lecture on gallstone associated acute pancreatitis
DESCRIPTION
Lecture on Gallstone Associated Acute Pancreatitis. Diagnostics. 诊 断. 全面 要有重点 有判断 有思路(各判断之间的联系) 具体 分类中所属位置 具体但要求足够的可信度, 依据 动态 History, present, development 对策 Feedback. 全 面 具 体. 治疗. Diagnosis about AGP. Diagnosis. Pancreatitis acute - PowerPoint PPT PresentationTRANSCRIPT
Lecture onGallstone Associated Acute Pancreatitis
诊诊断断 全面
要有重点 有判断 有思路(各判断之间的联系)
具体 分类中所属位置 具体但要求足够的可信度 , 依据
动态 History, present, development
对策 Feedback
全 面 具 体
治治疗疗
DiagnosticsDiagnostics
DiagnosisDiagnosis Pancreatitis acute Biliary or gallstone associated Severe, I,II; Fulminant
Gallstone In Gallbladder: pacted ? Strangulated? perforated ? In CBD: Pacted? changitis ? AOSC?
Metabolism 高渗,酮症,低血糖;电解质;… …
General condition
Complete
TreatmentTreatment
Diagnosis about AGPDiagnosis about AGPco
ncre
te
55 %%HyperlipidemiaHyperlipidemia
2525 %%AlcoholAlcohol
55 %%OthersOthers
6565 %% GallstoneGallstone
Etiology of APEtiology of AP
Treatment Strategy for critical Patients, SAP II , AOSC
对因治疗 梗阻,感染灶
全身状态的评估与维护 氧供,氧输送;循环;糖代谢 脏器功能:心、肺、肝、肾、脑
手术的时机 选择与创造
Effective, but higher risks morbidity Mortality
op within 48h 83 % 18 %op after 48h 48 % 12 %
Strategy Discriminate those with obstruction and Cholangitis Endoscopy delayed operation
The role of emergency operation
Role of ERCP & EST During Severe Attack
Three trial / randomized and control Neoptolemos JP ; Fan ST
regardless of presence of obstructive jaundice and / or cholangitis
Folsch UR restricted to the patients with obstructive jaundice
and / or cholangitis References : Neoptolemos JP, 6 papers
Ameliorate symptoms and progression
Operation to prevent the relapseOperation to prevent the relapse
Recommendation Cholecystectomy should be performed to avoid the
recurrence of Gallstone associated pancreatitis.
Evidence Recurrence in 29 % ~63 % cases if
Recommendation In mild cases, Cholecystectomy should be
performed as soon as the patients has recovered, and ideally during the same hospital admission.
In severe cases, Cholecystectomy should be delayed until sufficient resolution of the inflammatory response and clinical recovery.
EST to Prevent Further AttackEST to Prevent Further Attack
建议 : 对全身条件不适宜手术的病人,为降低胆石性胰腺炎复发的危险, EST 是胆囊切除术的替代措施。然而,理论上有导致无菌性胰腺坏死感染的危险( B 级)
依据: EST in 5 series with a total of 109 cases: median follow-
up time 22~39 months, only 1 仅 1 例( 0.9% )复发 文献: Davidson BR 等 5 篇
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Endoscopic Nasal Biliary Drainage