Early signs of acute pancreatitis.
Having three of the following symptoms should be considered as having acute pancreatitis: When the hemorrhagic necrotic type is accompanied by paralytic intestinal obstruction, vomiting may be relieved but there is significant abdominal distension. Taonan City Hospital of Traditional Chinese Medicine Department of Surgery Yu Nianfeng ● Fever Abdominal pain with fever is one of the characteristics of this disease -. Patients with edematous type often have moderate fever, a few can exceed 39℃, not accompanied by chills, and generally last for 3-5 days; patients with hemorrhagic necrosis have higher fever, which often persists, especially when there is peritonitis, pancreatic abscess with biliary tract infection, and often have flaccid hyperthermia. Shock Shock with shock accounts for about 2.5%-7.2%, commonly in acute hemorrhagic necrotizing pancreatitis, patients can gradually or suddenly appear irritable, skin pale, wet and cold, florid, blood pressure drops, pulse rate increases. A few patients town die suddenly within a short time after the onset of the disease. Biliary obstruction and sphincter of Oddi spasm are the causes of xanthogranuloma, which accounts for about 15%-25% of patients with acute pancreatitis and up to 37% of patients with hemorrhagic necrotizing pancreatitis. ● Disorders of water-electrolyte and acid-base balance Metabolic alkalosis may occur in patients with frequent vomiting; in patients with hemorrhagic necrotic type, there may be obvious dehydration and metabolic acidosis, and severe cases may cause hand and foot convulsions due to hypocalcemia.
Acute pancreatitis auxiliary examination
1. The white blood cell count is usually between 10 and 20×109/L. If the infection is serious, the count is high and there is a significant left shift of the nucleus. Some patients have increased urine sugar, and in severe cases there are protein, red blood cells and tubular type in the urine. 2. Blood and urine amylase measurement It has important diagnostic significance. Normal value: serum: 8 to 64 Winslow units, or 40 to 180 Somogyi units; urine: 4 to 32 Winslow units. In patients with acute pancreatitis, pancreatic amylase spills out of the pancreas and is rapidly absorbed into the blood and excreted by the urine, so blood and urine amylase is greatly increased, which is an important laboratory test for the diagnosis of the disease. Serum amylase begins to increase 1 to 2 hours after the onset of the disease, 8 to 12 hours specimen is the most valuable, to 24 hours to reach a peak of 500 to 3000 Somogyi’s units, and last 24 to 72 hours, 2 to 5 days gradually drop to normal, while urinary amylase begins to increase 12 to 24 hours after the onset of the disease, 48 hours to reach a peak, maintain 5 to 7 days, decline slowly. In the case of severe necrosis, the amylase value is not increased because of the severe destruction of the glandular vesicles and little amylase production. If the amylase value goes down and then goes up again, it indicates that there is a recurrence of the disease, and if it continues to increase, there may be complications. In some cases of peritonitis, biliary tract disease, ulcer perforation, strangulated intestinal obstruction, post-gastrectomy input collaterals obstruction, etc., amylase values can be increased to varying degrees, but are generally less than 500 SU units. Therefore, the diagnosis of acute pancreatitis is only meaningful when the measured value is >256 Winn units or >500 So units. 3 ． serum lipase assay Normal value 0.2 to 1.5 mg%, its value increases for the same reason as 2. It begins to rise 24 hours after the onset of the disease and can last for 5 to 10 days more than 1 Cherry-Crandall unit or Comfort method 1.5 units has diagnostic value. Because of its late decline, the measurement of its value can be useful for the diagnosis of those who visit the clinic late. 4. Serum calcium measurement The normal value is not less than 2.12 mmol/L (8.5 mg/d1 ). In heavy cases, it may drop to below 1.75mmol/L (7mg/d1), which indicates serious illness and poor prognosis. 5. serum orthoferritin (Methemalbumin, MHA) measurement MHA comes from the hemoglobin released from the destruction of red blood cells in the bloody pancreatic fluid, which is converted into orthoferritin under the action of lipase and elastase, and is absorbed into the blood and combined with albumin to form orthoferric hemoglobin. MHA is often seen 12 hours after the onset of severe disease and is positive in patients with severe acute pancreatitis and negative in the edematous type. 6 X-ray The abdomen shows limited or extensive intestinal paralysis (dilated and inflated small intestine without tension, enlarged pneumatization of the left transverse colon). Fluid and gas accumulation in the small omental sac. There is a calcified shadow around the pancreas. Diaphragmatic elevation, pleural effusion, occasional disciform atelectasis, and a “hairy glass” lung field in the presence of ARDS are also seen. 7 Ultrasound and CT can show the outline of pancreatic enlargement, the amount and distribution of fluid, and can also show pseudopancreatic cysts and abscesses.