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1、重新认识犬胰腺炎 History 病史 Signalment 临床表现 Diet Vomiting 饮食情况 呕吐 History of pancreatitis 胰腺炎病史 Diarrhea 腹泻 History 病史 Signalment 临床表现 Diet Vomiting 饮食情况 呕吐 History of pancreatitis 胰腺炎病史 Diarrhea 腹泻 History 病史 Signalment 临床表现 Diet Vomiting 饮食情况 呕吐 History of pancreatitis 胰腺炎病史 Diarrhea 腹泻 Knowing the LIMITA
2、TIONS of a test or procedure is often much more important than knowing what a procedure can do 了解某项检查或操作的 局限性 比了 解某项操作的作用更为重要 Physical Examination 体格检查 Anterior abdominal pain 前腹部疼痛 Icterus Profuse ascites 黄疸 大量腹水 Fever SQ abscesses 发热 皮下脓肿 Physical Examination 体格检查 Anterior abdominal pain 前腹部疼痛 Ict
3、erus Profuse ascites 黄疸 大量腹水 Fever SQ abscesses 发热 皮下脓肿 Physical Examination 体格检查 Anterior abdominal pain 前腹部疼痛 Icterus Profuse ascites 黄疸 大量腹水 Fever SQ abscesses 发热 皮下脓肿 WHICH CBC(S) IS/ARE FROM DOG(S) WITH ACUTE PANCREATITIS? 哪份血常规结果是来自急性胰腺 炎患犬的？ 147033 147198 90524 159796 PCV WBC Segs Bands 28.5
4、30,000 26,100 900 28.8 45,500 33,670 2,730 30 9,800 4,606 2,450 40 11,500 9,890 0 Plat 87,000 407,000 679,000 470,000 Toxic mod mod none none 147033 147198 90524 159796 PCV WBC Segs Bands 28.5 30,000 26,100 900 28.8 45,500 33,670 2,730 30 9,800 4,606 2,450 40 11,500 9,890 0 Plat 87,000 407,000 679,0
5、00 470,000 Toxic mod mod none none Clinical Pathology 临床病理学 An anorexic, vomiting dog with fasting hyperlipidemia probably has acute pancreatitis 患犬 厌食、呕吐 ，突然出现 高脂血症 可能患有急性胰腺炎 Clinical Pathology 临床病理学 An anorexic, vomiting dog with fasting hyperlipidemia probably has acute pancreatitis 患犬 厌食、呕吐 ，突然出
6、现 高脂血症 可能患有急性胰腺炎 Most dogs with pancreatitis DO NOT have fasting hyperlipidemia 大部分胰腺炎患犬 并未 突然出现高脂血症 Clinical Pathology 临床病理学 Amylase/Lipase Sensitivity 50% Specificity 50% 淀粉酶 /脂肪酶 敏感性 -50% 特异性 -50% TLI 血清胰蛋白酶样免疫反应 Sensitivity 35% 特异性 -35% Clinical Pathology 临床病理学 Amylase/Lipase Sensitivity 50% Spe
7、cificity 50% 淀粉酶 /脂肪酶 敏感性 -50% 特异性 -50% TLI 血清胰蛋白酶样免疫反应 Sensitivity 35% 特异性 -35% Clinical Pathology 临床病理学 cPLI Sensitivity 80-85% 敏感性 80-85% TAMU#203505 Sig: 14 yr M(n) Shih Tzu 14岁 雄性已去势 西施犬 CC: Abdominal pain 前腹部疼痛 HPI: Pain 2 days ago and yesterday 两天前和昨天疼痛 Vomited 1 time PU-PD for last week 呕吐一次
8、 上周多饮多尿 PE: Normal appetite/body weight 食欲 /体重正常 No abnormalities today 今日无异常 TAMU#203505 PCV = WBC = Segs = Bands = Lymphs = 24% (35-55) 23,300/ul (6,-14,000) 17,475/ul (4,-12,000) 0/ul ( 500) 4,660/ul (1,- 4,000) Platelets = 498,000/ul (200,- 500,000) TAMU#203505 肌酐 钙 钠 钾 Creatinine = Calcium = So
9、dium = Potassium = 0.78 mg/dl ( 2.0) 9.7 mg/dl (9.3-11.8) 153 mEq/L (138-148) 3.8 mEq/L (3.8-5.1) 白蛋白 Albumin = ALT = SAP = 胆红素 Bilirubin = 2.7 gm/dl (2.5-4.4) 8,258 IU/L ( 130) 2,354 IU/L ( 147) 0.3 mg/dl (0-0.8) TAMU#203505 Abd U/S: “. . enlarged pancreas with nodules . hepatic mass most consisten
10、t with primary liver tumor” 腹部超声检查：胰腺体积增大，可见胰腺结节 肝 脏肿物符合原发性肝肿瘤特征 TAMU#203505 Snap PL: positive cPL试剂盒检测： 阳性 Your best next step is: 下一步最好： 1 Forget about it (dog is now happy) 算了吧（狗狗现在挺开心的） 2 Repeat cPLI and ultrasound tomorrow 明日复查 cPLI和超声检查 3 Tx for acute pancreatitis (IV fluids) 治疗急性胰腺炎（静脉补液） 4 T
11、x with pancreatic enzymes 用胰酶治疗 5 Hepatic lobectomy 肝叶切除术 8 PANCREATITIS versus CLINICALLY IMPORTANT PANCREATITIS 胰腺炎 和 临床上需重视的胰腺炎 Diagnostics 诊断 cPLI Sensitivity 80% 敏感性 -80% Abdominal ultrasound 腹部超声检查 Sensitivity 40% - 65% 敏感性 40% - 65% Diagnostics 诊断 cPLI Sensitivity 80% 敏感性 -80% Abdominal ultra
12、sound 腹部超声检查 Sensitivity 40% - 65% 敏感性 40% - 65% Because clinicians rarely repeat the ultrasound 因为临床医师很少重复进行超声检查 Diagnostics cPLI Sensitivity 80% 敏感性 -80% Abdominal ultrasound 腹部超声检查 Sensitivity 40% - 65% 敏感性 40% - 65% Findings can change within hours . 检查结果数小时内就可能发生变化 WHAT IS THE BEST WAY TO DIAGN
13、OSE CANINE ACUTE PANCREATITIS? 诊断犬急性胰腺炎最好的方法是 Be willing to repeat ultrasound 重复进行超声检查 All things being equal, try to avoid surgery 平衡一切，尽量避免手术 All things being equal, try to avoid surgery 平衡一切，尽量避免手术 Be willing to repeat ultrasound 重复进行超声检查 THE REAL PROBLEM IS THAT ACUTE PANCREATITIS CAN PRESENT IN
14、 SO MANY DIFFERENT WAYS THAT YOU DONT EVEN SUSPECT IT INITIALLY 真正的问题是急性胰腺炎可能有很多种表 现，在开始时你也许都不会怀疑是胰腺炎？ TAMU#88267 Sig: 7 yr M Sheltie CC: Vomiting HPI: Began 5 weeks ago 7岁 雄性 喜乐蒂 呕吐 五周前开始 PE: Partial anorexia, vomits phlegm or bile once daily 有时厌食，呕吐黏液或胆汁，每日一次 Dog otherwise pretty healthy 其他方面无异常 No significant abnormalities 未见明显异常 TAMU#159796 Sig: 9 yr M(c) Pug 9岁 雄性去势 巴哥 犬 CC: Vomiting, yellow scleras 呕吐，巩膜发黄 HPI: Feeling bad 12 days ago 12天前状态不佳
