胰腺疾病 中山大學(xué) 內(nèi)科學(xué)-全文預(yù)覽
【正文】 / abdominal partment syndrome (ACS) ? fever / hyperthermia ? jaundice ? shock, MODS Presentation ? Grey Turner sign – flank bluish ecchymoses ? Cullen sign – umbilical bluish ecchymoses ? ARDS acute respiratory distress syndrome ? SIRS systemic inflammatory response syndrome ? MODS multiple an dysfunction syndrome Laboratory ? Serum amylase and lipase levels ? Serum calcium ? blood glucose ? arterial blood gas ? white blood cell count Laboratory Findings Imaging studies ? Chest/abdominal radiographs ? Ultrasound ? CT ? MRI ? MRCP contrast CT mild pancreatitis bleeding and necrotic focuses hemorrhagic focus pseudocyst Admission Age 55 yr WBC16000/mm3 Glucose 200 mg/dL LDH350 IU/L AST250 IU/L Initial 48 hrs Hct fall 10% BUN elevation 5mg/dL Ca2+ 2mmol/L PaO260mmHg Base deficit4mmol/L Fluid sequestration6L 3 or 4 signs mortality 15%, 7 or 8 signs mortality 90% Ranson’s Prognostic Signs Differential diagnosis ? acute cholangitis / cholecystitis ? perforated hollow viscus ? bowel obstruction ? mesenteric ischemia / infarction ? acute gastroenteritis ? acute myocardial infarction The stages of course ? stage of acute reaction – within 2w ? stage of systemic infection – 2w2m ?
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