文档介绍：ACUTE PANCREATITIS
Xu San rong
Department of Gastroenterology
Huashan Hospital
Fudan university
1
DEFINITION
An acute inflammatory process of the pan-creas usually associated with sever pain in the upper abdomen
in most instances, blood levels of pancrea-tic enzymes are increased
sever acute pancreatitis: organs failure and/or plications(necrosis, absc-ess, psuedocyst)
2
PATHOLOGY(1)
Mild acute pancreatitis(MAP)
characterized by interstitial edema associ-ated with inflammatory cell within parench-yma, and microscopic parenchyma necro-sis can be detectable.
3
PATHOLOGY(2)
Sever acute pancreatitis(SAP)
Sever necrotizing pancreatitis(SNP)
macroscopic evidence of either focal or
diffuse necrosis and hemorrhage of the
pancreatic parenchyma
4
PATHOGENY AND PATHOGENESIS(1)
mon channel and reflux of duodenal juice
gallstones
infection
Bile juice
reflux
trypsin
Kinin
systems
elastase
Trypsin
chymotrypsino
Phospho-
lipaseA2
Steatolytic
enzymes
Sever pain
hemorrhage
Free fat
acid
Serum
calcium,
5
PATHOGENY AND PATHOGENESIS(2)
2 alcoholic and overeat
3 obstruct of main pancreatic duct
4 diseases round the duodenum/ampullary region
5 postoperative pancreatitis and pancreatic trauma
6
PATHOGENY AND PATHOGENESIS(3)
6 infectious agents
7 medications: corticosteroids, estrogens
8 disorders of endocrinology and metabol-ism: hyperparathyroidism, hyperlipidemia
9 others:
7
PATHOGENY AND PATHOGENESIS(4)
6 inflammatory media theory
In AP, the leukocytes that appear first in areas of inflammation are neutrophils, then macrophages, monocytes, lymphocytes, and other cells. These cells can secrete a lot of inflammatory media.
(1) platelet activating factor, PAF
(2)prostaglandins, PGs
8
PATHOGENY AND PATHOGENESIS(5)
(3) leukotriens, LTs
(4) kallikrein kinin systems, KKS
(5) tumor necrosis factor-, TNF-
(6) nitrogen monoxide, NO
(7) complements
(8) others: nuclear factor B(NF- B), toll like receptors(TLRs).
9
DIAGNOSIS(1)
Clini