353.2 𩺠åèç
353.2.1 é«é »èé»
353.2.1.1 Acute Pancreatitis Etiology
- Gallstones (50%, women)
- Alcohol (25-30%, men)
- Hypertriglyceridemia (TG > 1000)
- Drugs
- ERCP
- Trauma
- Hypercalcemia
- Genetic
353.2.1.3 Severity (Atlanta 2012)
- Mild: no OF
- Moderate: transient OF or local complications
- Severe: persistent OF > 48 h
353.2.1.5 Treatment AP
- Aggressive IV LR (PAMPHLET trial)
- Analgesia
- Early oral feeding > NJ > TPN
- ERCP within 24-72 h for gallstone with cholangitis
- Antibiotics ONLY if infected necrosis
- Cholecystectomy before discharge (mild gallstone AP)
353.2.1.6 Local Complications
- Acute fluid collection
- Pseudocyst (4+ weeks, non-epithelial)
- Acute necrotic collection
- Walled-off necrosis (WON)
- Step-up approach (PANTER trial)
- Endoscopic transmural drainage preferred
353.2.1.7 Chronic Pancreatitis
- Alcohol most common
- Smoking independent risk
- Pain + exocrine + endocrine insufficiency
- Diagnosis: CT, MRCP, EUS, fecal elastase
- Treatment: alcohol cessation + PERT + insulin + analgesia
353.2.1.8 PERT (Pancreatic Enzyme Replacement)
- For exocrine insufficiency
- 25,000-75,000 units lipase per meal
- ADEK vitamins
353.2.1.10 Autoimmune Pancreatitis
- Type 1: IgG4-related; elderly males; sausage-shaped pancreas
- Type 2: Idiopathic duct-centric; younger; IBD association
- Steroid-responsive
353.2.2 ææ··æ·æ¯èŒ
| Type | Cause | Treatment |
|---|---|---|
| AP gallstone | Stone obstruction | ERCP + cholecystectomy |
| AP alcohol | Toxic + secretagogue | Cessation + supportive |
| AP HTG | TG > 1000 | Insulin + heparin + apheresis |
| AIP Type 1 | IgG4-related | Steroids |
| AIP Type 2 | Idiopathic duct-centric | Steroids |
| CP | Alcohol, smoking | PERT + alcohol cessation |
| Pseudocyst | Post-AP | Observation or endoscopic |
353.2.3 Special Topics
353.2.3.1 Pancreas Divisum
- Failure of dorsal-ventral fusion
- Drainage via accessory papilla
- Some develop pancreatitis
- ERCP with minor papilla sphincterotomy