What Is Acute Edema?

Acute edema pancreatitis, also known as acute interstitial pancreatitis, is a common type of acute pancreatitis. The symptoms of acute edema pancreatic inflammation are mild, mostly self-limiting, and the mortality is very low. It can be relieved within 3 to 5 days, and a few can be recurrent.

Basic Information

Visiting department: Gastroenterology
Common causes: Can be caused by biliary stones, hepatic and pancreatic ampulla sphincter dysfunction and alcoholism or overeating.

Common symptoms: Abdominal pain, nausea, vomiting after meals and drinking.
Contagious: no

Causes of Acute Edema Pancreatitis

1. Biliary calculus research shows that 70% of the so-called idiopathic acute pancreatitis (IDP) was caused by small biliary stones. The composition of this small stone is mainly bilirubin particles, which form with cirrhosis and bile Stasis, hemolysis, alcoholism, and aging are related.
2. Hepatopancreatic ampulla sphincter dysfunction Hepatopancreatic ampulla sphincter dysfunction can increase the pressure of the ampulla, affect the excretion of bile and pancreatic juice, and even cause bile to flow back into the pancreatic ducts, thereby causing acute pancreatitis.
3. Alcoholism or overeating: Patients with severe acute pancreatitis caused by alcoholism and overeating are mainly young males. After overeating and alcoholism, they can enter the duodenum due to a large amount of chyme and alcohol stimulates pancreatic secretion. And cholecystokinin release to increase pancreatic fluid secretion, which in turn causes papillary edema and hepatic-pancreatic ampulla sphincter spasm, eventually leading to the onset of severe acute pancreatitis.

Clinical manifestations of acute edema pancreatitis

1. Abdominal pain 90% of patients with acute pancreatitis have abdominal pain, most of which are sudden attacks, which often occur after full meals and drinking. Pain varies in severity, with blunt pain in the light and colic and scalpel pain in the severe, often with persistent exacerbations. The pain is usually in the middle and upper abdomen. If the inflammation of the pancreatic head is obvious, it is to the right of the middle and upper abdomen. If the inflammation of the pancreas and tail is mainly, it is usually in the middle and upper abdomen and radiates to the lower back.
2. Nausea and vomiting Most patients have nausea and vomiting, which often occur after eating. The vomit is often the contents of the stomach. In severe cases, vomiting bile.
3. Fever is usually mild to moderate fever, usually 3 to 5 days. If the body temperature continues to rise or rises day by day, it indicates that the infection is complicated.
4. Jaundice occurs 1 to 2 days after the onset, and is usually temporary obstructive jaundice, which usually resolves within a few days. The occurrence of jaundice can be caused by compression of the common bile duct by the enlarged pancreatic head, but those who do not regress or deepen jaundice are mostly caused by common bile duct stones.

Examination of acute edema pancreatitis

1. Blood routine white blood cell count increased (10-20) × 109 / L, and neutrophils also increased.
2. Serum amylase generally starts to rise 2 to 6 hours after the onset, and peaks around 24 hours. It usually lasts 3 to 5 days, but the severity of the disease is not consistent with the increase.
3. Urinary amylase begins to increase 12 to 24 hours after the onset, and lasts for 1 to 2 weeks. This test often affects its accuracy due to changes in urine output and renal function, and is not as reliable as serum amylase. However, it has diagnostic significance in patients whose serum amylase has decreased.
4. Serum lipase rises late and can last for 5-10 days. Early diagnosis is not as good as amylase, but it has diagnostic value for patients who come late.
5. Blood glucose and urine glucose About half of patients with pancreatitis have transient hyperglycemia, 30% have diabetes, and 2% to 10% have mild permanent diabetes.
6. Hypocalcemia occurs in 30% to 60% of patients with pancreatitis, which is usually the lowest in 3 days after the onset of the disease and can last up to 4 weeks after clinical recovery.
7. Biochemical examination may have jaundice, mostly obstructive. 20% of patients with AP may have hyperlipidemia.
8. Plain X-ray film of abdomen (1) rule out acute abdomen for other reasons.
(2) Provide indirect evidence to support the diagnosis of pancreatitis.
9. The chest X-ray may show signs of left lower lobe atelectasis, elevation of the left semi- diaphragmatic muscle, and left pleural effusion that reflect inflammation around the diaphragm and retroperitoneum.
10. Abdominal B-ultrasound examination can find abnormal pancreas enlargement, blurred edges, irregular, enhanced echo, unevenness and other abnormalities. There can also be small pieces of hypoechoic or non-echoic areas in the pancreas.
11.CT examination CT is the preferred method for the diagnosis of pancreatitis.
12.MRI examination Abdominal MRI is not superior to CT. 20% of acute edema pancreatitis has no change in the shape and signal of the pancreas on MRI, and it is expensive, but it can be used for patients with renal failure and severe allergies who cannot accept intravenous contrast agents. MR1 diagnosis of pancreatitis mainly depends on the presence or absence of changes in pancreatic morphology and peripancreatic effusion.

Diagnosis of acute edema pancreatitis

If there is obvious tenderness in the upper abdomen without obvious muscle tension, especially after full meal or drinking, pancreatitis should be considered first. If blood and urinary amylase are elevated at the same time, the size and morphological changes of the pancreas and the surrounding effusions can be diagnosed by ultrasound and CT.

Acute Edema Pancreatitis Treatment

1. Inhibit or reduce pancreatic enzyme secretion (1) Fasting and gastrointestinal decompression and excessive gastric acid can promote the secretion of secretin in the duodenal mucosa, so fasting can reduce the secretion of pancreatic juice; inject alkali from the gastric tube Sexual drugs, such as aluminum hydroxide gel, can neutralize gastric acid and indirectly inhibit pancreatic secretion.
(2) H2 receptor antagonists can reduce gastric acid secretion, reduce its stimulation of pancreatic juice secretion, and prevent the occurrence of stress gastric mucosal lesions.
(3) Somatostatin its effects include inhibiting the secretion of pancreatic juice, glucagon, cholecystokinin, lipase and amylase, inhibiting the release of gastrin, gastric acid and pepsin, reducing organ blood flow and promoting intestinal tract Water electrolyte absorption and so on. Octreotide acetate can be injected subcutaneously.
2. Inhibition of pancreatin activity Various aprotinin can inhibit pancreatin activity and is an ideal drug, but the clinical effect is not significant. It is generally advocated that a large number of early intravenous drips can control the progress of inflammation. Drugs can be aprotinin, gabexate and the like.
3. Rehydration and nutritional support All patients should be supplemented with fluids and electrolytes intravenously to maintain circulation stability, hydroelectricity balance, and prevent hypotension. Improve microcirculation and ensure pancreatic blood flow perfusion.
4. Improving pancreatic microcirculation Pancreatitis often has microcirculatory disturbances and insufficient pancreatic perfusion. Dextrose 40 and ligustrazine can be used to dilute the blood.
5. Analgesics can use strong analgesics, such as opioids.
6. Antibiotic pancreatitis is a chemical inflammation, so the purpose of early application of antibiotics is to prevent secondary infections. Since most of the pathogenic bacteria come from the intestinal bacteria, it is necessary to choose drugs that inhibit intestinal bacteria, and pay attention to the blood-pancreatic barrier. Penetrating power.
7. Promote the recovery of intestinal function. Infusion of traditional Chinese medicine that promotes intestinal peristalsis into the gastric tube is often beneficial to the recovery of intestinal peristalsis. Dachaihu decoction and Dachengqi decoction can be used. Repeated application in the early stage, try to defecate patients 4 or 5 times a day, and stop after bowel function is restored and clinical symptoms are relieved.