胰腺炎的诊治与发展

胰腺炎的诊治与发展Withthedevelopmentofthediagnosisandtreatmentofpancreatitis昆医海源学院2006级实习同学制作患者，女，39岁，因持续上腹痛伴恶心呕吐3天入院。5年来有胆囊结石病，常有短暂上腹不适症状。查体：神清，体温37.7°C，血压132/86mmHg，巩膜无黄染，心肺未及明显异常，上腹压痛，轻度肌紧张和反跳痛，肠鸣音正常。辅查：WBC13.5x109/L，血淀粉酶高出正常一倍以上。B超显示胆囊多发小结石，胆总管宽9mm，其内未见结石，胰腺肿大增厚，周围有积液。case最可能诊断为？1怎样进一步治疗？3如何明确诊断？2胰腺炎急性胰腺炎慢性胰腺炎pancreatitisAcutepancreatitisChronicpancreatitis

急性胰腺炎concept概念cause病因mechanism发病机制features临床表现diagnosis诊断treatment治疗急性胰腺炎concept概念cause病因mechanism发病机制features临床表现diagnosis诊断treatment治疗Acutepancreatitisconcept:急性胰腺炎是由于胰腺分泌的胰酶在胰腺内被激活后引起胰腺及胰周围组织自我消化的急性化学性炎症急性胰腺炎concept概念cause病因mechanism发病机制features临床表现diagnosis诊断treatment治疗cause胆道疾病我国最常见病因(占50%)饮酒过量国外常见病因(占60%)暴饮暴食最常见诱因亦称节日病231cause十二指肠液返流激活胰液蛋白分解酶和磷脂酶A手术与创伤胆囊手术,腹部方向盘伤等.56胰管阻塞结石,蛔虫,肿瘤,狭窄等均可引起.4cause药物噻嗪类利尿剂,糖皮质激素,磺胺类等其他高脂血症,胰腺缺血,高钙血症等89感染继发于传染性疾病7急性胰腺炎concept概念cause病因mechanism发病机制features临床表现diagnosis诊断treatment治疗mechanismofdiseases发病基础：胰腺分泌过度旺盛胰液排泄障碍胰腺血循环紊乱（缺血敏感）生理性胰蛋白酶抑制物质减少机制：胰腺消化酶激活胰腺自身消化急性胰腺炎concept概念cause病因mechanism发病机制features临床表现diagnosis诊断treatment治疗放射痛腹痛恶心呕吐临床表现电解质紊乱休克腹胀腹膜炎放射痛腹痛恶心呕吐Featuresofdiseases电解质紊乱休克腹胀腹膜炎放射痛Abdominalpain恶心呕吐Featuresofdiseases电解质紊乱休克腹胀腹膜炎RadiationpainAbdominalpain恶心呕吐Featuresofdiseases电解质紊乱休克腹胀腹膜炎RadiationpainAbdominalpain恶心呕吐Featuresofdiseases电解质紊乱休克Abdominaldistension.PeritonitisRadiationpainAbdominalpain恶心呕吐FeaturesofdiseasesElectrolytesdisturbance休克Abdominaldistension.PeritonitisRadiationpainAbdominalpain恶心呕吐FeaturesofdiseasesElectrolytesdisturbanceshockAbdominaldistension.PeritonitisRadiationpainAbdominalpainNauseaandvomitingFeaturesofdiseasesElectrolytesdisturbanceshockAbdominaldistension.Peritonitis腹痛：主要症状，为左上腹剧痛，呈持续性，可阵发加剧。呕吐后腹痛不缓解。放射痛：放射至左肩，左腰背部。恶心呕吐：剧烈且频繁，呕吐物为胃十二指肠液，常与腹痛相伴。腹胀和腹膜炎低血压或休克：最常见并发症。1·有效血容量不足2·缓激肽类致血管舒张3·胰腺坏死释放心肌抑制因子使心肌收缩不良4·并发感染或消化道出血。水电解质紊乱：代酸、低镁、低钾、低钙。体征：腰部、季肋部和下腹部出现大片青紫斑(Grey-Turner征)和脐周青紫斑(Cullen征)。并发症

complications局部并发症胰腺脓肿假性囊肿