acute pancreatitis：急性胰腺炎

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1、AcutePancreatitisRajeevJain,M.D.December15,2003NormalAnatomy&PhysiologyneutralizechymedigestiveenzymeshormonesExocrineFunctionpancreaticductcommonbileductampullapancreaticenzymesTAILBODYHEADUNCINATEEnzymeSecretionpancreaticductduodenumacinusmicroscopicviewofpancreaticaciniEnzymeSecretionHormonalCCK

2、gastrinNeuralacetylcholineVIPGRPSecretin(hormonal)H2ObicarbonateDigestiveEnzymesinthePancreaticAcinarCellPROTEOLYTICLIPOLYTICENZYMESENZYMESLipaseTrypsinogenProphospholipaseA2ChymotrypsinogenCarboxylesteraselipaseProelastaseProcarboxypeptidaseANUCLEASESProcarboxypeptidaseBDeoxyribonuclease(DNAse)Rib

3、onuclease(RNAse)AMYOLYTICENZYMESAmylaseOTHERSProcolipaseTrypsininhibitorNormalEnzymeActivationtrypsinogentrypsinchymotrypsinelastasephospholipasecarboxypeptidaseenterokinasechymotrypsinogenproelastaseprophospholipaseprocarboxypeptidaseduodenallumenExocrineStimulationThemoreproximalthenutrientinfusi

4、on…thegreaterthepancreaticstimulation(dogstudies)stomach–maximalstimulationduodenum–intermediatestimulationjejunum–minimal/negligiblestimulationElementalformulastendtocauselessstimulationthanstandardintactformulasintactprotein>oligopeptides>freeaminoacidsIntravenousnutrients(evenlipids)donotappeart

5、ostimulatethepancreasProtectiveMeasuresCOMPARTMENTALIZATION-digestiveenzymesarecontainedwithinzymogengranulesinacinarcellsREMOTEACTIVATION-digestiveenzymesaresecretedasinactiveproenzymeswithinthepancreasPROTEASEINHIBITORS–trypsininhibitorissecretedalongwiththeproenzymestosuppressanyprematureenzymea

6、ctivationAUTO“SHUT-OFF”–trypsindestroystrypsininhighconcentrationsAcutePancreatitisDefinitionAcuteinflammatoryprocessinvolvingthepancreasUsuallypainfulandself-limitedIsolatedeventorarecurringillnessPancreaticfunctionandmorphologyreturntonormalafter(orbetween)attacksAcutePancreatitisEtiologyCholelit

7、hiasisEthanolabuseIdiopathicMedicationsHyperlipidemiaERCPTraumaPancreasdivisumHereditaryHypercalcemiaViralinfectionsMumpsCoxsackievirusEnd-stagerenalfailurePenetratingpepticulcerAcutePancreatitisAssociatedC