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1、Acute PancreatitisXUE Huiping,Pancreatitis is an inflammatory process in which pancreatic enzymes autodigest the gland.,The gland can sometimes heal without any impairment of function or any morphologic changes. This process is known as acute pancreatitis. It can recur intermittently, contributing t
2、o the functional and morphologic loss of the gland, the pathological change referred to as chronic pancreatitis.,Acute pancreatitis refers to an attack involving a previously normal pancrease. Chronic pancreatis is applied to an attack involving a previously, permanently damaged pancrease.,Acute pan
3、creatitis is an acute inflammatory process of the pancreas, with variable involvement of other regional tissue or remote organ systems. Although pancreatic function and structure usually return to normal, the risk of recurrent attacks is 20 to 50% unless the precipitating cause is removed. The disea
4、se includes a broad spectrum of pancreatic disease, which varies from mild parenchymal edema to severe hemorrhagic pancreatitis associated with subsequent gangrene and necrosis. 急性胰腺炎（acute pancreatitis）是指胰酶在胰腺内激活后引起胰腺组织自身消化的急性化学性炎症。,A sensible classification system separates pancreatitis into mild
5、and severe disease based on physiologic findings, laboratory values, and radiologic imaging.,Mild pancreatitis is not associated with organ dysfunction or complications, and recovery is uneventful. Severe pancreatitis is associated with decreased function of the pancreas, local and systemic complica
6、tions, and a complicated recovery., 轻型急性胰腺炎是指仅有很轻微的脏器功能紊乱，没有明显腹膜炎体征及严重代谢紊乱等临床表现，临床恢复顺利者。该型病理上绝大多数为水肿型胰腺炎，少数也可有胰腺实质坏死。,Severe pancreatitis is defined as a local complication and/or organ failure.,重症急性胰腺炎是指急性胰腺炎伴有脏器功能障碍，或出现坏死、脓肿或假性囊肿等局部并发症，或两者兼有。该型病理上绝大多数为坏死型胰腺炎，但少数情况下水肿型胰腺炎也可表现为重症胰腺炎。,Local complicat
7、ions are defined as (1) acute fluid collections; (2) pancreatic necrosis; (3) pancreatic abscess; (4) pancreatic pseudosyst, The clinical presentation of acute pancreatitis is variable, from episodes of mild abdominal discomfort alone to a severe illness associated with hypotension, metabolic derang
8、ements, sepsis, fluid sequenstration, multiple organ failure or even death. It is always accompanied by an increased concentrations of pancreatic enzymes in blood and in urine.,Etiology Approximately 70-80% of patients either have gallstones or a history of sustained alcohol abuse.,Choledocholithias
9、is(胆总管石病) and ethanol abuse account for 70 to 80% of all cases., Gallstones may cause pancreatitis by impacting in the ampulla of Vater. The incidence of gallstone-associated pancreatitis parallels that of cholelithiasis(胆石症): it peaks at ages 50 to 70, and women outnumber men by 2 to 1.,Causes of A
10、cute Pancreatitis Obstruction: Biliary tract disease: cholelithiasis, tumor, ascarid, stenosis pancreatic duct obstruction: neoplasms, cysts,pancreas divisum annular pancreas ampullary stenosis, duodenal diverticulum Duodenal obstruction Alcohol Hyperlipidemia Hypercalcemia Hereditary Trauma:externa
11、l, operative,ERCP Ischemia:hypotension,cardiopulmonary bypass, atheroembolism,vasculitis Infectious causes: parastic bacterial viral fungal Drugs:steroids,azathioprine 6-mercaptopurine, Idiopathic,Obstructive Causes,Choledocholithiasis胆总管石病 Ampullary obstruction by tumor or sphincter of Oddi hyperte
12、nsion Choledochocele胆总管囊肿 Periampullary duodenal diverticulum(憩室) Pancreas divisum : annular(环状的) pancreas Primary or metastatic pancreatic tumor Parasites in pancreatic duct: Clonorchis(支睾吸虫), Ascaris,Drugs,azathioprine硫唑嘌呤/6-mercaptopurine6-巯基嘌呤; valproic acid丙戊酸; estrogens雌激素; metronidazole灭滴灵，甲硝
13、唑; loop diuretics, including thiazides 噻嗪类, furosemide速尿; pentamidine; sulfonamides, including sulfasalazine; methyldopa: L-asparaginase; tetracyclines, etc.,Pathogenesis 1.A complicated pathophysiologic process 2.Enzyme autoactivation and self-digestion (key point) 3. Many agents participating in t
14、he process 4. Complete mechanism remaining unknown,Pancreatic self-protective mechanism 1.mucopolysaccharide on pancreatic duct epithelia 2.proenzyme 3.pancreatin inhibitor 4.acinus metabolism activity 5. Anti-reflux mechanism: oddis sphincter pancreatic duct sphincter,Initiation factor in Earlier p
15、eriod,1. Pancreatic Enzyme Abnormally Activated Bile reflux Bile common channel pancreatic duct 1.hypertension in pancreatic duct 2.premature activation of pancreatic enzymes 3.injury to the lining of the pancreatic ducts pancreatic edema or necrosis MODS, Duodenal Refulx duodenal enterokinase pancreatic duct trypsinogen trypsin elastasnogen elastase phospholipasogen phospholipase lecithin lysolecthin,
