七年制医学课件 内科 21AP.pptVIP

Acute Pancreatitis Definition Acute pancreatitis is an acute inflammatory process of the pancreas usually associated with severe pain the upper abdomen， in most instances, blood levels of pancreatic enzymes, including amylase（淀粉酶） and lipase（脂肪酶） , are increased at least three times their upper limit of normal . If the cause of the attack can be eliminated (such as by choleccystectomy in gallstone-related AP), no further attacks will ensue , and the pancreas will return to normal in term of its morphology and function . If the attack is severe, there injury may be significant alterations in morphology and function. For example ,severe pancreatitis may cause pancreatic ductal injury resulting in ductal stricture obstruction and producing chronic obstructive pancreatitis .In addtion, after massive pancreatic necrosis,the patient may develop steatorrhea and and diabetes mellitus. Classification MAP(Mild acute pancreatitis) MAP was described as a condition associated with minimal or no organ dysfunction and an uneventful recovery. SAP(Severe acute pancreatitis) There was evidence of organ failure or local complications such as necrosis, abscess, or pseudocyst . Predisposing condition Gallstone Alcohol consumption Hyperlipidemia Hereditary pancreatitis Hyperparathyroidism and hypercalcemia Structural abnormalities Duodenal/ampullary （壶腹的）region Bile ducts Sphincter of Oddi dysfunction Main pancreatic duct Accessory pancreatic duct Medications Infectious agents and toxins Vascular disease ERCP Postoperative pancreatitis Pancreatic trauma Cystic fibrosis Pregnancy Miscellaneous Gallstones are responsible for 30% to 75% of all cases of AP.The pathogenesis of gallstone-related pancreatitis also remains unclear. Common channel theory In the according to this theory ,a gallstone becomes impacted in the duodenal papilla （乳头）and allows the reflux of bile from the common bile duct into the pancreatic duct.