Emergencies of the liver, gallbladder, and pancreas

Abdominal pain is a common presenting complaint in today's emergency department (ED). Disorders related to the liver, gallbladder, and pancreas are responsible for many of these presentations. With the increasing prevalence of gallstones, as well as alcohol use and abuse, the numbers of cases are likely to increase. This article examines hepatic emergencies including alcoholic hepatitis, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy. In addition, the authors review the presentation, evaluation, and management of acute biliary tract disorders with some emphasis on bedside ultrasonography. Evaluation and treatment of pancreatitis and its complications in the ED are discussed.     

超声内镜在肝胆胰外科的应用进展

胆道系统结构特殊，肝胆管分支深入肝内，解剖变异复杂多样，胆道系统疾病纷繁复杂，既有良性疾病，又有恶性肿瘤。其临床表现变化多端，有的很典型，有的则可以完全没有症状。由于胆道疾病多发生于深在细小的肝胆管管腔之内，给胆道系统疾病的诊断和治疗增加了许多困难，客观上给临床医生处理胆道疾病制造了重重障碍。     

集束化管理联合预防性护理对中心静脉导管相关性血流感染及并发症的影响

目的 评价小儿重症肺炎护理中开展综合护理模式的效果。方法 选取2018年11月至2023年1月期间我院收治的小儿重症肺炎患儿65例作为研究对象。通过随机双盲法将患儿分为对照组(30例患儿)与研究组(35例患儿)。对照组采用常规护理;研究组采用常规护理+综合护理。分析对比两组的并发症发生率、疼痛程度、哭闹情况及护理满意度。结果 护理后,研究组并发症发生率显著低于对照组(P<0.05)。护理后,研究组VAS疼痛评分显著低于对照组(P<0.05)。护理后,研究组哭闹情况显著好于对照组(P<0.05)。护理后,研究组家属的护理满意度显著高于对照组(P<0.05)。结论 小儿重症肺炎护理中应用综合护理模式,能减少并发症,缓解疼痛,改善哭闹情况,提高护理满意度。     

Serum beta2-microglobulin in liver disease.

The concentration of beta 2-microglobulin in serum was determined in seventy-one patients with various liver disorders. Elevated values were found in most patients with chronic active or chronic persistent hepatitis and in over 80% of patients with alcohol-induced liver cirrhosis. In contrast, patients with alcohol-induced fatty liver, the serum beta 2-microglobulin concentrations were mostly within the normal range. Significant correlation (P less than 0.001) was noted between the elimination rate of galactose from blood and the serum beta 2-microglobulin concentration in patients with alcoholic liver damage but not in patients with chronic hepatitis. The reasons for the increased S-beta 2-microglobulin concentrations in liver diseases are unknown. Several explanations including a release of beta 2-microglobulin from necrotic liver cells or an increased synthesis of beta 2-microglobulin consequent to inflammation in the liver are possible. Alternatively, raised beta 2-microglobulin levels may reflect the hepatic synthesis during reparative growth.     

Abdominal MDCT: liver, pancreas, and biliary tract.

Multidetector row computed tomography (MDCT) enables rapid thin-section acquisition of regional body anatomy. MDCT is adapted to hepatic and pancreatic imaging to produce, in appropriate clinical circumstances, a multipass multiplanar study obtained during defined circulatory phases to best outline vasculature and detect and characterize focal parenchymal lesions. In this chapter, a rational approach to hepatic and pancreatic MDCT acquisition is outlined with emphasis on circulatory phases and contrast material pharmacokinetics as well as biological characteristics of focal parenchymal lesions.     

Serum immunoreactive prolyl hydroxylase in liver disease

The concentration of serum immunoreactive prolyl hydroxylase (SIRPH) was measured in thirty patients with chronic active hepatitis, thirteen with primary biliary cirrhosis, four with alcoholic or idiopathic cirrhosis, and four with acute hepatitis; the values were compared with those in twenty-three control subjects. Increases in SIRPH were found in all the groups with liver diseases, individual values being highest in primary biliary cirrhosis in which about two-thirds of patients had values more than two standard deviations above the mean value in the control subjects. No correlation was found between SIRPH and other tests of liver function or some routine laboratory tests. SIRPH may reflect some hitherto unknown of unmeasured process in the diseased hepatic cells.     

Serum bile acids in alcoholic liver disease. Comparison with histological features of the disease.

Fasting serum bile acids were measured by gas-liquid chromatography in 64 patients with alcoholic liver disease and compared with histological features in their percutaneous liver biopsy specimens. Total bile acid concentrations were normal (less than 2 mug/ml) or minimally increased in 6 patients in whom fatty infiltration was the only hepatic lesion. In the remaining 58 patients with more severe histological lesions, levels were increased in 93%, whereas serum bilirubins were elevated in only 43%. Chenodeoxycholic acid was usually the predominant serum bile acid, regardless of the degree of necrosis or connective tissue change in the biopsy specimen. Only small amounts of the secondary bile acids, deoxycholic acid and lithocholic acid, were detected. Levels of these secondary bile acids did not correlate with histological features.     

肥胖与高脂血症、脂肪肝、胆囊疾患相关性的研究

目的　探讨肥胖与高脂血症、脂肪肝、胆囊疾患的关系。方法　对 6 6 0名具有高级职称教师 (高职教师 )进行检测身高、体重、血脂及腹部B超检查 ,并对结果进行统计分析。结果　超重及肥胖现患率分别为 2 6 36 %和 36 0 6 %,男性肥胖现患率明显高于女性 (P <0 0 1) ;TC、TG数值随着BMI的增大而上升 ;男女肥胖组并发高TG、脂肪肝的患病率均明显高于对照组 (P <0 0 1或P <0 0 5 ) ,女性肥胖组并发胆囊结石的患病率亦明显高于对照组 (P <0 0 1) ;肥胖组且高TG并发脂肪肝、胆囊结石的患病率明显高于对照组 (P <0 0 1)。结论　肥胖是导致高脂血症、脂肪肝、胆囊结石的主要因素 ,高TG与脂肪肝、胆囊结石关系密切。     

Serum aldolase isoenzymes in benign and malignant liver disease

Using a radio-immunoassay, aldolase A and B isoenzyme concentrations have been measured in the sera of patients in order to assess their specificity and sensitivity in a variety of hepatic disorders. Serum aldolase A has been confirmed to be elevated in some patients with malignant infiltration of the liver, but its sensitivity is not sufficient to be of clinical value. Aldolase B is a sensitive marker of liver cell damage which correlates closely with conventional biochemical markers of inflammation. It appears to distinguish successfully between hepatic and cardiac damage.     

Serum alphafetoprotein in cystic fibrosis of the pancreas.

Serum alphafetoprotein concentrations were measured by three different types of radioimmunoassay in 30 patients with cystic fibrosis of the pancreas and in 55 controls. The highest value obtained in cystic patient was 10.2 ng/ml and in a control 10.8 ng/ml. These are within published normal limits. Previously reported large increases in serum AFP in patients with cystic fibrosis and in heterozygote carriers have not been confirmed.