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1、ACUTEPANCREATITISXuSanrongDepartmentofGastroenterologyHuashanHospitalFudanuniversity1DEFINITIONAnacuteinflammatoryprocessofthepan-creasusuallyassociatedwithseverpainintheupperabdomeninmostinstances,bloodlevelsofpancrea-ticenzymesareincreasedseveracutepancreatitis:organsfailureand/orlocalco
2、mplications(necrosis,absc-ess,psuedocyst)2PATHOLOGY(1)Mildacutepancreatitis(MAP)characterizedbyinterstitialedemaassoci-atedwithinflammatorycellwithinparench-yma,andmicroscopicparenchymanecro-siscanbedetectable.3PATHOLOGY(2)Severacutepancreatitis(SAP)Severnecrotizingpancreatitis(SNP)macrosc
3、opicevidenceofeitherfocalordiffusenecrosisandhemorrhageofthepancreaticparenchyma4PATHOGENYAND PATHOGENESIS(1)1commonchannelandrefluxofduodenaljuicegallstonesinfectionBilejuicerefluxtrypsinKininsystemselastaseTrypsinchymotrypsinoPhospho-lipaseA2SteatolyticenzymesSeverpainhemorrhageFreefatac
4、idSerumcalcium,5PATHOGENYAND PATHOGENESIS(2)2alcoholicandovereat3obstructofmainpancreaticduct4diseasesroundtheduodenum/ampullaryregion5postoperativepancreatitisandpancreatictrauma6PATHOGENYAND PATHOGENESIS(3)6infectiousagents7medications:corticosteroids,estrogens8disordersofendocrinologyan
5、dmetabol-ism:hyperparathyroidism,hyperlipidemia9others:7PATHOGENYAND PATHOGENESIS(4)6inflammatorymediatheoryInAP,theleukocytesthatappearfirstinareasofinflammationareneutrophils,thenmacrophages,monocytes,lymphocytes,andothercells.Thesecellscansecretealotofinflammatorymedia.(1)plateletactiva
6、tingfactor,PAF(2)prostaglandins,PGs8PATHOGENYAND PATHOGENESIS(5)(3)leukotriens,LTs(4)kallikreinkininsystems,KKS(5)tumornecrosisfactor-?,TNF-?(6)nitrogenmonoxide,NO(7)complements(8)others:nuclearfactor?B(NF-?B),tolllikereceptors(TLRs).9DIAGNOSIS(1)Clinicalcharacteristics1abdominalpain2fever
7、3nauseaandvomiting10DIAGNOSIS(2)4hypotensionandshock5jaundice6tenderness7peritonealirritationsigntenderness,reboundtenderness,andabdominalmuscletenseness8Grey-turnersign,cullensign9ascites11DIAGNOSIS(3)Assistantexamination1bloodexamination(1)bloodroutineexamin
