Practice Guidelines in Acute Pancreatitis（急性胰腺炎的实践指南）.pdf

American Journal of Gastroenterology ISSN 0002-9270 C 2006 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2006.00856.x Published by Blackwell Publishing Practice Guidelines in Acute Pancreatitis Peter A. Banks, M.D., M.A.C.G.,1 Martin L. Freeman, M.D., F.A.C.G.,2 and the Practice Parameters Committee ∗ of the American College of Gastroenterology 1Division of Gastroenterology, Center for Pancreatic Disease, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; 2Division of Gastroenterology, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota (Am J Gastroenterol 2006;101:2379–2400) INTRODUCTION PATHOPHYSIOLOGY Guidelines for the diagnosis and treatment of acute pancre- The pathophysiology of acute pancreatitis is generally consid- atitis were published by the American College of Gastroen- ered in three phases. In the first phase, there is premature ac- terology in 1997 (1). These and subsequent guidelines (2–7) tivation of trypsin within pancreatic acinar cells. A variety of have undergone periodic review (6, 8–13) in accordance with mechanisms have been proposed including disruption of cal- advances that have been made in the diagnosis and treatment cium signaling in acinar cells (14–18), cleavage of trypsino- of acute pancreatitis. Guidelines for clinical practice are in- gen to trypsin by the lysosomal hydrolase cathepsin-B, and tended to apply to all health-care providers who take care of decreased activity of the intracellular pancreatic trypsin in- patients with acute pancreatitis and