Biliary acute pancreatitis

Introduction to biliary acute pancreatitis Biliary acute pancreatitis refers to pancreatic duct obstruction caused by biliary stones, inflammation, pancreatic mucosal barrier damage, pancreatic juice spillover, pancreatic tissue self-digestion, and acute biliary pancreatitis. Its clinical incidence is higher, second only to acute appendicitis, acute intestinal obstruction, acute biliary infection and gastroduodenal ulcer. basic knowledge Sickness ratio: 0.0012% Susceptible people: no specific people Mode of infection: non-infectious Complications: jaundice shock

Causes of biliary acute pancreatitis

Stones (25%):

The stones of the biliary system move in the body. Not only the stones itself can cause the ampulla of the ampulla, but also the stones can cause damage to the mucous membranes, causing secondary edema or infection, aggravating stenosis, ampullary stenosis, increased pressure in the biliary tract, and bile reflux In the pancreas, pancreatic enzyme is activated, causing the pancreas to digest itself.

Infection (20%):

Bacterial infection of the biliary system, the bile contains a large number of bacteria and their metabolites, some of which, such as bacterial amidase, can activate pancreatic enzymes, causing self-digestion and acute inflammation of the pancreas; inflammation of the common bile duct can directly affect the pancreatic duct The pancreatic duct drainage is not smooth and the disease occurs in the pancreatic tissue.

Other (10%):

Biliary parasites, scar stenosis, tumor and Oddi sphincter dysfunction can cause pancreatic duct obstruction, poor pancreatic juice excretion, bile reflux and other diseases.

Various diseases of the biliary tract, including stones, mites, infections, scar stenosis, tumors, inflammatory edema, etc. can cause acute pancreatitis. The "common pathway" is the anatomical basis of its occurrence, in which stones and infections are the most common. the reason.

Pathogenesis

1 The stone is invaded in the ampulla, and the bile flows back into the pancreatic duct through a common pipeline. The infection is brought into the pancreatic duct. During the excretion of the gallstone, the Oddi sphincter is paralyzed and the intestinal contents flow back into the pancreatic duct, causing pancreatitis. 3 toxic substances on pancreatic tissue damage, including: free bile acids, bacteria, unconjugated bilirubin and lysolecithin, free bile acids are toxic, can damage the pancreatic duct mucosal barrier; bacteria can secrete glucuronidase ( -glucuronidase), which can decompose and bind bilirubin to unconjugated bilirubin, but not bilirubin to the pancreas; patients with acute cholecystitis have lysolecithin in the bile, which can directly damage pancreatic tissue.

Biliary acute pancreatitis prevention

1. This disease is caused by biliary tract diseases. Therefore, active treatment of biliary tract diseases can effectively prevent the occurrence of this disease. For example, prevention of intestinal mites, timely treatment of biliary stones and avoiding acute attacks of biliary tract disease are important measures to avoid causing acute pancreatitis.

2. Control fat intake, during the treatment of pancreatitis, do not eat fatty meat, avoid alcoholism, diet structure to eat low-fat foods, such as soy products, fish, shrimp, eggs and some lean meat.

Complications of biliary acute pancreatitis Complications

1. A small number of hemorrhagic and necrotic patients with jaundice, jaundice is a manifestation of liver damage caused by severe intra-abdominal infection.

2. Some patients in shock have faster pulse, lower blood pressure, faster breathing, pale face, cold limbs, indifferent expression or irritability.

3. Bleeding signs Local skin is blue-purple, visible in the waist, anterior lower abdominal wall or umbilical cord.

Biliary acute pancreatitis symptoms Common symptoms Expression indifferent intestinal paralysis irritability Abdominal muscle tension Serious abdominal infection Umbilical skin Skin blue purple spot Abdominal tenderness Nausea perforation

Symptom

(1) Abdominal pain: It is the main symptom of this disease. It starts in the upper abdomen and appears early. The typical person often feels pain on the left side of the umbilicus. It is persistent and has a paroxysmal aggravation. It is cut into the knife and often radiates to the shoulder. Department, flank and lower back, with the spread of inflammation, the range of abdominal pain can be banded, or spread to the whole abdomen.

(2) nausea and vomiting: It is an early symptom of this disease, which occurs almost at the same time as abdominal pain. The initial episodes are frequent, often sprayed, with food and bile, and intestinal paralysis in the late stage, which can vomit fecal samples.

(3) bloating: It is a common symptom of this disease. The degree of bloating has a certain relationship with the degree of pancreatitis. The lighter lasts for 2 to 3 days, and the severe one can last for more than 7 days, often accompanied by venting and defecation.

(4) Astragalus: generally lighter, mostly obstructive, but a small number of patients with hemorrhagic necrosis, jaundice is a manifestation of liver function damage caused by severe intra-abdominal infection.

(5) Others: fever, gastrointestinal bleeding, shock signs, etc. may occur in some patients.

2. Signs

(1) Abdominal tenderness and abdominal muscle tension: Most patients have abdominal tenderness, mainly above the abdomen, and the abdominal muscles are more tense, but the degree is not as good as gastrointestinal perforation or gallbladder perforation, and some patients have diffuse peritonitis.

(2) Shock: Some patients have faster pulse, lower blood pressure, faster breathing, pale face, cold limbs, indifferent expression or irritability.

(3) signs of bleeding: the overflowing pancreatic juice reaches the subcutaneous fat along the interstitial space, causing the capillary to rupture and hemorrhage, so the local skin is blue-purple, which can be seen in the waist, anterior lower abdominal wall or umbilical cord.

(4) intestinal obstruction and mobile dullness: intestinal obstruction is often paralyzed, intra-abdominal hemorrhage, when there is more exudation, can move out of mobile dullness.

Examination of biliary acute pancreatitis

Blood test

The disease often has low blood volume shock and combined infection, white blood cell count is mostly increased, hemoglobin and hematocrit increase, carbon dioxide binding capacity decreases, blood sugar increases in the early stage of attack, lasts for several hours to several days, acute necrosis type blood calcium in 2 ~ 5 days began to decline, if it is below 1.75mmol, indicating that the disease is heavy, blood urea gelatinase is one of the important basis for the diagnosis of pancreatitis, 70% to 95% of patients with acute pancreatitis showed an increase in serum amylase, reaching a peak at 24h. Within 5 days, the patient returned to normal and continued to increase for more than 12 days, indicating that there were complications. The increase of urinary amylase was delayed and lasted for a long time. Serum lipase increased to 1.5 Kang unit above 24 hours after onset.

2. Abdominal puncture acute necrotizing pancreatitis, abdominal puncture can often draw turbid liquid, and may see fat droplets, may be purulent when infected, peritoneal fluid amylase often increased, often higher than serum amylase, and The duration is also 2 to 4 days longer than serum amylase.

3. Abdominal plain film 2/3 of patients with acute pancreatitis can show abnormalities, such as: increased pancreatic shadow, unclear margin, increased density, localized intestinal paralysis, transverse colon truncation (the liver of the colon can be seen in the supine position) The song, the spleen is inflated, and the middle part of the transverse colon is airless.

4. Chest fluoroscopy can be seen in the left diaphragmatic muscle, moderate left pleural effusion, or left lower lobe atelectasis.

5. B-mode ultrasonography can be found diffuse swelling of the pancreas, increase, the outline is slightly curved, the positive rate can reach 45% to 90%, and biliary tract disease can be found.

6. CT examination is a modern and sensitive non-invasive diagnosis method, 70% to 90% of patients have abnormal performance: focal or diffuse pancreas enlargement, uneven density, irregular shape, pancreatic or pancreatic fluid accumulation Wait.

Diagnosis and diagnosis of biliary acute pancreatitis

Differential diagnosis

The diagnosis of acute pancreatitis still lacks a unified standard. It is often combined with clinical, biochemical and imaging findings to make a comprehensive judgment. The criteria established by Japan in 1988 are as follows:

1. Acute abdominal pain is accompanied by upper abdominal tenderness or peritoneal irritation.

2. Increased trypsin in blood, urine or ascites.

3. Imaging examination, surgery and biopsy found that the pancreas is abnormal, with more than 2 criteria including the first item and exclude other acute abdomen can be diagnosed as acute pancreatitis, clinical reference.

Early or edematous pancreatitis should be differentiated from gastroduodenal ulcer, acute biliary tract disease, intestinal obstruction and appendicitis. Hemorrhagic necrotic pancreatitis should be perforated with gastroduodenal ulcer, strangulated intestinal obstruction, mesenteric vessel The identification of embolism, myocardial infarction, etc., can not be identified by some special examinations, should be laparotomy, the identification of this disease and non-biliary pancreatitis is sometimes difficult, but because the two treatments are basically the same, therefore, is not identified Focus.

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