小结
定义
病史和体格检查
关键诊断因素
- 上腹痛
- 恶心和呕吐
- 低血容量的体征
- 胸腔积液体征
- 厌食
- 存在的危险因素
其他诊断因素
- 器官功能障碍的征象
- 呼吸困难
- 黄疸
- 低钙击面征
- 皮肤瘀斑和变色（Cullen/Grey-Turner/Fox 征）（罕见）
危险因素
- 中年女性
- 青年至中年男性
- 结石
- 酒精
- 高甘油三酯血症
- 致病药物
- 内镜逆行胰胆管造影术 (ERCP)
- 创伤
- 高钙血症
- 腮腺炎
- 柯萨奇病毒
- 肺炎支原体
- 系统性红斑狼疮
- 干燥综合征
- 胰腺分裂
- 胰腺癌
- Oddi 括约肌功能障碍
- 胰腺炎家族史
诊断性检查
首要检查
- 血清脂肪酶或者淀粉酶
- 全血细胞计数 (FBC) 和分类计数
- C 反应蛋白 (CRP)
- 尿素/肌酐
- 脉搏血氧测量测定法
- 肝功能检查 (LFT)
- 胸部 X 线检查（CXR）
- 经腹超声
- 血清钙
需考虑的检查
- 血清甘油三酯
- 腹部 CT 扫描（CECT）
- 超声内镜 (EUS)
- 磁共振胰胆管造影术 (MRCP)
- 动脉血气
新兴检查
- 尿胰蛋白酶原-2
- 血清 IL-6 和 IL-8
治疗流程
所有患者
5-7 日后症状恶化或未改善
撰稿人
专家顾问
Alexander Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC RCSEd
Emergency Medicine Consultant
Barts Health NHS Trust
Physician Response Unit Consultant
London’s Air Ambulance
Royal London Hospital
UK
利益声明
AA declares that he has no competing interests.
鸣谢
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Nicholas J. Zyromski, MD
Associate Professor of Surgery
Department of Surgery
Indiana University
Indianapolis
IN
Johann Grundlingh, MBChB, FCEM, FFICM, EDICM, DFMS, DipMedTox, MMedTox, MSB, ERT, MEWI, MBA
Emergency Medicine Consultant
Royal London Hospital
Barts Health NHS Trust
Honorary Senior Lecturer
Queen Mary University
London
UK
同行评议者
Sven van Dijk, MD
Department of Surgery
Amsterdam UMC
University of Amsterdam
Amsterdam
Department of Surgery
St Antonius Hospital
Nieuwegein
The Netherlands
利益声明
SvD declares that he has no competing interests.
Marc G Besselink, MD, PhD, MSc
Hepatopancreatobiliary Surgeon
Department of Surgery
Amsterdam UMC
University of Amsterdam
Principal Investigator
Dutch Pancreatitis Study Group
Academic Medical Center
Amsterdam
The Netherlands
利益声明
None declared
编辑
Jo Haynes
Head of Editorial, BMJ Knowledge Centre
利益声明
JH declares that she has no competing interests.
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
利益声明
TAO declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
鉴别诊断
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- 内脏穿孔
- 食管痉挛
更多 鉴别诊断指南
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- IAP/APA 循证指南：急性胰腺炎的管理。
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