醫(yī)學(xué)保健]胰腺疾病(參考版)
2025-01-07 04:09本頁(yè)面
【正文】 各學(xué)科專(zhuān)業(yè)間交叉融合，這形成現(xiàn)代醫(yī)學(xué)的特點(diǎn)之一。治療和預(yù)防疾病的有效（ df肺 25s血液 f369血小板 t5172紅血球 gdf55m白血球 fd2）手段在 20世紀(jì)才開(kāi)始出現(xiàn)。由于本病具有自愈傾向，腎功能多可逐漸恢復(fù)，一般不需要長(zhǎng)期維持透析。本病恢復(fù)期脈證表現(xiàn)不很明確，辨證不易掌握，仍以清熱利濕為主，佐以養(yǎng)陰，但不可溫補(bǔ)。 慢性腎炎 圖書(shū) 四、中醫(yī)藥治療 本病多屬實(shí)證。利尿后高血壓值仍不滿(mǎn)意時(shí)，可加用鈣通道阻滯劑如硝苯啶 20～ 40mg/d,分次口服或血管擴(kuò)張藥如肼酞嗪 25mg,每日 3次。 三、對(duì)癥治療 利尿、消腫、 降血壓 。 二、治療感染灶 首選青霉素（過(guò)敏者更換為對(duì)革蘭氏陽(yáng)性菌高度敏感的大環(huán)內(nèi)酯類(lèi)、頭孢第一代抗生素） 800萬(wàn)單位靜脈滴注， 10～ 14天，但其必需性現(xiàn)有爭(zhēng)議。腎功能正常者蛋白質(zhì)入量應(yīng)保持正常（每日每公斤體重 1g），但氮質(zhì)血癥時(shí)應(yīng)限制蛋白質(zhì)攝入，并予高質(zhì)量蛋白（富含必需氨基酸的動(dòng)物蛋白）。 一、一般治療 肉眼血尿消失、水腫消退及血壓恢復(fù)正常前應(yīng)臥床休息。 急性腎小球腎炎治療： 本病治療以休息及對(duì)癥為主，少數(shù)急性腎功能衰竭病例應(yīng)予透析，待其自然恢復(fù)。病變嚴(yán)重時(shí)，增生和浸潤(rùn)的細(xì)胞可壓迫毛細(xì) 血管袢 使毛細(xì)血管腔變窄、甚至閉塞，并損害腎小球?yàn)V過(guò)膜，可出現(xiàn)血尿、蛋白尿及管型尿等；并使腎小球?yàn)V過(guò)率下降，因而對(duì)水和各種溶質(zhì)（包括含氮代謝產(chǎn)物、無(wú)機(jī)鹽）的排泄減少，發(fā)生水鈉潴留，繼而引起細(xì)胞外液容量增加，因此臨床上有水腫、尿少、全身循環(huán)充血狀態(tài)如呼吸困難、 肝大、 靜脈壓增高等。病理類(lèi)型為毛細(xì)血管內(nèi)增生性腎小球腎炎。 bluish discoloration in the flank (Grey Turner’s sign) or periumbilical area (Cullen’s sign) Grey Tuner征 Cullen征 Clinical Findings Laboratory findings ? Serum amylase concentration: rises from 312h, the peak is 2448h and 25d normal ? Urine rises from 1224h, slow decrease ? Elevated serum lipase ? Elevated hematocrit due to dehydration ? Low hematocrit due to blood loss Clinical Findings Laboratory findings ? Moderate leukocytosis ? In necrotic pancreatitis: sugar, calcium, PaO2, increased BUN, acidosis and even MODS ? Abdominal puncture: bloody ascites, increased amylase Clinical Findings Imaging study ? CT and US show a diffuse enlargement, necrosis, and ascites ? Xray: isolated dilation of a segment of gut (sentinel loop) consisting of jejunum, transverse colon, or duodenum adjacent to the pancreas. Gas distending the right colon that abruptly stops in the mid or left transverse colon (colon cutoff sign) is due to colonic spasm 正常胰腺 CT 胰腺動(dòng)態(tài) CT 時(shí)間 膽源性胰腺炎 patch of saponification Essentials of Diagnosis ? Abrupt onset of epigastric pain, frequently with back pain ? Nausea and vomiting ? Elevated serum or urinary amylase ? Cholelithiasis or alcoholism (many patients) Differential Diagnosis ?Acute cholecystitis: biliary colic, fever and chills, Murphy’s sign and enlarged gall bladder ?Peptic ulcer perforation ?Acute abdominal obstruction ?Renal colic ?Acute gastroenteritis ?Coronary disease Treatment Medical treatment: the goals of medical therapy are reduction of pancreatic secretory stimuli and correction of fluid and electrolyte derangement. ?Gastric suction and diet control ?Oxygen ?Fluid replacement and nutrition ?Antibiotics Treatment(2) Medical treatment: ? Calcium and magnesium replacement ? Antienzyme drugs: 5FU (250500mg in 5%glucose 500ml), octreotide, sandostatin, aprotinin, and H2 receptor bl
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