| Acute pancreatitis is a common disease with acute and serioussymptom.The incidence increases with elevation of living standardand alteration of dietary pattern rencent years.Thus, it is essential todiagnosis and treat early. The retrospective analysis is performed in this study to 136 APcases hospi-talized in the digestive department of our hospital, whichare divided into acute biliary pancreatitis (ABP) group,alcoholicpancreatitis group,dietary factor group and others according theiretiological factors;which are divided into mild acute pancreatitis(MAP) group and severe acute pancreatitis (SAP) group accordingclinical situation. The observing contents include 1. Epidemiology:Sex, episodic age and etiological factors. 2. Clinical situation: Theclinical feature of these there groups. 3. laboratory examination: Theserum enzyme feature with abnormal hepatic function of AP. Thevalue of laboratory examination to predict patient's condition. 4.Imaging examination: The diagnostic value of Prognosis abdominalcolour ultra-sound and computerized tomographic scanning (CT). 5.prognosis: The therapeutic effect after combined therapy of internalmedicine. Result: 1. 136AP patients were included in this research, andmale was 76 female was 60. The male female ratio is 1.27:1. Meanage: 43.7±15.5 year old. AP's on-set peak happens in the 25-55 yearsold. The main etiological factors are biliary system disease whichincreases with age-growth, but the incidence of unknown origin ishigher than alcoholic pancreatitis and association with dietary factor.2. Clinical situation has no specificness. But it is important indiagnosis. abdominal pain is major appearance and primary symptom.SAP may occure tenderness,muscular tension,rebound tendernessbecause of pancreatic necrosis and effusion diffusion. The symptomsof nausea,vomiting,abdominal distension and fever are common. Theincidence of jaundice of ABP is higher than none-acute biliarypancreatitis (NABP) in abnormal hepatic function of AP.3. (1) Abnormal hepatic function of ABP is more serious thanNABP, especially the increasing of alanine aminotransferase(ALT),total bilirubin (TBIL). Abnormal hepatic function of MAP ismild. On contract, abnormal hepatic function of SAP is serious.Abnormal hepatic function is positive correlation with patient'scondition. (2) Hypocalcemia (<2mmol/L), Hypoproteinemia (<32g/L),hyperglycaemia (>11.2mmol/L) as independencet index to earlypredict for patient's condition. All above are positive correlation withpatient's condition.4. Diagnose rate of CT is higher than abdominal colourultrasound for AP,especially for mild pathological changes inpancreas.Thus, CT is a better imaging examination to evaluatepathological changes of pancreas and range of inflammation aroundpancreas.5. The therapeutic effect after combined therapy of internalmedicine (reduce pancreatic secretion, inhibit gastric acid, usingantibiotics prophylacticly, retrieve electrolyte disturbances,intravenous nutrition et. al) is satisfactory. The incidence ofcompli-cation and mortality of SAP cut down.Discussion: 1. 136AP patients who were in the digestivedepartment of our hospital in past two years were included in thisresearch, and male was 76 female was 60. The male female ratio is1.27: 1.ABP was 58. alcoholic pancreatitis was 26. Dietary factor was24. Unknown origin was 28. MAP was 118 and SAP was 18 whichwere coincidence with literature report. The three major etiologicalfactors responsible for acute pancreatitis are biliary system desease,alcohol and Binge overeating. The main etiological factors are biliarysystem disease which increases with age-growth, but the incidence ofunknown origin is higher than alcoholic pancreatitis and associationwith dietary factor in our study. The incidence of Idiopathicpancreatitis increased. we consider it has relation with microlithiasis,pancreas inherent heteroplasia, some drugs and viral infection. 2.Clinical situation has no specificness. But it is important in diagnosis.abdominal pain is major appe-arance and primary symptom which isaggravated after eating. SAP may occure tenderness , musculartension,rebound tenderness. It is notable that very few senility and (or)physically weak patients have no abdominal pain. The symptoms ofnausea,vomiting,abdominal distension and fever are common. Theincidence of jaundice of ABP is higher than NABP in abnormalhepatic function of AP. we consider it has relation with biliary calculi,biliary inflammation, cholestasis.3. (1) The abnormal indexes ofhepatic function are: increasing of ALT,aspartate aminotransferase(AST) ,γ -glutamyltransferase (GGT) , bilirubin, descending ofalbumin. There were 46 patients with abnormal hepatic function in136 AP patients. Percen-tage is 33.8%. It is lower than literaturereport. minior sample size and liminted range of cases had influenceon the result. Abnormal hepatic function of ABP is more serious thanNABP, especially the increasing of ALT. Bile duct and pancreaticduct are obstructed by calculus which lead to pressure increasing ofbiliary, biliary infection of biliary tract, bacterium hepatitis throughblood circulation and lymph circulation, all above lead to hepaticfunction lesion. Abnormal hepatic function of MAP is mild. Oncontract abnormal hepatic c function of SAP is serious. Abnormalhepatic function is positive correlation with patient's condition. Theincidence of hypocalcemia, hypoprotei-nemia, hyperglycaemia isobviously higher in SAP than MAP in our study. It shows thathypocalcemia (<2mmol/L), hypoproteinemia (<32g/L),hypergly-caemia (>11.2mmol/L) as independencet index to earlypredict for patient's condition. It is coincidence with literature report. 4.Diagnose rate of CT is higher than abdominal colour ultrasound forAP. There are noticeable difference between abdominal colourultrasound and CT. The following factors include (1) Flatuosity whichmakes pancreas fuzziness influences abdominal colou r ultrasound. (2)Pancreas's shape doesn't change in earlier period of pathologicalchanges. (3) abdominal colour ultrasound is a subjective imagingexamination which has been influenced by anthropic factor. Thus, CTis a better imaging examination for suspicious patients to evaluatepathological changes of pancreas and range of inflammation aroundpancreas. 5. The therapeutic effect after combined therapy of internalmedicine (reduce pancreatic secretion, inhibit gastric acid, usingantibiotics prophyl-acticly, retrieve electrolyte disturbances,intravenous nutrition et. al) is satisfactory. |
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