revise Acute Pancreatitis课件.pptVIP

Acute Pancreatitis 急性胰腺炎 Acute pancreatitis Acute pancreatitis is an acute inflammation process of the pancreas caused by auto-digestion action of pancreatic enzymes. It characterized by abdominal pain, nausea, vomiting, fever and ※increased blood pancreatic enzymes. Acute pancreatitis is most common in middle-aged men an women, but affects men than woman. Etiology and pathophysiology病因和病理生理 Etiologic factors 致病因素 ※Biliary tract diseases 胆道疾病 Infection Alcohol Trauma Drugs (corticosteroids thiazide diuretics噻嗪类利尿剂 Tetracycline 四环素 sulfa drug 璜胺类药物) Postoperative GI surgery Metabolic disorders Activation of pancreatic Enzymes Autodigestion action of Pancreatic enzymes Trpsin 胰蛋白酶 Elastase胰肽酶 Phosphipase 磷酸(酯)酶 Lipase脂肪酶 Kallikreins激肽释放酶: Vascular permeability↑ Smooth muscle contraction Shock Injury to pancreatic cells Clinical manifestation 临床表现 ※Abdominal pain is predominant symptom of acute pancreatitis, often suddenly occur after crash diet暴饮暴食 or alcohol 酗酒. The pain is usually located in the ※ left upper quandrant左上象限 but may be in the midepigastrium 中上腹. It commonly ※ radiates to the back 腰背. The pain has a sudden onset and is described as severe, deep, piercing 尖锐的 and continuous or steady. Pain is aggravated by ※ eating. Pain can be relieved with ※ tuck position弯腰抱膝位, it is not relieved by ※ food, vomiting; and antacids, gastrointestinal antispasmodic drugs are ineffective. The pain may be accompanied by flushing 面红, cyanosis发绀 and dyspnea 呼吸困难. Clinical manifestation 临床表现 Intravascular damage from circulating trpsin 胰蛋白酶 may cause areas of cyanosis紫绀or greenish 绿色 to yellow-brown黄棕色discoloration of the abdominal wall. Other areas of ecchymoses 瘀斑 are the flanks 两侧腰部(Greg-Turner’s sign格雷格-特纳征) and the periumbilical 脐周areas (Cullen’s sign卡伦征). Hypovolemia低血容量also occurs as a result of exudation of blood血液渗出and plasma proteins血浆蛋白into the retroperitoneal space 腹膜后间隙. Shock may occurs because of hemorrhage into the pancreas or toxemia毒血