Research Advancement Of Acute Pancreatitis

1. Cause of diseaseThe pathogeny of acute pancreatitis (AP) is mainly caused by biliary origin,alcohol, and eating and drinking too much. In recent years, many factorsleading to acute pancreatitis were reported, such as high fat blood disease,ERCP, the belly surgical operation.(1). AP is mainly concerned with TG in HL.(2). ERCP: Injecting contrast medium too much or high pressure or injectingtime and again will result contrast medium into acinus, and pancreasdevelopment is discovered. In addition, unskilled intubatton is also thefactor of AP after ERCP.(3). Belly surgical operation and trauma: all kinds of factors, including bluntmachine harm, punchthrough injury, surgical operation, and interveninginspection, ect, will lead to the development of AP.2. Pathogenesis(1) The "the common passage" theory and pancreatic enzyme activating exceptionally: Several kinds of causes resulting in pancreatic enzyme activating exceptionally were factors of AP enabling.(2) The "the waterfalls effect" and inflammatory reaction of the whole body of cytokines: Recently, many studies show that there is excessive releasingof inflammatory cytokines in the early period of AP (namely, so- called" the waterfalls effect") and excessive inflammatory reaction of the whole body, that is to say, syndrome of inflammatory reaction of the whole body, then lead to MODS, and become the core problems of AP acute reaction phase.(3) Microcirculation obstacle of pancreas: pancreas ischemia is an important factor leading and aggravating damage of pancreas.(4) Apoptosis of pancreas cell: Cell apoptosis is an active process depleting energy, and a way of getting rid of unrecovery cells after trauma during AP occurs.(5) Shift of intestine bacteria: Intestine origin infection is in the main place in the secondary infection of pancreas necrosis tissue of SAP. After intestine bacteria endotoxin enter body cycle, then activate mono-macrophage to release cytokine and inflammatory medium, and promote development of SIRS, accordingly form the "second-strike" pancreas, and induce and aggravate multi-organ failure.3. DiagnosisDiagnosis of AP is on the basis of the measurement of amylase of bloodurine, with the development of science and technology, inspection oflaboratory and iconography are developed accordingly and used in clinic,which provided the basis of diagnosing acute pancreatitis and estimatingseverity extent.(1) Laboratory inspection: Detection of serum marker (C Reaction Protein,IL-6, etc) is essential in diagnosis of acute pancreatitis and necrosis.(2) Detection of iconography: CTSCT is very high sensitivity and specificity in estimating pancreas necrosis.4. Therapy(1). Non- surgical therapy for acute pancreatitis.In general, drug administrations are used to inhibit the secretion of digestive juices and pancreatic enzymes and the synthesis of pancreatic enzymes. In Recent years, Chinese traditional medicine such as Qingyi Decoction (QYD) and Chaishaochengqi Decoction (CSCQD) make perfect effect on the treatment of AP. In addition, According to nourishment support, the patients suffering from SAP depend on the vein nourishment until patients' condition is relieved and then consider intestine nourishment. (2). Surgical therapy for acute pancreatitis.1) Standard of operation: At present, although the standard of operation about AP exists difference among specialists, most of them support that one of the standards is pancreatic infection following necrosis.And then, (D For biliary origin SAP, the drainage of bile duct is performed or constrictor is cut with the help of endoscopes.? Emergency operation should be performed for the cases of acute fulminant pancreatitis.(3) the pressure of abdomen > 26cmH2O complicating with ACS is also an operative indication.2) Method (type) of operation: The main treatment of pancreatic necrosiscomplicated with infection is to remove the pancreatic necrosis tissue anddrainage or lavage pancreatic bed. Of course, there are other correlatedoperations.(3) New development on treatments?Local arterial drug perfusionMedicine can directly make effect on pancreas through LAI; as a result,blood and medicine concentration of pancreatic body will be higher thanthat of general vein or hypoderma.?Purification of bloodSAP is a kind of severe acute abdomen symptom accompanying with typicalsevere inflammatory reaction syndrome (SIRS). Purification of blood is veryeffective in immune regulation, correcting electrolyte disorder and organfunction, ect, so it can be used to treat SAP.(DLaparoscopically placed abdominal drainage and lavageLaparoscopically placed abdominal drainage and lavage can clean a lot ofascites and pancreas necrosis tissues complicating with infection, in addition,can decrease pancreas necrosis and infection, and reduce incidence ofsyndrome.(DlmmunotherapyRecently, immunotherapy of antagonism cytokine is extensively focused.PAF antagonist can be used in clinic to decrease mortality in the early phase.In addition, LI-1, LI-6 antagonist can be also used in clinic.?Therapy of abdominal compartment syndrome(ACS)Lately, the studies of SAP complicated with abdominal compartmentsyndrome (ACS) have been emphasized, and non-surgical treatment isextensively accepted in the early phase, when pressure of abdomen exceed26cmH2O(3 grades), the therapy of decompress in abdomen should beconducted.5 Problems and prospect(1) ProblemsCD Dispute of inflammatory cytokines interdicting disease developmentExpect for infection, in the early phase of AP, there is over-releasing ofinflammatory cytokines and overall inflammatory reaction, which is a keyfactor of aggravating severe acute pancreatitis. However, so far some studiesare based on animal models, and these studies remain to be furtherdeveloped.? Surgical treatment of aseptic necrosisFirst, in the case of aseptic necrosis, some of focus of cases can assimilateand digest; others can form necrosis tissue, which will give rise to secondaryinfection, breakage or pressure, block and delayed gastric emptying ofdigestive tract. Second, it is shown that 10% of patients of aseptic necrosisin preoperative diagnosis can complicate with infection. In a word, a largenumber of SAP of aseptic necrosis need to be operated, but opportunity andindication of surgery should be considered.?Dispute about fulminant pancreatitisThe core problem of fulminant pancreatitis is not infectious but early phase severe multi-organ failure. It is reported that it is very effective method to adopt early drainage and intensive cave unit. At present, the understanding of fulminant pancreatitis is very narrow, and variance in therapy, so it is very necessary to improve therapy methods existed. ?Dispute about disturbance of brain in association with pancreatitis Complications of central nervous system (Pancreatic encephalopathy) arouse by SAP are very difficult for therapy, and one of factors related to the death. Identification and treatment of disease of disturbance of brain is still a difficult problem. With the understanding and controlling of severe complications, such as shock, ARDS, Renal failure, bacteria and fungus infection, striking problem of complications and death and disability of disturbance of brain is considered to be urgent to solve in the clinic. (2) ProspectIn non-surgical operation, pathogenesis of AP, removal of inflammatory medium, cleaning of blood, high selectivity of artery and compound perfusion of drug remain to be developed; and in surgical operation, simple surgical operation, tiny-initiating, intervention treatment and discussing surgical occasion can be key research of acute pancreas.