~Teachingcenter的醫學筆記~

結石阻塞造成之胰臟炎的處置
Management of Gallstone-related Pancreatitis：
1. Urgent ERCP (within 24h)：當伴隨膽管炎發生時，建議盡早ERCP
2. Early ERCP (within 72h)：高度懷疑總膽管結石阻塞時，建議72小時內ERCP
3. 除非有其他不可手術之原因，應於胰臟炎解除後，出院2~4周內接受膽囊切除手術
4. 只有嚴重的胰臟炎需要手術介入，輕微者，手術無幫助

※結石造成之胰臟炎，相較於酒精性胰臟炎或高血脂導致之胰臟炎，有較好的預後(重點就在於石頭有沒有移除，膽道有沒有通~)

阻塞性黃疸的成因
Etiology of Obstructive Jaundice
1.先天性 Congenital：
= 膽道閉鎖 Biliary atresia
= 特發性、不明成因Idiopathic dilatation of common bile duct
(胰管膽管功能異常Pancreaticobiliary malfunction)
=囊狀纖維化 Cystic fibrosis
=總膽管囊腫 Choledochal cysts
2.後天性 Acquired
= 膽囊炎中的Mirrizi Syndrome
= 總膽管阻塞Common bile duct obstruction
--- (1). 膽管結石 Choledocholithiasis
--- (2). 腫瘤 Tumor：膽囊、膽管、乏特氏壺腹(ampulla of Vater )、胰臟、淋巴瘤、轉移性癌症
--- (3). 外部壓迫 External compression：腫大的淋巴結
3.創傷 Trauma
4.門脈性膽道病 Portal biliopathy
5.狹窄 Strictures
= Common bile duct
= Sphincter of Oddi
= Primary sclerosing cholangitis
6. AIDS (隱孢子蟲病Cryptosporidium)
7.胰臟炎 Acute and Chronic Pancreatitis
8.腹內結核 Intra-abdominal tuberculosis
9.寄生蟲 Parasites

阻塞性黃疸造成之病生理作用
Pathophysiologic Effects of Obstructive Jaundice
1. 急性膽管炎Acute cholangitis = Ascending cholangitis
→需要抗生素與膽道引流減壓治療
2. 凝血功能異常Alteration of Coagulation function
→尤其以維他命K相關的因子影響較大(Vitamin K-dependent Factors：II, VII, IX, XI)
3. 免疫功能異常Alteration of Immune system
4. 肝腎功能異常 Renal and Hepatic dysfunction
5. 傷口癒合能力下降 Impaired wound healing
6. 胃腸功能下降 Nausea, malabsorption, bacterial translocation