胃腸道-中英文willard圖片見8-chn pancreatitis in dogs

HistorySignalment臨床表

飲食情Historyof胰腺炎病 腹HistorySignalment臨床表Di胰腺炎病

飲食 腹VmiH胰

History飲史 腹KnowingtheLIMITATIONSofatestorprocedureisoftenmuchmoreimportantthanknowingwhataprocedurecandoPhysicalAnteriorabdominal Profuse 發(fā)SQ 皮下膿PhysicalAnteriorabdminal Profuse 發(fā)SQ 皮下膿

Physical lIs疸s發(fā)皮下膿WHICHCBC(S)IS/AREFROMDOG(S)WITHACUTE000ClinicalAnanorexic,vomitingdogfastinghyperlipidemiaprobablyhasacutepancreatitis ClinicalAnanorexic,vomitingdogwithhyperlipidemiaprobablyhasacute MostdogswithpancreatitisDONOThavefastinghyperlipidemiaClinicalSensitivity~Specificity~

Sensitivity~ ClinicalAmylase/Lipa – cificity~ –

Clinical–Sensitivity~80-敏感性~80-Sig:14yrM(n)ShihTzu14 Abdominal HPI:Pain2daysagoandVomited1PU-PDforlast

Noabnormalities PCV=WBCSegsBands=Lymphs= ets

24%(35-23,300/ul(6,-17,475/ul(4,-0/ul(<4,660/ul(1,-498,000/ul(200,-肌酐Creatinine 0.78mg/dl(<鈣Calcium9.7mg/dl(9.3-鈉Sodium鉀Potassium3.8mEq/L(3.8-ALT=SAP=

2.7gm/dl(2.5-8,258IU/L(<2,354IU/L(<0.3mg/dl(0-AbdU/S:“....enlargedpancreaswithnodules...hepaticmassmostconsistentwithprimarylivertumor” SnapPL: cPL試劑盒檢測：YourbestnextstepForgetaboutit(dogisnowRepeatcPLIandultrasoundTxforacutepancreatitis(IVTxwithpancreaticHepatic 肝葉切除 CLINICALLYIMPORTANT胰腺炎和 需重視的胰腺

Sensitivity~ AbdominalSensitivity40%-

Sensitivity~ 敏感性-Abdominalultrasound腹部超聲檢Sensitivity40%65%敏感40% Becausecliniciansrarelyrepeatthe

Sensitivity~ 敏感性-Abdominalultrasound腹部超聲檢Sensitivity40%65%敏感40%Findingscanchangewithinhours檢查結(jié)果數(shù)小時內(nèi)就可能發(fā)生變化WHATISTHEBESTWAYTODIAGNOSECANINEACUTEBeBewillingtorepeatAllAllthingsbeingequal,trytoavoidsurgeryBeBewillingtorepeatAllAllthingsbeingequal,trytoavoidsurgeryTHEREALPROBLEMISTHATACUTEPANCREATITISCANPRESENTINSOMANYDIFFERENTWAYSTHATYOUDON’TEVEN ITINITIALLY 7yrMSheltie HPI:Began5weeks

Partialanorexia,vomitsphlegmorbileoncedaily有時厭食 Dogotherwisepretty Nosignificant Sig:9yrM(c)犬

9 Vomitingyellow HPI:Feelingbad12daysago12天前狀態(tài)不佳Startedvomiting,respondedtofluidtherapy,butbecameillagainwhenstartedfeedingit Dog’seyesturned PCV=BUN葡萄Glucose Potassium=膽固醇Cholesterol=白蛋白Albumin=ALT=SAP

4mg/dl(8-95mg/dl(75-3.6mEq/L(3.8-597mg/dl(120-2.9gm/dl(2.5-1,691IU/L(<3,134IU/L(<4.5mg/dl(0-TAMU 9yrF(s)

9HPI:Vomitingfood/bile6-8Xin2 Diarrheaconstantfor2weeksDecreasedappetitefor10days,anorexiafor5食欲減退10天，厭食5 T=39.2C,HR=TAMUPCVWBCSegs葉狀中性粒細(xì)Bands

35.5%(35-21,700/ul(6,-15,200/ul(4,-630/ul(<桿狀中性粒細(xì)Lymphs=1,400/ul(1,-淋巴細(xì) ets=568,000/ul(200,-TAMU鈉Sodium152mEq/L(138-鉀Potassium4.1mEq/L(3.5-葡萄Glucose107mg/dl(60-白蛋Albumin2.7gm/dl(2.5-123IU/L(<SAP2,174IU/L(<肌 1.3mg/dl(<TAMU“…Smallamountofanechoiceffusionbetweenliverlobesandaroundurinary TAMUAbdominalfluid:WBC=RBC=

Totalprotein 4.6總蛋90%nondegenerate8%macrophages,SterilepancreatitisVersus和SepticAbdominalfluidTP0AbdominalfluidTPgmPANCREATITIS無腹腔積makealittleabdominal產(chǎn)生少量腹腔積Pancreatitiscanpresent胰腺炎可表現(xiàn)acutevomitingwithabdominal急 伴有腹部疼chronic,lowgradevomiting/anorexia慢性輕 /厭食（膿腫icterus(biliarytract黃疸（膽道阻塞ascites(minimal,littleor腹水（少量、無腹水或大量acuteabdomen(looksjustlikesepticSIRS(lookslikesepticshock)RESPONSESYNDROME全身性炎癥反應(yīng)綜合 usedtobecalled“Septicshock”曾被稱為“敗血性休克”RESPONSESYNDROME inadequateperfusionofthebodytissuesbecauseofanexaggeratedinflammatory劇烈的炎癥反應(yīng)導(dǎo)致機體組織灌注不WHATISSUPPOSEDHAPPEN認(rèn)為會發(fā)生什Bacterialtoxin,inflammatoryLymphnodes,hepatic ，肝臟巨噬細(xì)Systemic全身循WHATISSUPPOSEDHAPPEN認(rèn)為會發(fā)生什Bacterialtoxin,inflammatoryLymphnodes,hepatic ，肝臟巨噬細(xì)Systemic全身循WHATCAN會發(fā)生什InflammatoryLymphnodes全身循Mildunevenvasodilatation“HighoutputshockBrightredmucus FastcapillaryrefilltimeBounding

LATE–Severeperipheralvasodilatation+poorcardiaccontractility嚴(yán)重的外周血管擴張“LowoutputshockPalemucusmembranesWeak SlowrefilltimeTHERAPYFOROnlysupportiveand僅用支持療法和對癥治NPO(nothingperos)vsEarlyTHERAPYFOROnlysupportiveand僅用支持療法和對癥治Early 早期飼 Feedsmallamountsofultra-lowfatfoodevenifvomiting即 也飼喂少量超低脂食 Continuefeedingaslongasthepatientdoesnotgetworse只要動物病情沒 ，便繼續(xù)飼THERAPYFOROnlysupportiveand僅用支持療法和對癥治EarlyFluid

Crystalloids

THERAPYFOROnlysupportiveandEarlyFluid

液體療Crystalloids

Hetastarchisnolongereveryone’sfriend...(JVetEmergCriticalCare25:20-47,羥乙基淀粉不再是所有人最好的朋友THERAPYFOROnlysupportiveandEarlyFluid

液體療Crystalloids

完全/部分腸外營養(yǎng)支THERAPYFOROnlysupportiveand僅用支持療法和對癥治EarlyFluid

早期飼液體療Crystalloids

Jejunostomyfeeding空腸造口(PEG-J,NasalJ,regularTHERAPYFOROnlysupportiveandEarlyFluid

液體療Crystalloids晶體

鎮(zhèn)痛THERAPYFOROnlysupportiveandgesicsHydromorphoneor FLKcocktail(CRIoffentanyl, –Butorphanol(moreofa 劑THERAPYFOROnlysupportiveandEarly Fluid Anti-