急性胰腺炎和结核性腹膜炎ppt课件.pptVIP

急性胰腺炎（acute pancreatitis);概 念;分 类;分 类 ;病因和发病机制;胆管疾病（胆源性急性胰腺炎）;;Biliary tract obstruction caused by a gallstone in the distal common bile duct. ;;F, 49 Y/O, there is much exudate between the gastric wall and the pancreatic parenchyma.;;;;;;大量饮酒和暴饮暴食;;;;Picture 2. ERCP of pancreas divisum. Injection of contrast following cannulation of the minor ampulla (same patient as Picture 1) demonstrates filling of a separate larger duct of Santorini, which drains the entire pancreatic body and tail. ;;;;手术与创伤 内分泌与代谢障碍 感染 药物;;发病机制; 卵磷脂 溶血卵磷脂 →组织坏死、溶血 弹力蛋白酶→破坏弹力纤维→胰腺出血和血栓 激肽原 激肽和缓激肽→血管扩张、 通透性↑→休克 脂肪酶→脂肪坏死、液化 ;炎症反应;微循环障碍;病 理;;临床表现;轻型急性胰腺炎;重症急性胰腺炎;临床表现;腹痛的机制;休克的机制;体 征;R.E.Pounder et.al. 1989;;病 程;并发症;并发症;;;实验室检查;;淀粉酶、肌肉酐清除率比值（CAm/CCr%）;血清脂肪酶： 晚升高 特异性 血清正铁血蛋白： 出血坏死性胰腺炎（+）;生化检查;腹部B超;CT检查;;;;;;;诊 断;诊断标准;55岁 16×109 11.1mmol/L 250U/L 350U/L 下降10% 上升1.8mmol/L 2mmol/L 8kPa 4mEq/L 6L;急性生理学和慢性健康评估系统APACH-Ⅱ SCOREAcute Physiology and Chronic Health Evaluation;鉴别诊断;溃疡穿孔;;胆囊炎;急性肠梗阻;心肌梗塞;治 疗;治 疗;Vedio ;;手 术 治 疗;The end!