妊娠期急性胰腺炎的早期诊断

妊娠期急性胰腺炎是妊娠期罕见且严重的并发症之一,发病急、病情进展迅速、诊断困难,严重威胁母婴健康。准确判断妊娠期急性胰腺炎的病因、尽早确定诊断是临床处理的关键。从妊娠期急性胰腺炎的病因,早期诊查方法及常见疾病的鉴别诊断等方面归纳总结了近年来该病早期诊断的进展。     

妊娠合并重症急性胰腺炎

妊娠合并重症急性胰腺炎,是一种严重的妊娠期疾病,具有起病急、临床表现不典型及母婴病死率高等特点。国内外报道妊娠合并急性胰腺炎的发病率约为1／1000—1／12000,而合并重症急性胰腺炎（出血坏死型胰腺炎）的更少。由于妊娠牵涉到母婴健康和安全的特殊情况,所以该病的临床治疗有一定的特殊性。作者报道了南京医科大学第一附属医院胰腺外科中心近1年来4例妊娠合并重症急性胰腺炎的诊治体会。     

急性胰腺炎首发72h的处理

急性胰腺炎是消化系统常见疾病之一,起病急,如治疗不及时,可在短时间内重症化,重度急性胰腺炎死亡率仍较高。因此,急性胰腺炎早期,特别是首发72 h的处理显得尤为重要。本文阐述了急性胰腺炎的诊断标准、严重程度分级、预后影响因素以及病因治疗、液体复苏、营养支持、抗菌药物的使用、器官功能维护等早期处理措施,有助于规范临床医师对急性胰腺炎的早期处理。     

重视急性胰腺炎的病因诊断

急性胰腺炎病因复杂,地区差异明显。明确病因有助于临床医师对病情严重程度、转归的判断,且对预后和复发的评估有重要的作用,可指导急性胰腺炎的诊断和治疗。病因存在可加重胰腺的损害,根据病因进行相关的治疗,有助于胰腺炎的恢复,亦是治疗急性胰腺炎的重要措施之一。     

急性胰腺炎的少见病因

急性胰腺炎是临床常见疾病,病因复杂多样,常见病因包括胆源性、高甘油三酯血症性和酒精性,约20%的急性胰腺炎病因不明被归类为特发性急性胰腺炎。对急性胰腺炎的病因进行早期诊断和治疗有助于缓解病情、改善预后和减少胰腺炎复发的风险。因此,临床医师须了解急性胰腺炎的少见病因,如肿瘤、感染、药物、高钙血症、自身免疫病、血液透析相关...     

妊娠期胰腺炎的诊疗经验

妊娠期急性胰腺炎是较为罕见的疾病,发病率为1／1000—4000,其中胆源性所占比例最高,妊娠期间的病理生理变化令这一疾病的诊疗有一定特殊性和难度。本研究回顾了2001～2012年来本院诊治的19例胆源性妊娠期胰腺炎病例,并讨论、总结诊断和治疗经验。     

妊娠期高血压疾病血压管理专家共识(2019)

妊娠期高血压疾病是妊娠与高血压并存的一组疾病,是导致孕产妇和胎儿死亡的重要原因。近年来,随着计划生育"两孩"政策的放开,我国高龄孕产妇比例增加,妊娠期高血压疾病患病率增加。由于其独特的病理生理机制,使其血压管理策略与非妊娠期不同。该共识制定了妊娠期高血压疾病诊断、评估体系和管理流程,内容包括诊断、分类、血压及靶器官损害评估、生活方式指导及药物治疗。以便于内科医师及广大基层医师规范化诊治妊娠期高血压疾病,最大程度保障妊娠期母婴安全。     

急性胰腺炎合并外分泌功能不全的诊治

急性胰腺炎发病后可出现不同程度的胰腺外分泌功能不全, 严重影响患者的生活质量, 增加疾病负担。目前急性胰腺炎合并胰腺外分泌功能不全的相关研究较少, 且临床医师认识不足。现对急性胰腺炎合并胰腺外分泌功能不全的诊断与治疗研究进展进行综述。     

胆源性急性胰腺炎与高脂血症性急性胰腺炎临床特点比较的研究进展

胆源性急性胰腺炎(BAP)和高脂血症性急性胰腺炎(HLAP)是急性胰腺炎(AP)的常见类型。该文综述了BAP与HLAP在发病机制、实验室指标(炎性反应指标和生物化学指标)、治疗(常规治疗和特异性治疗)这3个方面的差异,以期帮助临床医师进行早期诊断,从而降低AP的病死率和复发率。     

妊娠期胰腺炎的诊疗经验

正妊娠期急性胰腺炎是较为罕见的疾病,发病率为1/1 000-4 000,其中胆源性所占比例最高,妊娠期间的病理生理变化令这一疾病的诊疗有一定特殊性和难度。本研究回顾了2001年-2012年来我院诊治的19例胆源性妊娠期胰腺炎病例,并讨论、总结诊断和治疗经验。1材料和方法1.1一般资料和诊断标准本研究回顾了2001年~2012年以来19例因胆源性胰腺炎入院治疗的病例。其中经产妇5例     

Symptomatic choledocholithiasis during pregnancy - the role of ultrasound, ERCP and EUS

We present an overview of the management of acute bilary pancreatitis in pregnancy with particular reference to endoscopy. Ultrasound is the gold standard for diagnosis. If clinical symptoms, laboratory parameters and transabdominal ultrasound do not allow appropriate decision making, endoscopic ultrasound (EUS) is the method of choice. EUS is preferably performed prior to ERCP during the same clinical session, this is of particular relevance for pregnant women with regards to the safety of mother and fetus. However, because the procedure is performed under fluoroscopic guidance, there are potential risks related to the radiation exposure. ERCP, especially in pregnant patients demands high expertise from the endoscopist, and with due diligence and attention to detail, the procedure can be safely performed.     

Pneumocystis jirovecii pneumonia and alveolar hemorrhage in a pregnant woman with human T cell lymphotropic virus type-1 infection

Acute lung injury during pregnancy results in morbidity and mortality in both the mother and the fetus. Pneumocystis jirovecii pneumonia (PCP) is a rare disease but may occur in pregnant immune-suppressed women. Here, we describe a case of acute lung injury due to PCP and alveolar hemorrhage in a pregnant woman who was a human T lymphotropic virus type-1 (HTLV-1) carrier. PCP should be considered in the differential diagnosis of pulmonary complications during pregnancy in HTLV-1 endemic areas.     

ST‐elevation acute myocardial infarction in pregnancy: 2016 update

Acute myocardial infarction (AMI ) during pregnancy or the early postpartum period is rare, but can be devastating for both the mother and the fetus. There have been major advances in the diagnosis and treatment of acute coronary syndromes in the general population, but there is little consensus on the approach to diagnosis and treatment of pregnant women. This article reviews the literature relating to the pathophysiology of AMI in pregnant patients and the challenges in diagnosis and treatment of ST ‐elevation myocardial infarction (STEMI ) in this unique population. From a cardiologist, maternal–fetal medicine specialist, and anesthesiologist's perspective, we provide recommendations for the diagnosis and management of STEMI occurring during pregnancy.     

Serum amylase and lipase activities in normal pregnancy: a prospective case-control study

OBJECTIVE: The diagnosis of acute pancreatitis during pregnancy is usually based on the association of upper abdominal pain, nausea or vomiting, and elevated serum amylase or lipase activities. The changes in these enzymatic activities have not been clearly established during normal pregnancy. The aim of this study was therefore to evaluate serum amylase and lipase activities in healthy pregnant women. METHODS: Serum amylase and lipase activities were measured in 103 pregnant women (first trimester, n = 34; second trimester, n = 36; third trimester, n = 33) and in 103 nonpregnant women matched for age and not receiving oral contraception. RESULTS: Serum amylase activity was similar in pregnant women and nonpregnant women during all trimesters of pregnancy. Serum lipase activity was significantly lower during the first trimester of pregnancy compared to nonpregnant women (48.6+/-27.6 vs 59.2+/-29.3 IU/L, p < 0.05) and compared to the third trimester (48.6+/-27.6 vs 76.3+/-35.8 IU/L, p < 0.001). Serum lipase activity was not statistically different between pregnant and nonpregnant women during the second and third trimesters. CONCLUSION: An increase in serum amylase and lipase activities during pregnancy should be taken into account, as in nonpregnant women.     

Gallstone disease and pancreatitis in pregnancy.

Controversy exists over whether pregnancy is a risk factor for gallstone formation; however, changes in hepatobiliary function do occur during pregnancy to create a lithogenic environment; these changes include gallbladder stasis and secretion of bile with increased amounts of cholesterol and decreased amounts of chenodeoxycholic acid. In women with existing gallstones, pregnancy may bring out symptoms, including pain and even acute cholecystitis. This may be more common during the postpartum period than during pregnancy itself; however, the overall occurrence of symptomatic biliary disease in association with pregnancy is low. The effects of pregnancy, if any, on pancreatic exocrine function are undefined. Acute pancreatitis can occur during pregnancy but does not appear to do so with either increased or, alternatively, decreased frequency. The concept of pancreatitis caused by pregnancy per se is not valid, although in susceptible women with lipid disorders, hypertriglyceridemia can occur and serve as an etiologic factor. Gallstones are a common cause of pancreatitis, but in contrast to nonpregnant women, alcohol is unusual as a cause. Although the presentation of both acute cholecystitis and acute pancreatitis may be similar to that in the nonpregnant state, the differential diagnosis of both these disorders is expanded because of unique pregnancy-related conditions and the shift of abdominal viscera by the enlarging uterus. The diagnosis is clinical and supported with conventional laboratory studies and ultrasound; management is supportive and in most patients successful. Cholecystectomy is seldom necessary during pregnancy, either for acute cholecystitis or gallstone pancreatitis, but can be safely performed if necessary after the first trimester. Endoscopic papillotomy and stone removal for choledocholithiasis are possible during pregnancy and may be the treatment of choice for this unusual condition. Specific enteral or parenteral nutrition may be necessary in women with pancreatitis associated with hypertriglyceridemia.     

El impacto del embarazo en el desenlace de pancreatitis biliar aguda

Background and objectiveAcute pancreatitis is one of the most common gastrointestinal conditions requiring hospitalization. Even though its presentation during pregnancy is uncommon, it is a medical challenge. Currently, no studies compare the clinical outcomes between pregnant patients with acute pancreatitis and nonpregnant patients with acute pancreatitis. Our aim was to compare the characteristics and clinical outcomes of pregnant and nonpregnant women with acute pancreatitis.MethodsWe conducted a retrospective study that included all patients admitted to our hospital with acute pancreatitis over a 10-year period. Demographics, general characteristics, and clinical outcomes were evaluated and compared between pregnant and nonpregnant women with acute pancreatitis, at a ratio of 1:5.ResultsOver 10 years, 27 pregnant patients with acute pancreatitis were treated. Etiology was biliary in 96% and hypertriglyceridemia was the cause in 3.4% (1 patient). The mean patient age was 26.2 years (range 15-36 years). The main cause of acute pancreatitis was biliary disease (96%). Patients in the study group were in their first, second, or third trimester of pregnancy, at 7.4%, 33.3%, and 59.3%, respectively. In the comparison of pregnant versus nonpregnant patients with acute pancreatitis, there were no differences in age, hospital stay (7.37 vs. 10.8, P=.814), severity (severe 3.7% vs. 16.7%, P=.79), local complications (0% vs. 1.9%, P=.476), or mortality (0% vs. 1.9%, P=.476).ConclusionsThe clinical evolution of both groups with biliary acute pancreatitis was similar, with low morbidity and mortality.     

Gastrointestinal endoscopy in the pregnant woman

About 20000 gastrointestinal endoscopies are performed annually in America in pregnant women. Gastrointestinal endoscopy during pregnancy raises the critical issue of fetal safety in addition to patient safety. Endoscopic medications may be potentially abortifacient or teratogenic. Generally, Food and Drug Administration category B or C drugs should be used for endoscopy. Esophagogastroduodenoscopy(EGD) seems to be relatively safe for both mother and fetus based on two retrospective studies of 83 and 60 pregnant patients. The diagnostic yield is about 95% when EGD is performed for gastrointestinal bleeding. EGD indications during pregnancy include acute gastrointestinal bleeding, dysphagia 1 wk, or endoscopic therapy. Therapeutic EGD is experimental due to scant data, but should be strongly considered for urgent indications such as active bleeding. One study of 48 sigmoidoscopies performed during pregnancy showed relatively favorable fetal outcomes, rare bad fetal outcomes, and bad outcomes linked to very sick mothers. Sigmoidoscopy should be strongly considered for strong indications,including significant acute lower gastrointestinal bleeding, chronic diarrhea, distal colonic stricture, suspected inflammatory bowel disease flare, and potential colonic malignancy. Data on colonoscopy during pregnancy are limited. One study of 20 pregnant patients showed rare poor fetal outcomes. Colonoscopy is generally experimental during pregnancy, but can be considered for strong indications: known colonic mass/stricture, active lower gastrointestinal bleeding, or colonoscopic therapy. Endoscopic retrograde cholangiopancreatography(ERCP) entails fetal risks from fetal radiation exposure. ERCP risks to mother and fetus appear to be acceptable when performed for ERCP therapy, as demonstrated by analysis of nearly 350 cases during pregnancy. Justifiable indications include symptomatic or complicated choledocholithiasis, manifested by jaundice, cholangitis, gallstone pancreatitis, or dilated choledochus. ERCP should be performed by an expert endoscopist, with informed consent about fetal radiation risks, minimizing fetal radiation exposure, and using an attending anesthesiologist. Endoscopy is likely most safe during the second trimester of pregnancy.     

Case management of malaria in pregnancy

In all malarious areas, infection by any of the main human plasmodial species during pregnancy is detrimental to the mother and the fetus. These potentially fatal infections must be prevented, but when they develop they require prompt diagnosis and treatment. Current tools to detect malaria parasites in pregnant women are often not used and remain too insensitive to detect a low parasitaemia. The kinetics, safety, and efficacy of available antimalarial drugs are poorly documented because pregnant women are systematically excluded from clinical trials. A considerable effort, involving clinical trials, is urgently required to improve the diagnosis and case management of malaria during pregnancy if the morbidity and mortality of maternal malaria is to be reduced.     

妊娠合并急性胰腺炎的临床特征——附6例报道及文献复习

目的探讨妊娠合并急性胰腺炎AP的病因、临床特点、诊断、治疗及预后。方法将我院6例患者和文献检索的94例患者分为A、B两组,观察患者发病时的孕龄、孕周、诱因、病因、BMI、临床表现、生化指标、治疗结果及预后。结果两组中重症AP(SAP)41例,轻症AP(MAP)59例。其中79例孕中晚期发病,11例产后发病,临床上有不同程度腹痛、恶心、呕吐,部分患者症状不典型,血淀粉酶轻度升高或正常,33例血脂明显升高,48例发病与胆道疾病有关;A组BMI孕后较孕前上升16.90%;两组中29例剖腹探查,71例保守治疗,其中内镜治疗4例,31例孕妇顺产,其中1例为SAP;孕妇死亡率为9%,胎儿24%,孕妇胎儿均死亡6%,死亡原因多为并发MSOF。结论高脂血症、胆道疾病、孕后体重增长过快是发病的主要因素;重症多,死亡率高,妊娠中晚期发病率高,临床表现复杂,易误诊;内科保守治疗为主,适时终止妊娠,外科介入为基本治疗原则;控制体重、血脂和胆道疾病的发作,合理饮食,对预防本病具有重要意义。