怎样确诊慢性胰腺炎

2025-02-07 13:15:33
推荐回答(1个)
回答1:

病情分析:慢性胰腺炎系指胰腺泡和胰岛组织萎缩,胰腺实质广泛纤维化的病理过程.常伴有钙化及假性囊肿形成.临床上主要表现为腹痛,腹泻或脂肪泻, 消瘦及营养不良等胰腺功能不全的症候.典型慢性胰腺炎在我国较为少见,确诊较难. 意见建议:【概述】 是指胰腺实质的坏死,出血,脂肪坏死等引起的局部及全身多器官一系列的损害.本病病情危重,死亡率极高. 【诊断】 一,病史提问 发病初期同急性胰腺炎,如病情继续发展,腹痛持续不缓解,伴高热,可出现面色苍白,呼吸急促,烦躁不安,血压下降,少尿等休克的表现,继续发展可出现精神恍惚,呕血,黑便等多脏器功能衰竭的表现.因病情危重,少数病人发病后短期内死亡.询问病史详见急性胰腺炎. 二,体检发现 体温升高,心率增快,呼吸急促,血压下降,上腹部压痛,反跳痛,腹肌紧张,肠鸣音减弱等急性腹膜炎之体征.部分病人可触及上腹部包块,少数病人出血渗入皮下,脐周(Cullen 征)或两侧腹部出现青紫色(Grey Turmer 二氏征).移动性浊音阳性.两肺听诊可闻及湿罗音,如有胸腔积液时局部呼吸音可减弱或消失.严重呼吸困难可出现紫绀. 三,实验室检查 血中白细胞总数及中性粒细胞明显增高,血,尿淀粉酶可增高也可正常,血清正铁白蛋白阳性,血钙降低,血糖升高, 腹水为血性,胸腹水中淀粉酶明显高于血中.呼吸系统可出现PaO2下降,严重致ARDS.肾功可出现BUN升高及血尿蛋白尿.肝功能异常,大便隐血阳性,如出现败血症时血培养阳性.心电图可有心率不齐,心肌缺血等多种异常.胸部X线检查可有胸腔积液, 肺不张 ,肺炎,心影扩大等.腹部平片在胰腺脓肿时上腹部可见气液平.B超及CT可观察胰腺大小,形态,有无脓肿及囊肿形成,有无胸,腹水及心包积液等. 四,应与其它急腹症,休克,急性肾功衰竭等相鉴别. 【治疗措施】 如病人符合上述临床表现,应立即给以吸氧,建立静脉通道,在生命体征平稳后急诊收入病房. 预防常识:积极治疗者可缓解症状,但不易根治.晚期多死于并发症,极少数可演变为胰腺癌.积极治疗胆道疾病,戒酒及避免暴饮暴食.

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