文档介绍：Kamal Bani-Hani
FRCS (Glasgow), ., . (Leeds)
King Abdullah University Hospital
Department of Surgery – Faculty of Medicine
Jordan University of Science & Technology
Acute pancreatitis
Acute pancreatitis
Autodigestion of the pancreas by its escaped enzymes
Etiological Factors
1
Biliary tract disease
7
Scorpion venom
2
Alcohol
8
Drugs
3
Ischemia (hypotension, cardio-pulmonary by-pass, atheroembolism, vasculitis)
9
Pancreatic duct obstruction (tumor, pancreatic divisum, ampullary stenosis, ascaris infestiopn)
4
Duodenal obstruction
10
Metabolic (hypercalcemia, hyperthyroidism, Hyperlipidemia)
5
Trauma (external, operative, ERCP)
11
Viral infection (mumps, coxsaki B4)
6
Familial
12
Idiopathic
Drug Induced pancreatitis
Azathioprine*
L-asparaginase
Estrogenes*
Phenformin
Corticosteroids
Procainamide
Thiazide diuretics
Valproic acid
Furosemide
Clonidine
Ethacrynic acid
Pentamidine
Sulfonamides
Dideoxyinosine
Tetracycline
H2 antagonist
Surgical Pathology
Edema
Exudation
Hemorrhage
Suppuration
Necrosis
Fat necrosis (combination of liberated fatty acids from hydrolized fat with calcium)
Fluid loss Hypovolemia
Pseudocyst
Clinical features (Symptoms)
Pain (sudden,intense,continuous, upper abdomen back, bizarre position)
Nausea and Vomiting
Clinical features (Signs)
General
Local
Shock
Peritonitis
Fever
Paralytic ileus
Jaundice
Abdominal mass
Left pleural effusion
Cullen’s sign. Grey Turner sign
Acute pulmonary failure
Subcutaneous necrosis
Cerebral abnormalities
Investigation
General
Laboratory Tests
Radiology
CBC
S. amylase
Chest X-ray
S. electrolytes
S. amylase isoenzymes (P+S types)
Abdominal X-ray
Lft
Urinary amylase
Ba. Meal
S. Ca+2
Amylase-creatinine clearance ratio
US
Blood glucose
S. lipase
CT scan
S. methemalbumin
MRI
Peritoneal fluid analysis
Intra-abdominal Disorders associated with Hyperamylasemia
Pancreatic disorders
Non pancreatic disorders
Acute pancreatitis
Rupt