I. Etiology of severe acute pancreatitis (SAP)?
1, multifactorial cause, multi-systemic injury.
2, cytokine doctrine.
3, domestic biliary tract diseases caused by 40-70%.
4, it is currently believed that the proportion of hyperlipidemia is significantly elevated.
Second, the classification of severe acute pancreatitis?
1, Mild (Mild, MAP).
2.Moderate (Modern, MASP).
3, Severe (Severe, SAP), (in the past: called hemorrhagic necrotizing pancreatitis – ANP).
Third, the diagnostic criteria of severe acute pancreatitis?
1, symptoms such as abdominal pain consistent with acute pancreatitis, with organ failure.
2, serum amylase and or lipase ≥ 3 times the upper limit of normal value, or normal, or decreasing.
3, imaging features of severe acute pancreatitis with CT values ≤ 40 Hu.
IV. Local complications of severe acute pancreatitis?
1, acute peripancreatic fluid accumulation.
2, acute necrotizing fluid accumulation.
3, pancreatic pseudocysts.
4, encapsulated necrosis.
5, pancreatic abscess (enhanced CT suggests bubble sign, positive bacterial or fungal culture of fine needle puncture material).
V. Systemic complications of severe acute pancreatitis?
1, organ failure.
2, systemic inflammatory response syndrome (SIRS).
3, systemic infection.
4, abdominal compartment syndrome (ACS).
5, pancreatic encephalopathy.
Sixth, the staging of severe acute pancreatitis?
1, early: 1 week to 2 weeks after onset, the clinical manifestations of the systemic inflammatory response syndrome, which can develop into organ failure.
2, late stage: 1 week after onset, can last for weeks or even months. Local complications and/or persistence of systemic complications.
Seven, the principles of treatment of severe acute pancreatitis?
1. early surgery for severe acute pancreatitis will only aggravate the blow to the organism and increase the systemic inflammatory response.
2. for uninfected pancreatic necrosis, conservative treatment under supervision should be the mainstay.
3. Unless there is infection, surgical treatment is not advocated within two weeks.
Eight, the main monitoring content of severe acute pancreatitis?
1.Hemodynamic measurements.
2.Abdominal CT.
3.Arterial blood gas analysis.
4.Blood routine, blood calcium, blood glucose.
5, liver function, kidney function, etc.
IX. Treatment of severe acute pancreatitis?
1.Early fluid resuscitation.
2, maintenance of vital organ function (ventilator, hemofiltration).
3.Enzyme inhibition: growth inhibitors and their analogues (octreotide).
4. H2 receptor antagonists or proton pump inhibitors.
5. prevention of infection.
6.Nutritional support.
7.Combination of Chinese and Western medicine treatment.
Ten, the treatment principles of AP surgical intervention?
1, acute biliary pancreatitis during this hospitalization to perform cholecystectomy.
2. delayed cholecystectomy (≥ 6 weeks after onset) is recommended for severe acute pancreatitis.
3, severe acute pancreatitis with biliary obstruction.
4, severe acute pancreatitis with infection.
5, aseptic necrosis for intervention or surgical intervention.
6, surgical intervention preferred to percutaneous or retroperitoneal puncture for tube drainage or endoscopic drainage.
7, endoscopic or surgical removal of necrotic tissue if necessary.
XI. The advantages of Chinese medicine in treating acute severe pancreatitis?
1.Improve pancreatic blood circulation: Chinese herbal medicines such as rhubarb, mangosteen, peach kernel and salvia can reduce blood viscosity and significantly improve pancreatic blood flow.
2, inhibit bacterial infection and anti-endotoxin: rhubarb and other can inhibit intestinal bacterial translocation by promoting gastrointestinal peristalsis, and have obvious inhibitory effect on endotoxin fever and intestinal endotoxin, which can significantly reduce plasma endotoxin level.