内科学 急性胰腺炎-徐三荣

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1、ACUTEPANCREATITISXuSanRongDepartmentofGastroenterologyHuashanHospitalFudanUniversity1Generalconsideration(1)Pancreatitisacutepancreatitis（AP）chronicpancreatitis(CP)recurrentpancreatitisFromedematouspancreatitis(MAP)~pancreaticnecrosis(SAP).2Generalconsideration(2)Epidemiologi

2、calInformation:incidence:4.8~24/106meanage:55yearMildacutepancreatitis(MAP)severeacutepancreatitis(SAP)3Generalconsideration(3)CausesofacutepancreatitisCommoncausesgallstonespostoperativealcoholconsumptiondrugshypertriglyceridemiaERCPtraumasphincterofOddidysfunction4G

3、eneralconsideration(4)Uncommoncausesvascularcausesandvasculitis:CTD(systemiclupuserythematosus,SLE)andTTPcancerofpancreas:pancreaticdivisum5Generalconideration(5)rarecausesinfectiousagents:(mumpsvirus)autoimmune:(SS)causesofrecurrentpancreatitiswithoutanobviousetiology

4、microlithiasisidiopathic6EtiologyandPathogenesis(1)Etiology1Gallstones:30%~60%(54.4%,1).2Alcohol:5/106,(8.0%,4).3Hypertrilyceridemia:1.3%~3.8%(12.6%,3).4ERCP:5%~20%.5Drugs:2%~5%.6idiopathic:(19.70%,2).注：括弧里的数据为2005年全国12所三甲医院6223例病人的资料。见：中华医学会第7次消化病学术会议论文汇编，2007：423~4257Etiol

5、ogyandPathogenesis(2)Autodigestion:tobeactivatedinthepancreas?intheintestinallumen?anumberoffactorsproenzymesEnzymestrypsinautodigestionActivateOtherenzymes8EtiologyandPathogenesis(2)ThreephasesoftheevolutionofAPinitialstep:proenzymesactivationinacinus,Acinarcellinjurybyacti

6、vatedenzymes.secondstep:activation,chemoattraction,andsequestrationofneutrophils.9EtiologyandPathogenesis(3)thirdstepinjuryofthedistantorgansActiveenzymesTrypsinElastasePhospholipase……MediatorsBradykininPeptideVascularSubstanceshistamineInjuryofthedistantorgans10Etiologyand

7、Pathogenesis(4)Acascadesystemicinflammatoryresponsesyndrome(SIRS)acuterespiratorydistresssyndrome(ARDS)multipleorganfailure(MOF)(multipleorgandysfunctionsyndrome,MODS)11EtiologyandPathogenesis(5)gallstonesinfectionBilejuicerefluxtrypsinKininsystemselastaseTrypsinchymotrypsino

8、Phospho-lipaseA2lipidaseFreefatacidhemorrhageSeverpainSerumcalcium12