Current Status Of Acute Pancreatitis

1. EtiologyThe pathogeny of acute pancreatitis(AP) is more, and has certain local difference. Big parts of districts mainly with biliary origin, alcohol and eating too much at one meal for lord. In recent years, more factors leading to acute pancreatitis were reported, such as hyperlipidemia, ERCP-the belly surgical operation.(1) Biliary tract disease:Various factors can cause biliary obstruction which can cause acute pancreatitis, such as cholecystitis, cholecystolithiasis, parasites.(2) Alcohol:Excessive alcohol intake can cause systemic vascular spasm leading to micro-circulatory failure which cause acute pancreatitis. It Is more common in Europe and the United States.(3) ERCP:Acute pancreatitis is the most common complication of ERCP. Multiple intubation and Injecting contrast medium time and again are factors that cause acute pancreatitis.(4) Hyperlipidemia:Hyperlipidemia and acute pancreas are closely related.2. Pathogenesis(1) Pancreas digestion and trypsin activation:Acute pancreatitis is mainly due to the gland itself digestion, which is mainly caused by trypsin activation.(2) The activation and excessive release of inflammatory cytokines:Many studies show that there is excessive releasing inflammatory cytokines in the early period of acute pancreatitis, which leads to multiple organ dysfunction syndromes.(3) Shift of intestine bacteria:Infection is the main cause of pancreatic tissue necrosis in acute pancreatitis and the shift of intestine bacteria plays an important role in it.(4) Apoptosis of pancreas cell:Apoptosis of pancreas cell is a way of getting rid of unrecovered cells after trauma during acute pancreatitis. And negatively correlated with the degree of pancreatic tissue necrosis.(5) Calcium overload of pancreatic acinar cell:Calcium usually accumulate in the pancreatic tissue in the early lesions in acute pancreatitis. It makes abnormal calcium channels open, large amounts of calcium into the cell resulting in intracellular calcium overload.3. Diagnosis The main diagnostic criteria for acute pancreatitis is based on signs and symptoms, blood and urine amylase determination and imaging diagnosis. Its severity extent is determined by Ranson score, APACHEII score. With the development of basic medicine and the In-depth study of the pathogenesis of acute pancreatitis, some laboratory indicators such as CRP,PCT,etc are considered to be early to predict the condition of acute pancreatitis, severity and prognosis.4. TherapyMost non-gallstone pancreatitis are mainly treated through non-surgical therapy, including drug administrations which are used to inhibit the secretion of pancreatic enzymes such as somatostatin, octreotide,and durgs to inhibition the synthesis of pancreatic enzymes such as Gabexate. In Recent years some Chinese traditional medicine such as Qingyi Decoction(QYD) is also used in the treatment of acute pancreatitis. Nourishment support is usually used in the patients suffering from SAP. It mainly means the vein nourishment until patients’ condition is relieved and then consider intestine nourishment is considered. Acute pancreatitis surgery therapy have strict surgical indications. Only in the case of biliary obstruction pancreatic hemorrhage necrosis secondary infection and when conservative medical treatment fails surgery therapy is needed.