1mmol/l AST > 250 IU/L
Within 48 Hours
Hematocrit decrease by >10% Urea nitrogen increase > 5 mg/dl Serum calcium < 1.87 mmol/l Arterial PO²< 8KPa(60 mm Hg) Base deficit > 4 mEq/L Estimated fluid sequestration > 6 L
急性胰腺炎
• Pathology • acute edematous
pancreatitis • acute hemorrhagic
necrotizing pancreatitis (acute hemorrhagic pancreatitis, acute necrotizing pancreatitis)
急性胰腺炎
• Imaging finding • X-ray • Dilated loop of small bowel (sentinel loop)
• Abrupt cessation of gas in the distal transverse colon (colon cutoff sign)
• Radioopaque densities (biliary calculi)
• Left-sided pleural effusion • B-US: pancreatic edema, ascites---• CT: Important
•CT is the best diagnostic test for the diagnosis of acute pancreatitis. •Contrast-enhanced CT is excellent for diagnosis of pancreatic necrosis
急性胰腺炎
• Peritoneal irritation sign （Abdominal tenderness， rebound tenderness and rigidity）
• Shifting dullness • Decreased bowel sounds • Cullen’ sign: discoloration of periumbilical
Edematong
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 Tachycardia and hypotension and Shock Mild jaundice, Pleural effusion.
dysfunction • Trauma • Pancreas circulation disorder • Other factors:
Drug: Azathioprine(硫唑嘌呤) .6-Mercaptopurine(6-巯基嘌呤), Pancreas divisum(胰分裂), Microlithiasis Metabolic cause Infectious causes, ascaris worms蛔虫,HIV----Miscellaneous