Transcription of 急性胰臟炎之診治準則 - tsim.org.tw
1 1 / : ,000 ,000 1968-1980 ,000 1985-1995 ,000 40-60 ,000 ,000, ,000 2% 22% 10% (15~25%vs<10%) 2.
2 1992 Atlanta 48 Ranson s criteria APACHE-II score pancreatic necrosis 20% extrapancreatic fluid collection pancreatic pseudocyst 4 pancreatic abscess hemorrhagic pancreatitis phlegmon cytokine elastase nitric oxide amylase lipase 3 amylase lipase ACCR amylase isoenzymes amylase ALT > 80 U/dL 50% CRP IL-6 Leukocyte elastase-1 enzyme TAP(Trypsinogen activation peptide) 1.
3 (Abdominal ultrasound): 3 24-48 2. (Dynamic contrast-enhanced CT scan) CT (CT Balthaqar s index) morbidity 3. (ERCP): 4. : (MRI) (EUS) 1. : : A. (ilewu, UGI bleeding?) B. Body mass index:>30kg/m2 ; >40kg/m2 C. :X ; ; D. E. CRP ( ) F. Ranson s criteria 24 : A. B. ,Glasgow Score CRP 150mg/L 48 : 4A. B. Glasgow Score Ranson s criteria CRP 2.
4 : 7-10 (total parenteral nutrition) (Post-endoscopic nasogastrojejunal tube feeding) 3. : 72 24 (inactivated protease) (peritoneal lavage) somatostatin platelet activating factor 4. : (microcirculation) isovolemic hemodilution (translocation) ( Imipenem) (30% 12%) CT (guided percutaneous aspiration) 4-6 55.
5 ( pseudocyst ) (abscess): (acute pancreatic fluid accumulation) (Dynamic contrast-enhanced CT scan) (MRI) (Dynamic contrast-enhanced CT scan) (ERCP) (Endoscopic internal drainage) (Surgical internal or external drainage) CT 6 Acute PancrestitisResuscitation Non Biliary Pancreatitis Biliary Pancreatitis Severe (or Cholangitis)Mild Early ERCP + ESCholecystectomyCholecystectomyERCP + ES (If old or unfit) Discharge Severe Mild/ moderateContrast- enhanced CT Medical managementAntibiotics(1 week) No improvement improvement CT-guided aspiration Continue antibiotics(3-5 weeks)> 30% necrosis <30% necrosisInfected Sterile Surgery immediate Surgery (elective) Surgery care Assesment of severity Old or Unfit
