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Lecture on Gallstone Associated Acute Pancreatitis

Lecture on Gallstone Associated Acute Pancreatitis. Diagnostics. 诊 断. 全面 要有重点 有判断 有思路（各判断之间的联系） 具体 分类中所属位置 具体但要求足够的可信度, 依据 动态 History, present, development 对策 Feedback. 全 面 具 体. 治疗. Diagnosis about AGP. Diagnosis. Pancreatitis acute

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Lecture on Gallstone Associated Acute Pancreatitis

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  1. Lecture onGallstone Associated Acute Pancreatitis

  2. Diagnostics 诊 断 • 全面 • 要有重点 • 有判断 • 有思路（各判断之间的联系） • 具体 • 分类中所属位置 • 具体但要求足够的可信度, 依据 • 动态 • History, present, development • 对策 • Feedback 全 面 具 体 治疗

  3. Diagnosis about AGP Diagnosis • Pancreatitis • acute • Biliary or gallstone associated • Severe, I,II; Fulminant • Gallstone • In Gallbladder: pacted？Strangulated? perforated？ • In CBD: Pacted? changitis？AOSC? • Metabolism • 高渗，酮症，低血糖；电解质；… … • General condition Complete concrete Treatment

  4. Gallstone 65％ Alcohol 25％ Hyperlipidemia 5％ Others 5％ Etiology of AP

  5. Treatment Strategy for critical Patients, SAP II , AOSC • 对因治疗 • 梗阻，感染灶 • 全身状态的评估与维护 • 氧供，氧输送；循环；糖代谢 • 脏器功能：心、肺、肝、肾、脑 • 手术的时机 • 选择与创造

  6. The role of emergency operation • Effective, but higher risks morbidity Mortality op within 48h 83％ 18％ op after 48h 48％ 12％ • Strategy • Discriminate those with obstruction and Cholangitis • Endoscopydelayed operation

  7. Role of ERCP & EST During Severe Attack Ameliorate symptoms and progression • Three trial / randomized and control • Neoptolemos JP；Fan ST • regardless of presence of obstructive jaundice and / or cholangitis • Folsch UR • restricted to the patients with obstructive jaundice and / or cholangitis • References：Neoptolemos JP, 6papers

  8. Operation to prevent the relapse • Recommendation • Cholecystectomy should be performed to avoid the recurrence of Gallstone associated pancreatitis. • Evidence • Recurrence in 29％~63％ cases if

  9. Recommendation • In mild cases, Cholecystectomy should be performed as soon as the patients has recovered, and ideally during the same hospital admission. • In severe cases, Cholecystectomy should be delayed until sufficient resolution of the inflammatory response and clinical recovery.

  10. EST to Prevent Further Attack • 建议: • 对全身条件不适宜手术的病人，为降低胆石性胰腺炎复发的危险，EST是胆囊切除术的替代措施。然而，理论上有导致无菌性胰腺坏死感染的危险（B级） • 依据： • ESTin 5 series with a total of 109 cases: median follow-up time 22~39 months, only 1仅1例（0.9%）复发 • 文献：Davidson BR等5篇

  11. ERC Basket

  12. Baloon Catheter

  13. Display

  14. Endoscopic Nasal Biliary Drainage

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