Note内科学急性胰腺炎

Etiology-“GetSmashed”

Gallstone（胆结石）→胆源性胰腺炎：急性胰腺炎发病时或已排石，故腹部超声可能未见胆囊或胆管结石，但肝功提示一过性胆管酶升高。

Ethanol（乙醇）→酒精性胰腺炎。

Trauma（外伤）。

Steroid（类固醇激素）。

SabreA,GuthrieMM,MalekniaR.Acutenecrotisingpancreatitisderivedfromlow-dosecorticosteroiduse:animportantreminderofclinicalmanagement.BMJCaseRep.Jul6;.

Mumps（腮腺炎等病毒感染）：柯萨奇病毒、腮腺炎病毒、CMV、EBV、HAV、HIV等。

Autoimmunedisease（自身免疫性疾病）：常见于自身免疫性胰腺炎（AIP）、系统性红斑狼疮（SLE）、干燥综合征（SS）（→急性腮腺炎→急性胰腺炎）、结节性多动脉炎（PAN）等。

Scorpion（蝎子螫伤等毒物）。

Hyperlipidimia（高脂血症）→脂源性胰腺炎：甘油三酯（TG）11.3mmol/L时风险明显增加；「H」也指Hypercalcemia（高钙血症）。

ERCP：经内镜逆行胆胰管造影术插管时导致十二指肠乳头水肿或注射造影剂压力过高等引起胰腺炎。

Drug：抗反转录病毒药物、硫唑嘌呤、甲氨蝶呤、噻嗪类利尿剂、磺胺、培门冬酰胺酶、四环素等。

此外，致胰管梗阻的解剖遗传因素（如先天性乳头肌发育不良）也是病因之一。（Etiology部分源自协和8）

Fig.1

Hemorrhagicornecrotizingpancreatitis

Fig.2

GreyTurner’ssign:1to2weeksaftertheonset,largeecchymoses(瘀斑)mayappearintheflanks侧腹

Cullen征：

Fig.3

Ultrasoundexaminationshowingtwolargepancreaticpseudocysts.Bothcystsareindicatedbythelargewhitearrows.

Fig.4

CTshowssignificantswellingandinflammationofthepancreas

Case1

Gallstones,acutepancreatitis,andglandnecrosisina47-year-oldmanwithfourRansongravesigns.(a)EarlytransversenonenhancedCTscanobtainedatthetimeofadmissiontothehospitalshowsahomogeneouslyenlargedpancreas(solidarrows).Therearelargeheterogeneousperipancreaticfluidcollections(openarrows).Glandnecrosiscannotberuledout.K=kidney,L=liver,P=pancreas,Sp=spleen,St=stomach.

(b)Follow-uptransversecontrast-enhancedCTscanobtained13daysafterarevealstwozones(straightarrows)ofliquefiedpancreaticnecrosisintheneckandtailofthegland.Thereareresidualnodularareasadjacenttothetailofthepancreas,consistentwithfatnecrosis(curvedarrow).P=pancreas.

(c)Follow-uptransversecontrast-enhancedCTscanobtained10daysafterbrevealsdevelopmentoflargepseudocysts(P)intheneckandtailofthepancreas.

Case2afterERCP

Pancreatitisinducedbyendoscopicretrogradecholangio-pancreatography(ERCP)ina37-year-oldwoman.TransverseCTscanobtainedwithintravenousandoralcontrastmaterialshowsanenlargedandhomogeneouslyenhancingpancreaticgland(p).ResidualcontrastmaterialfromrecentERCPisseeninthe