精品医学课件-胰腺疾病完整版.pptVIP

Acute pancreatitis etiological factor Obstruction of end of bile duct or pancreatic duct：calculus、stenosis、tumor alcoholism Injury directly pancreatic juice↑＋oddi sphincterismus → pressure of pancreatic duct ↑ →rupture Binge overeating Duodenal juice back flow Injury factor Other factor hypercalcemia hyperlipidemia Pregnancy predisposing genes idiopathic pancreatitis Pathology Edema hyperemia hemorrhage necrosis Acute edematous pancreatitis Acute hemorrhagic necrotic pancreatitis clinical manifestation Abdominal Pain abdominal distension nausea、vomiting Peritonitis sign others：shock、jaundice、fever、 convulsion 、Cullen、 Grey-Turner Severe abdominal distension Grey-Turner diagnosis clinical manifestation auxiliary examination 胰酶测定 serum amylase （3-12h 后升高，24h达高峰，4-5d正常） urinary amylase（24h后升高，48h达高峰，下降缓慢） 血尿淀粉酶值的高低与病变的轻重不一定成正比 Ultrasonic 、CT、MRI abdominal paracentesis ：淀粉酶升高有确诊价值 Differential Diagnosis biliary tract disease acute perforation of gastroduodenal ulcers acute gastroenteritis coronary heart disease acute ileus treatment 个 体 化 原 则 Surgical therapy Nonsurgical therapy nonsurgical therapy Fasting and gastrointestinal decompression Replenish blood volume、 correct water-electrolytes disturbance Restrain pancreatic secretion Nutritional Support Control or prevent infection Symptomatic treatment Improve microcirculation： Hemofiltration therapeutic endoscopy Surgical indication 不能除外其它急腹症时 胰腺和胰周坏死组织继发感染 保守治疗无效 暴发性胰腺炎经过短期(24H)非手术治疗MODS仍不能得到纠正 胆源性胰腺炎 病程后期合并肠瘘或胰腺假性囊肿 Principle of surgery clean necrotic tissue omentum minus drainage or lavage relieve obstruction of biliary tract chronic pancreatitis Chronic alcoholism Obstruction of end of bile duct or pancreatic duct：calculus、stenosis、tumor etiological factor clinical manifestation Abdominal Pain： stimulate never pressure of pancreatic duct↑ Digestive tract function disability： abdominal distention dyspepsia fatty diarrhea Diabetes mellitus diag