Hot pot is becoming more and more popular, but doctors are worried because of the increase in overeating and heavy drinking, and the inevitable high incidence of tricky pancreatitis.
Acute pancreatitis has a variety of pathogenic risk factors, domestic biliary tract disease is dominant, accounting for more than 50%, called biliary pancreatitis.
Etiology.
1, biliary tract diseases bile duct stones, bile duct roundworms, as well as inflammation and surgical instruments cause obstruction of the end of the common bile duct.
2, alcohol consumption is one of the common causes. Alcohol and high protein and high fat food intake at the same time, not only increased pancreatic enzyme secretion, but also can cause hyperlipoproteinemia.
3, metabolic diseases can be related to hypercalcemia, hyperlipidemia and other conditions.
4, duodenal fluid reflux when the pressure in the duodenum increases, duodenal fluid can reflux into the pancreatic duct. If the lower end of the bile duct is obviously obstructed, the pressure in the bile duct is very high, and the high pressure bile flows back into the pancreatic duct, causing the rupture of the pancreatic vesicles, pancreatic enzymes into the interstitial pancreatic and pancreatitis occurs.
5, medical factors endoscopic retrograde cholangiopancreatography (ERCP) can lead to pancreatitis in about 2-10% of patients, pancreatic duct jejunostomy stenosis may also lead to residual pancreatitis.
6, other diet, tumor, drugs, trauma, infection, pregnancy, etc. can lead to pancreatic duct obstruction and thus acute pancreatitis.
Clinical manifestations.
1, abdominal pain
It is the main symptom of the disease. The abdominal pain is severe, persistent, with paroxysmal aggravation, located in the upper middle abdomen (or favoring the right upper abdomen or left upper abdomen), often involving the chest and back or both ribs and lower abdomen.
2.Abdominal distension
Coexisting with abdominal pain. It is the result of intestinal paralysis produced by the stimulation of nerves in the abdominal cavity, caused by reflex intestinal paralysis in the early stage, and later in severe cases, mostly due to the stimulation of retroperitoneal inflammation. The more severe the retroperitoneal inflammation, the more pronounced the abdominal distension. Abdominal distension can be aggravated when fluid accumulates in the abdominal cavity. The patient stops defecating and passing gas, and bowel sounds are diminished or absent. Increased intra-abdominal pressure can lead to abdominal septal compartment syndrome.
3, nausea, vomiting
The symptoms can appear early, vomiting is intense and frequent, vomiting often persists, vomit is gastroduodenal contents. Abdominal pain is not relieved after vomiting.
4, peritonitis
In mild cases, the pressure pain is limited to the upper abdomen, often without obvious muscle tension. In severe pancreatitis, there is obvious pressure pain, rebound pain and muscle tension in the epigastrium, disappearance of bowel sounds, intestinal paralysis and intestinal distension are more obvious. Mobile turbid sounds are mostly positive.
5.Fever
Mild acute edematous pancreatitis may not be febrile or mildly febrile, but in biliary pancreatitis with biliary obstruction, there can be high fever and chills in the early stage of the disease. In case of pancreatic necrosis with infection, persistent hyperthermia is one of the main symptoms.
6. Hypotension and shock
Hypotension and signs of shock appear rapidly in severe pancreatitis, mainly due to large amount of body fluid exudation and bleeding in the abdominal, retroperitoneal and thoracic cavities.
7.Jaundice
It can be caused by edema of the head of the pancreas compressing the common bile duct, but in most cases it is produced by concomitant common bile duct stones and biliary tract infection.
8.Multi-organ failure
Severe pancreatitis can cause respiratory distress, hypoxemia oxygen partial pressure, abnormal ECG and liver and kidney functions, and even DIC and psychiatric system symptoms, which are manifested as confusion, agitation, disorientation, jaundice, elevated ALT, low urine, elevated urea nitrogen and creatinine.
Diagnostic points.
1. history of a full meal or alcohol consumption with sudden onset of severe epigastric pain radiating to the lower back with nausea, vomiting, abdominal distention and fever.
2, signs of peritonitis, positive mobile turbid sounds, absent bowel sounds, Grey-Tnrner sign (large cyanotic-purple petechiae on the skin of the lumbar region, quarter ribs and abdomen), Cullen sign (blue changes in the skin around the umbilicus).
3. elevated serum and urinary amylase and elevated serum lipase for a preliminary clinical diagnosis.
4. Ultrasound, enhanced CT scan and MRI examination can help to diagnose and differentiate edematous and hemorrhagic necrotizing pancreatitis.
Treatment.
Select appropriate treatment according to the typology, stage and etiology of acute pancreatitis.
1.Non-surgical treatment
(1) fasting, gastrointestinal decompression.
(2) rehydration, anti-shock: intensive care should be given to critically ill patients, oxygen, maintaining SO2 ≥ 95%.
(3) Analgesia and antispasmodic.
(4) suppression of pancreatic secretion.
(5) nutritional support.
(6) antibiotic application.
(7) Chinese herbal medicine treatment.
2., Surgical treatment.
Indications
1. When the diagnosis is not clear and it is difficult to differentiate from other acute abdominal diseases such as gastrointestinal perforation.
2. Secondary infection of the pancreas and peripancreatic tissue.
3, combined with intestinal perforation, hemorrhage or pancreatic pseudocysts.
4. When biliary pancreatitis is in an acute state and surgical operation is needed to release the obstruction.
Surgery: The most common method is necrotic tissue removal with drainage. If necessary, a gastrostomy is performed to allow gastrointestinal decompression and a jejunostomy is performed to allow the input of enteral nutrition fluid.
Management of biliary pancreatitis: The purpose of surgery is to remove bile duct stones, relieve obstruction, and unblock drainage. If the symptoms of gallbladder stones are mild, cholecystectomy should be performed during the initial hospitalization. Those with combined bile duct stones, severe disease or poor general condition, unable to tolerate surgery should undergo Oddi sphincterotomy, stone extraction and nasobiliary drainage by emergency or early ERCP.