内科学课件:Acute Pancreatitis
85页1、Acute Pancreatitis234OverviewPancreatitis is an inflammation of the pancreas.PancreatitisAcute pancreatitisChronic pancreatitis5Acute PancreatitisPancreatitisisaninflammatoryprocessinwhichpancreaticenzymesautodigesttheglandAcutepancreatitisnPathophys-insultleadstoleakageofpancreaticenzymesintopancreaticandperipancreatictissueleadingtoacuteinflammatoryreaction7Classification:Pathological:nacuteedematouspancreatitisnacutehemorrhagicnecrotizingpancreatitisClinical:nMildacutepancreatitis(MAP)nSevere
2、acutepancreatitis(SAP)8Etiology and mechanism:原发性的 9Etiology and mechanismn n70-80% of patients either have 70-80% of patients either have gallstones or a history of sustained gallstones or a history of sustained alcohol abuse. alcohol abuse. nMild acute pancreatitis is not associated with organ dysfunction or complications, and recovery is uneventful. nSevere acute pancreatitis is associated with decreased function of the pancreas, local and systemic complications, and a complicated recovery. 1
3、011水 肿 型 的 病 理 外观: 胰腺肿大、变硬、少量周围组织坏死。 显微镜下: 间质充血、水肿、炎症细胞浸润,少量腺泡坏死。12出 血 坏 死 型 病 理 外观: 胰腺弥漫性肿大、大网膜 和胰腺上大小不等的钙皂 显微镜下: 胰实质、脂肪坏死; 水肿、出血和血栓形成; 炎症反应。 PathologyPathology1.Edematous pancreatitis:1.Edematous pancreatitis:*interstitial edema*interstitial edema*inflammatory cell infiltration of the gland *inflammatory cell infiltration of the gland parenchyma parenchyma2.Hemorrhagic or necrotizing pancreatitis2.Hemorrhagic or necrotizing pancreatitis*extensive pancreatic and peripancreatic *extensive pancre
4、atic and peripancreatic fat necrosis fat necrosis *parenchymal necrosis*parenchymal necrosis14Acute hemorrhagic pancreatitis.15Clinical manifestationsnSymptomsn1、 Abdominalpain:predominant clinical predominant clinical featurefeature16Clinical manifestations Abdominalpain,usuallyepigastric,constantwithradiationtotheback Clinical PresentationClinical PresentationnSteady, dull, or boring midepigastric pain associated with nausea and vomiting is the classic presentation of acute pancreatitis.Abdomi
5、nal pain Abdominal pain n na penetrating pain, radiating to the back a penetrating pain, radiating to the back ( (It radiates straight to the midline of the lower thoracic vertebral region in about 50% of patients and is usually worse in the supine position.)Abdominal painAbdominal painn nrarepatientswithoutabdominalpainbutrarepatientswithoutabdominalpainbutwithaseveresystemicillness(withaseveresystemicillness(hypotension,hypoperfusionandhypotension,hypoperfusionanddepressionofmentalstatus)-depr
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