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医学课件大全急性胰腺炎acutepancreatitis

医学课件大全急性胰腺炎acutepancreatitis

⑴stimulate the pancreas to secrete pancreatic hypertention tiny pancreatic duct and acinus rupture pancreatic juice spillage ⑵spasm of the sphinctor of oddi ⑶direct injury to pancreas
1.hypertension in pancreatic duct 2.premature activation of pancreatic enzymes 3.injury to the lining of the pancreatic ducts
pancreatic edema or necrosis
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√Acute pancreatitis refers to an attack involving a previously normal pancrease. √Chronic pancreatis is applied to an attack involving a previously, permanently damaged pancrease.
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√ The clinical presentation of acute pancreatitis is variable, from episodes of mild abdominal discomfort alone to a severe illness associated with hypotension, metabolic derangements, sepsis, fluid sequenstration, multiple organ failure or even death.
急性胰腺炎AcutePancreatitis

急性胰腺炎AcutePancreatitis


诊断和鉴别诊断
主要依靠临床表现、实验室检查、B超和CT。
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临床常用Ranson标准来评估病情严son评分标准： 入院时年龄＞55岁；白细胞 ＞16×109/L；血糖＞11.2mmol/L；AST＞250U/L；LDH＞350U/L。入院48小时 HCT下降＞10%；BUN 上升＞1.8mmol/L；血钙＜2 mmol/ L；PaO2＜8kpa；BE＞4mEq/ L；估计体液丢失＞6000ml。每项记1分。 Ranson评分＜3分，或CT分级为A、B、C级，为可诊断为轻症急性胰腺炎 Ranson评分≥3分，或CT分级为D、E级，则为重症胰腺炎。
营养支持疗法
禁食及胃肠减压； 生长抑素及其类似物：思他宁（14肽）奥曲肽（8肽）； H2RT或PPI。
抑制胰液分泌
治 疗
5.抑制胰酶活性
抑肽酶或氟尿嘧啶（5-FU）
6.抗菌药物
非胆源性轻症急性胰腺炎可不用抗生素； 胆道疾病所致者及重症胰腺炎应常规使用抗生素，须遵循：针对革兰.阴性菌、厌氧菌为主，脂溶性强，有效通过血-胰屏障三大原则，一线用药推荐甲硝唑联合喹诺酮类。
单击此处可添加副标题
病因很多，以胆道疾病为主，其次为大量饮酒和暴饮暴食。 胆道疾病 人群中约2/3的个体胆总管和胰管共同开口于Vater壶腹部； 胆道炎症、结石、寄生虫引起壶腹部发生阻塞或Oddi括约肌松弛引起十二指肠液反流； 细菌、游离胆酸进入胰腺。 胰管阻塞 胰管结石、狭窄、肿瘤等； 先天性胰腺分离。
胰腺的自身防御系统： 胰管内压力高于胆总管和十二指肠的压力； 胰管开口处有括约肌屏障； 主胰管上皮覆盖有一层粘液性膜; 胰腺、胰液和血清中存在α1抗胰蛋白酶和α2巨球蛋白等胰蛋白酶的抑制物。 不同病因可通过不同机制破坏和削弱胰腺的防御机制。
急性胰腺炎(Acute Pancreatitis)

急性胰腺炎(Acute Pancreatitis)

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2）上腹压痛： 反跳痛
39
3）上腹肿块：压痛性 胰腺肿大 粘连性
囊肿性
4）手足搐搦
少数起病急:症状→休克,似心源性/失血性
猝死 暴发性胰腺炎
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五、预后
水肿型：3~5天好转 →1W左右症状完全消失 出血坏死型: 2~3W恢复，易成慢性 少数起病急:症状→休克,似心源性/失血性
猝死 暴发性胰腺炎
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四、临床表现：
发病率：占尸检1%，占住院27% 年龄：20-60 男30-50 女较男轻 性别：男：女 < 1 相近或女多 1、症状： 1）腹痛 轻重不一 性质：钝 、剧、绞、刀割 持续性或阵发性加重 餐后1~2小时或脂肪餐后逐渐加重 部位：剑下，左右季肋，向腰背部扩散 特殊体位：仰卧加重；屈曲位稍缓。
急性坏死型：局限或弥漫实质坏死
胰表面、大网膜、后腹膜、肠系膜 →黄白色坏死灶 重症在坏死灶加出血 胰黑褐色、粥状、崩毁坏死
32
胰腺黑褐色崩毁坏死
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重症在坏死灶加出血
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继发感染时： 化脓 脓肿 镜下：腺泡细胞凝固坏死，消失 实质出血，小叶间水肿，淋巴管炎， 血管炎，血栓 炎细胞浸润 临床：危重 并发症多 常导致死亡
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X线：肠麻痹时 → 液面
EKG： 胰腺T波：低平或倒
ST：↓与休克，电解质紊乱有关， 病好立好。
46
影像学在诊断及分级中的作用
增强CT是目前诊断AP最佳影像检查 -A级：正常，计0分； -B级：胰腺肿大，少量胰周积液，计1分； -C级：除B级变化外，胰腺周围软组织轻度改 变，计2分； -D级：除C级变化外，胰腺周围软组织明显改 变，胰周积液不超过一个部位，计3分； -E级：胰周多部位积液或积脓，计4分。
急性胰腺炎英文版-PPT课件

急性胰腺炎英文版-PPT课件

There has been an increase in the incidence of acute pancreatitis reported worldwide.Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with signifcant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis,recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the gall stone–induced pancreatitis.
最新急性胰腺炎英文版 ppt课件-PPT文档

最新急性胰腺炎英文版 ppt课件-PPT文档


Diagnosis of acute pancreatitis
Diagnosis of acute pancreatitis (2 of the following) • Abdominal pain (acute onset of a persistent, severe, epigastric pain often radiating to the back) • Serum lipase activity (or amylase) at least 3 times greater than the upper limit of normal • Characteristic findings of acute pancreatitis on computed tomography or magnetic resonance imaging Serum lipase has a slightly higher sensitivity for detection of acute pancreatitis.One study demonstrated that at day 0–1 from onset of symptoms, serum lipase had a sensitivity approaching 100% compared with 95% for serum amylase.13 For days 2–3 at a sensitivity set to 85%, the specifcity of lipase was 82% compared with 68% for amylase. Serum lipase is therefore especially useful in patients who present late to hospital.
急性胰腺炎

急性胰腺炎

【疾病名】急性胰腺炎【英文名】acute pancreatitis【缩写】【别名】【ICD号】K85【概述】急性胰腺炎(acute pancreatitis，AP)是比较常见的一种急腹症，其发病率占急腹症的第3～5位。

其中80%以上的病人病情较轻，即急性水肿性胰腺炎，可经非手术治愈，基本上是一种内科病。

10%左右的病人属于重症胰腺炎，即急性出血性坏死性胰腺炎(acute hemorrhagic necrotic pancreatitis，AHNP)，胰腺的炎症已非可逆性或自限性，常须手术治疗，应视为外科病。

由于对急性胰腺炎的认识较前深入，诊断技术和治疗方法更有了较大的发展，已成为外科医生很感兴趣的问题，同时因病死率仍居高不下，达30%～60%，且易发生各种严重合并症，对医生是一个严峻的挑战。

【流行病学】许多报道指出，该病有逐年增加的趋势，与胆道疾病发病率增加、临床医师的认识有所提高等因素有关。

急性胰腺炎的发病女性多于男性，男女之比为1∶1.7。

可见于各种年龄，但以20～50岁者多见。

然而，发病年龄与病因也有些关系，如蛔虫引起的胰腺炎以儿童多见，随着人类寿命的延长，胆石病的发病率增加，其发病年龄也将会有所提高。

【病因】引起急性胰腺炎的病因甚多，存在地区差异。

在我国半数以上由胆道疾病引起，在西方国家，除胆石症外，酗酒亦为主要原因。

1.胆道系统疾病 正常情况下，胆总管和胰管共同开口于Vater壶腹者占80%，汇合后进入十二指肠，这段共同管道长约2～5mm，在此“共同通道”内或Oddis括约肌处有结石、胆道蛔虫或发生炎症、水肿或痉挛造成阻塞，胆囊收缩，胆管内压力超过胰管内压力时，胆汁便可反流到胰管内激活胰酶原引起自身消化，即所谓“共同管道学说”(common duct theor y)，50%的急性胰腺炎由此引起，尤其以胆管结石最为常见；若胆石移行过程中损伤胆总管、壶腹部或胆管炎症引起Oddis括约肌功能障碍，如伴有十二指肠腔内高压，导致十二指肠液反流入胰管，激活胰酶产生急性胰腺炎；此外，胆道炎症时，细菌毒素释放出激肽可通过胆胰间淋巴管交通支激活胰腺消化酶引起急性胰腺炎。

急性胰腺炎英文版 ppt课件共23页文档

急性胰腺炎英文版 ppt课件共23页文档

Serum lipase has a slightly higher sensitivity for detection of acute pancreatitis.One study demonstrated that at day 0–1 from onset of symptoms, serum lipase had a sensitivity approaching 100% compared with 95% for serum amylase.13 For days 2–3 at a sensitivity set to 85%, the specifcity of lipase was 82% compared with 68% for amylase. Serum lipase is therefore especially useful in patients who present late to hospital.
C O N TA N T S
Methodology
Diagnosis of acute pancreatitis
AssessMent of severity
Supportive care
C O N TA N T S
Nutrition
Prophylactic antibiotics
Management of acute gallstone pancreatitis
1 2
Diagnosis of acute pancreatitis (2 of the following) • Abdominal pain (acute onset of a persistent, severe, epigastric pain often radiating to the back) • Serum lipase activity (or amylase) at least 3 times greater than the upper limit of normal • Characteristic findings of acute pancreatitis on computed tomography or magnetic resonance imaging
急性胰腺炎acutepancreatitis

急性胰腺炎acutepancreatitis


形不规则，T1WI表现为低信号，T2WI表现 为高信号。胰腺的边缘模糊不清。胰腺炎产 生的胰腺内、外积液，MRI上表现为T1WI低 信号、T2WI高信号区。假性囊肿形成表现为 圆形、边界清楚、光滑锐利的病灶，呈T1WI 低信号、T2WI高信号。如果胰腺炎合并有出 血时，随着正铁血红蛋白的出现，可表现为 T1WI和T2WI均呈高信号。
读片者：牟万春
1.临床症状：
发热；恶心、呕吐、腹胀等胃肠道症状；上腹 部持续剧烈性疼痛，常放射到胸背部，严重者 可出现休克症状；上腹部压痛、反跳痛、肌紧 张。 实验室检查：血白细胞计数升高；血、尿淀粉 酶升高。
1. 急 性 间 质 性 胰 腺 炎 ， 也 称 水 肿 性 胰 腺 炎 ： 是胰腺炎中最轻的类型，仅显示水肿和细胞浸润， 胰腺体积增大，胰腺内散在少数小的局灶性坏死， 胰腺周围脂肪组织轻度皂化； 2.急性坏死性胰腺炎：胰腺实质和胰腺临近组织发生 广泛的坏死、出血、液化，肾筋膜增厚。
胰腺脓肿和假性囊肿为急性胰腺炎 的局部并发症，前者表现增强后胰 腺内有不规则低密度区，其可靠地 征象为低密度区内出现散在的小气 泡，提示产气杆菌感染；假性囊肿 在CT上表现为大小不一的圆形或卵 圆形囊性病变，内为液体密度，绝 大多数为单房，囊壁均匀，可厚可 薄。
MRI：急性胰腺炎性改变导致胰腺肿大、外
1.急性胰腺炎常有明确病史、体征及实 验检状出 6.假性动脉瘤：由于被炎症激活的胰酶的侵蚀，受侵的 内脏血管管壁变薄、局限性扩张，一般见与脾动脉和十 二指肠动脉。
CT：
急性水肿性胰腺炎：少数轻型患者，
CT可无阳性表现。多数病例均有不同程 度的胰腺体积弥漫性增大。胰腺密度正 常或为均匀、不均匀轻度下降，后者为 胰腺间质水肿所致。胰腺轮廓清楚或模 糊，渗出明显者除胰腺轮廓模糊外，还 可有胰周积液。增强CT扫描，胰腺均匀 强化，无不强化的坏死区
急性胰腺炎

急性胰腺炎

Acute pancreatitis急性胰腺炎in dengue登革hemorrhagic fever出血热.标题翻译:摘要: We reported a case of acute pancreatitis急性胰腺炎as the complication合并症,并发症of dengue登革hemorrhagic fever出血热(DHF). This complication合并症,并发症can cause more severe fatal condition, and difficulties困难in treatment, although it is rare. Dengue登革hemorrhagic fever出血热(DHF) is one of the endemic特有的,特产的,地方病的diseases and often come as an outbreak爆发,猖獗,暴发event in South East Asia including包括的,算入的,包含Indonesia. Dengue登革hemorrhagic fever出血热(DHF) is a global球形的,总体的,周面的public health公共卫生problem, because until now there has been no medicine to eradicate根除,消灭the dengue virus波加卡热病毒,登革热病毒, no dengue登革vaccine菌苗,疫苗and difficult to eradicate根除,消灭the mosquitoes as the contagious接触传染的vector矢量,带菌体,昆虫媒介者. Diagnosis诊断and treatment of acute pancreatitis急性胰腺炎as early as possible is important to improve the patient's condition and survival残存,存活率,存活. The patient was a 59 year old male and had been treated治疗的,处理的conservatively. The patient was admitted to the hospital, oral fasting禁食,绝食,禁食的until the fourth day, given parenteral nutrition静脉营养,注射营养法,肠胃外营养法, antibiotic抗菌素,抗生物质,抗生的and other intravenous静脉的,静脉注射的,静脉内的medicines. Initial oral liquid diet流质饮食,流质膳食was given on the fifth day of hospitalization住院,入院,住医院治疗and changed变化的,改变的gradually逐渐地,渐进地according to the condition. The patient was then improved改善的,好转的,改造的and discharged from the hospital.摘要翻译:笔记:主题词: Acute Disease急性病;Dengue登革Hemorrhagic出血的Fever/complications/*diagnosis诊断;Humans;Male;Middle Aged自动化综合实验装置;Pancreatitis/*diagnosis/etiology。

急性胰腺炎

急性胰腺炎

【疾病名急性胰腺炎称】acute pancreatitis【英文名称】【缩AP写】肝胆外科/胰腺炎症【类别】【 ICD 号】K85【概述】急性胰腺炎(acute pancreatitis，AP)是比较常见的一种急腹症，其发病率占急腹症的第3～5位。

其中80%以上的病人病情较轻，即急性水肿性胰腺炎，可经非手术治愈，基本上是一种内科病。

10%左右的病人属于重症胰腺炎，即急性出血性坏死性胰腺炎(acute hemorrhagic necrotic pancreatitis，AHNP)，胰腺的炎症已非可逆性或自限性，常须手术治疗，应视为外科病。

由于对急性胰腺炎的认识较前深入，诊断技术和治疗方法更有了较大的发展，已成为外科医生很感兴趣的问题，同时因病死率仍居高不下，达30%～60%，且易发生各种严重合并症，对医生是一个严峻的挑战。

【流行病学】急性胰腺炎国外报道发病率为(48～110)/100万人；国内尚无准确的关于发病率的统计学资料，但有逐年上升的趋势。

据不完全统计，本病占住院人数的0.32%～2.04%。

本病常发生于成年人，好发于30～70岁，胆源性急性胰腺炎多见于女性，酒精性急性胰腺炎则以男性常见。

【病因】引起急性胰腺炎的病因甚多，存在地区差异。

在我国半数以上由胆道疾病引起，在西方国家，除胆石症外，酗酒亦为主要原因。

1.胆道系统疾病正常情况下，胆总管和胰管共同开口于Vater壶腹者占80%，汇合后进入十二指肠，这段共同管道长约2～5mm，在此“共同通道”内或Oddis括约肌处有结石、胆道蛔虫或发生炎症、水肿或痉挛造成阻塞，胆囊收缩，胆管内压力超过胰管内压力时，胆汁便可反流到胰管内激活胰酶原引起自身消化，即所谓“共同管道学说”(common duct theory)，50%的急性胰腺炎由此引起，尤其以胆管结石最为常见；若胆石移行过程中损伤胆总管、壶腹部或胆管炎症引起Oddis括约肌功能障碍，如伴有十二指肠腔内高压，导致十二指肠液反流入胰管，激活胰酶产生急性胰腺炎；此外，胆道炎症时，细菌毒素释放出激肽可通过胆胰间淋巴管交通支激活胰腺消化酶引起急性胰腺炎。

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The guideline was developed under the auspices of the University of Toronto. They searched Medline for guidelines published between 2002 and 2014 using the Medical Subject Headings “pancreatitis” and “clinical practice guideline.” This search identifed 14 guidelines published between 2008 and 2014. Another electronic search of Medline was performed using the Medical Subject Headings “pancreatitis,”“acute necrotizing pancreatitis,” “alcoholic pancreatitis,” and “practice guidelines” to update the systematic review. The results were limited to articles published in English between January 2007 and January 2014. The references of relevant guidelines were reviewed. Up-todate articles on acute pancreatitis diagnosis and management were also reviewed for their references.
D i a g n o s i s of a c u t e pa n c r e a t i t i s
It was the best of times, it was the worst of times; it was the age of wisdom, it was the age of foolishness.
Methodology
D i a g n o s i s of acute pa n c r e a t i t i s
CO N TA N T S
AssessMent of severity
Suppor tive care
Nutrition
Prophylactic antibiotics
Management of acute gallstone pancreatitis
AssessMent of severity
It was the best of times, it was the worst of times; it was the age of wisdom, it was the age of foolishness.
AssessMent of severity
CO N TA N T S
Methodology
It was the best of times, it was the worst of times; it was the age of wisdom, it was the age of foolishness.源自ethodology1 2 3
Clinical practice guideline: m a n a g e m e n t of a c u t e pa n c r e a t i t i s
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Repoeter
Weirui Ren
Graduate student in Heibei Medical University
In severe disease, CT is useful to distinguish between interstitial acute pancreatitis and necrotizing acute pancreatitis and to rule out local complications. However, in acute pancreatitis these distinctions typically occur more than 3–4 days from onset of symptoms, which makes CT of limited use on admission.
Diagnosis of acute pancreatitis
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Magnetic resonance cholangiopancreatography is useful in identifying CBD stones and delineating pancreatic and biliary tract anatomy. A systematic review that included a total of 67 studies found that the overall sensitivity and specificity of MRCP to diagnose biliary obstruction were 95% and 97%, respectively. Sensitivity was slightly lower, at 92%, for detection of biliary stones.
Diagnosis of acute pancreatitis
Diagnosis of acute pancreatitis (2 of the following) • Abdominal pain (acute onset of a persistent, severe, epigastric pain often radiating to the back) • Serum lipase activity (or amylase) at least 3 times greater than the upper limit of normal • Characteristic findings of acute pancreatitis on computed tomography or magnetic resonance imaging Serum lipase has a slightly higher sensitivity for detection of acute pancreatitis.One study demonstrated that at day 0–1 from onset of symptoms, serum lipase had a sensitivity approaching 100% compared with 95% for serum amylase.13 For days 2–3 at a sensitivity set to 85%, the specifcity of lipase was 82% compared with 68% for amylase. Serum lipase is therefore especially useful in patients who present late to hospital.
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At 48 hours, serum CRP levels above 14286 nmol/L have a sensitivity, specifcity, positive predictive value and negative predictive value of 80%, 76%, 67%, and 86%, respectively, for severe acute pancreatitis. Levels greater than 17 143 nmol/L within the frst 72 hours of disease onset have been correlated with the presence of necrosis with the sensitivity and specifcity both greater than 80%. Serum CRP generally peaks 36–72 hours after disease onset, so the test is not helpful in assessing severity on admission. A variety of reports have correlated a higher APACHE II Score at admission and during the first 72 hours with a higher mortality (< 4% with an APACHE II Score < 8 and 11%–18% with an APACHE II Score ≥ 8).There are some limitations in the ability of the APACHE II Score to stratify patients for disease severity. For example, studies have shown that it has limited ability to distinguish between interstitial and necrotizing acute pancreatitis, which confer different prognoses.In a recent report, APACHE II Scores generated within the frst 24 hours had a positive predictive value of only 43% and negative predictive value of 86% for severe acute pancreatitis.