急性胰腺炎acute pancreatitis（八年制）.ppt

Acute Pancreatitis Xia, Zhongsheng Department of Gastroenterology The Second Affiliated Hospital Sun Yat-sen University Teaching Objective To know the etiology and pathogenesis of acute pancreatitis To master the clinical features and key points of diagnosis for different types of acute pancreatitis To master the therapy principles of acute pancreatitis Definition Acute pancreatitis is a inflammation of the pancreas induced by the activation of the pancreatic enzymes derived from various causes. Etiology Biliary duct diseases: gallstone, acute and chronic cholecystitis, ascariasis accompanied with inflammatory stricture at the level of the papilla. Common channel hypothesis Alcohol and/ or square meal hyperlipidemia Postoperation: post-ERCP, abdominal operation. Etiology Metabolic diseases: hyperparathyroidism, hypercalcemia, etc. Drugs: glucocorticords, diuretics, azathioprine, estrogen, etc. Autoimmune diseases: SLE, RA, vasculitis, etc. Viral infections: mumps, coxsackie virus , HIV, etc Idiopathic pancreatitis. Pathogenesis trypsinogen→ trypsin trypsin →pancreatic enzymes, complement system and kinin system Pathophysiological changes: leukocyte chemotaxis, release of active agents, oxygenic stress, microcirculation disorder and bacteria transposal. Trypsin activates other proenzymes and results in proteolysis, edema and vascular damage Lipase produces extrapancreatic fat necrosis Phospholipase degrades the lecithin into the lysolecithin which induces pancreatic necrosis and hemorrhage Kallikrein and elastase cause vascular destruction Bradykinin peptidase and vasoactive substance induce vasodilatation, increase vascular permeability and edema Cytokine, oxygen free radicals, platelet activating factor, prostaglandins, blood circulation disturbance, systemic inflammation response syndrome (SIRS) Pathology Mild form (interstitial or edematous pancreatitis) focal or diffused edema slight leukocyte infiltration Severe form (necrotic or hemorrhagic pan