徐三荣－急性胰腺炎.ppt

ACUTE PANCREATITIS Xu San rong Department of Gastroenterology Huashan Hospital Fudan university DEFINITION An acute inflammatory process of the pan-creas usually associated with sever pain in the upper abdomen in most instances, blood levels of pancrea-tic enzymes are increased sever acute pancreatitis: organs failure and/or local complications(necrosis, absc-ess, psuedocyst) PATHOLOGY(1) Mild acute pancreatitis(MAP) characterized by interstitial edema associ-ated with inflammatory cell within parench-yma, and microscopic parenchyma necro-sis can be detectable. PATHOLOGY(2) Sever acute pancreatitis(SAP) Sever necrotizing pancreatitis(SNP) macroscopic evidence of either focal or diffuse necrosis and hemorrhage of the pancreatic parenchyma PATHOGENY AND  PATHOGENESIS(1) 1 common channel and reflux of duodenal juice PATHOGENY AND  PATHOGENESIS(2) 2 alcoholic and overeat 3 obstruct of main pancreatic duct 4 diseases round the duodenum/ampullary region 5 postoperative pancreatitis and pancreatic trauma PATHOGENY AND  PATHOGENESIS(3) 6 infectious agents 7 medications: corticosteroids, estrogens 8 disorders of endocrinology and metabol-ism: hyperparathyroidism, hyperlipidemia 9 others: PATHOGENY AND  PATHOGENESIS(4) 6 inflammatory media theory In AP, the leukocytes that appear first in areas of inflammation are neutrophils, then macrophages, monocytes, lymphocytes, and other cells. These cells can secrete a lot of inflammatory media. (1) platelet activating factor, PAF (2)prostaglandins, PGs PATHOGENY AND  PATHOGENESIS(5) (3) leukotriens, LTs (4) kallikrein kinin systems, KKS (5) tumor necrosis factor-?, TNF- ? (6) nitrogen monoxide, NO (7) complements (8) others: nuclear factor ?B(NF- ?B), toll like receptors(TLRs). DIAGNOSIS(1) Clinical characteristics 1 abdominal pain 2 fever 3 nausea and vomiting DIAGNOSIS(2) 4 hypotension an