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Clinical Pancreatology for Practising Gastroenterologists and Surgeons - part 2

Đau bụng là tính năng nổi bật nhất của viêm tụy cấp tính, xảy ra ở khoảng 95% bệnh nhân. Viêm tụy đã được ghi nhận mà không đau kết hợp với bệnh Legionnaires, thuốc trừ sâu, sau phẫu thuật tiểu bang, và lọc máu. | 4 How should acute pancreatitis be diagnosed in clinical practice Richard S. Kwon and Peter A. Banks Acute pancreatitis is a clinical syndrome characterized by abdominal pain and elevated pancreatic enzymes. The clinical and pathologic findings were first described in 1889. However the diagnosis still remains quite elusive despite the availability of numerous laboratory and radiographic tests. The fact that autopsy studies continue to show a 30-42 incidence of undiagnosed pancreatitis underscores the complexity in the diagnosis of acute pancreatitis. History and physical examination Abdominal pain is the most prominent feature of acute pancreatitis occurring in approximately 95 of patients. Pancreatitis has been documented without pain in association with Legionnaires disease insecticide postoperative states and dialysis. The pain is usually in the epigastric and periumbilical area of the abdomen with radiation to the back in 50 of cases. Occasionally the pain is diffuse or radiates to the lower abdomen. Rarely the pain radiates to the chest. The onset is frequently acute and reaches maximum intensity within 30-60 min. The pain is often very severe boring in character and constant in duration. Patients often describe an inability to get comfortable and consequently may appear restless. Rarely the pain is ameliorated by hunching forward which frees the retroperitoneal space. Significant doses of narcotics are usually required for adequate pain control. Nausea and vomiting occurs in a majority of patients and may require the insertion of a nasogastric tube for relief. Other diseases to consider in the differential diagnosis of acute pancreatitis include inferior wall myocardial infarction peptic ulcer disease including gastric or duodenal perforation intestinal ischemia or infarction intestinal strangulation or obstruction biliary colic cholecystitis appendicitis diverticulitis dissecting aortic aneurysm ovarian torsion or ectopic pregnancy. Many of these diseases .