内科学84急性胰腺炎课件.pptxVIP

急 性 胰 腺 炎 Acute Pancreatitis;【概念 】conception;【病因和发病机制】 etiopathogenisis and pathogenesis ;（一）梗阻与反流obstruction and refluxing ;2．胰管梗阻:pancreatemphraxis;3．十二指肠乳头邻近部位病变 Disease of adjacent position of duodenal papilla. ;（二）大量酗酒和暴饮暴食 alcohol and overeating 　;（三）手术与创伤 　operation and injury;（四）内分泌和代谢障碍 endocritic and metabolic disfunction 　　 1．高钙血症 hypercalcinemia 　　2．家族性高脂血症 familinal hyperlipidemia 　　3．妊娠 pregnancy 　　4．糖尿病昏迷 diabetic coma ;（五）感染 infection （六）药物 medicine （七）其他other 　;【病理】pathology;【临床表现】Clinical Manifestations ;●腹痛部位: 一般位于中上腹，可偏左或偏右 Location: superior belly. may deviation to left or right;●腹痛特点 1）急性发作 acute episode 2）疼痛性质：钝痛、刀割样、或绞痛 quality: dull pain; lance-like; 3）持续性疼痛并有阵发性加重 lasted pain and paroxysmal aggravation 4）疼痛可向腰背部放散 the pain frequently is located in the epigastrium with radiation to the midback . ;5）进食后疼痛加重，前倾坐位或弯腰抱位可缓解 aggravate after foodintake, relieve when anteverted sitting position or cyrto-lumbar brooding position 6）不能为一般解痉剂缓解 can’t be relieved by spasmolytic 7）水肿型持续3～5天自限缓解 interstitial pancreatitis Self-relief after 3-5 day ; 2．恶心、呕吐及腹胀 nausea; vomiting; abdominal distention 特点 呕吐后腹痛无缓解 abdominal pain is not relieved by vomiting ;3．发热 fever 　腹痛伴发热是本病的特点之一 abdominal pain with fever is one of features of this disease ; 4．低血压或休克 仅见于重症 hypotension or shock :only in severe case; 5．水、电解质紊乱 water-electrolyte disturbances 　脱水、代酸、低钾、低镁、低钙血症等。血钙2mmol/L。 dehydrolysis; metabolic acidosis ;hypopotassaemia; hypomagnesemia; hypocalcemia.blood calcium 2mmol/L.;（二）体征 sign 1．轻型：一般全身情况尚好，体征较少，多.数有上腹压痛，无肌紧张与反跳痛，可有腹胀、肠鸣音减弱，一般无移动性浊音 most have minimal local tenderness, abdominal distension, decreased bowel sounds. ;2．重症： 全身情况：表情，脉搏，血压，呼吸； 腹部：压痛明显，腹膜刺激征，Grey-Turner综合征或者Cullen征,肠麻痹，移动性浊音阳性；黄疸；腹水常为血性，淀粉酶明显增高 severe case: systemic condition: expression; pulse; blood pressure; respiration; etc. Abdominal: tenderness obvi