Biliary acute pancreatitis

　　1. Causes of Disease

　　Various diseases of the bile duct, including gallstones, tapeworms, infections, scar stenosis, tumors, inflammatory edema, etc., can all cause the occurrence of acute pancreatitis. 'Common channel' is the anatomical basis for its occurrence, among which gallstones and infections are the most common causes.

　　1. Gallstones in the biliary tract system can move within the body, not only causing stenosis at the ampulla itself, but also leading to mucosal injury, secondary edema or infection, and exacerbating stenosis. Stenosis of the ampulla increases the pressure within the bile duct, causing bile to flow back into the pancreas, activating pancreatic enzymes and leading to pancreatic auto-digestion.

　　2、感染胆道系统的细菌感染时，胆汁内含有大量细菌及其代谢产物，其中的某些成分如细菌酰胺酶等可激活胰酶，造成胰腺的自身消化和急性炎症；胆总管的炎症可直接累及胰管，胰管引流不畅而向胰组织内逆流而发病。

　　2, Infection During bacterial infection of the biliary tract, bile contains a large amount of bacteria and their metabolites. Some components, such as bacterial amylase, can activate pancreatic enzymes, causing self-digestion of the pancreas and acute inflammation; the inflammation of the common bile duct can directly affect the pancreatic duct, causing the pancreatic duct to drain poorly and flow back into the pancreatic tissue, leading to the disease.

　　3, Other factors such as biliary parasites, scar stenosis, tumors, and dysfunction of the Oddi sphincter can cause obstruction of the pancreatic duct, unsmooth excretion of pancreatic juice, bile reflux, and lead to this disease.

　　Second, Pathogenesis

　　1, Gallstones stuck in the ampulla The bile flows back into the pancreatic duct through the common channel, and infection is brought into the pancreatic duct.

　　2, Excretion of gallstones The process of gallstone excretion may cause paralysis of the Oddi sphincter, leading to retrograde flow of intestinal contents into the pancreatic duct, causing pancreatitis. The gallstones may get stuck in the ampulla, causing bile to flow back into the pancreatic duct through the common channel, and infection is then carried into the pancreatic duct.

　　1, Jaundice In some cases with hemorrhagic necrosis, jaundice is a manifestation of liver function damage caused by severe intra-abdominal infection.

　　2, Shock In some patients, the pulse may quicken, blood pressure may drop, breathing may accelerate, the face may become pale, extremities may become cold, and expression may be indifferent or restless.

　　3, Hemorrhagic signs The local skin may appear bluish purple, visible at the waist, anterior lower abdominal wall, or around the umbilicus.

　　First, Symptoms

　　1, Abdominal pain:It is the main symptom of this disease, starting from the upper abdomen and appearing early. Typical cases often suddenly feel pain on the left side of the umbilicus, which is persistent and may worsen periodically, presenting as a cutting pain, often radiating to the shoulder, flanks, and lumbar region. As the inflammation spreads, the range of abdominal pain may become striped or spread to the entire abdomen.

　　2, Nausea and vomiting:It is an early symptom of this disease, almost appearing at the same time as abdominal pain. The initial attacks are frequent and often喷射状, containing food and bile. In the late stage, intestinal paralysis may occur, and fecal-like substances may be vomited.

　　3, Abdominal distension:It is a common symptom of this disease, and the degree of abdominal distension is related to the severity of pancreatitis. Mild cases may last for 2 to 3 days, while severe cases may last for more than 7 days, often accompanied by flatus and cessation of defecation.

　　4, Jaundice:Generally mild, mostly obstructive, but in a few cases with hemorrhagic necrosis, jaundice is a manifestation of liver function damage caused by severe intra-abdominal infection.

　　5, Other:Fever, gastrointestinal bleeding, shock signs, etc., may occur in some patients.

　　Second, Signs

　　1, Abdominal tenderness and abdominal muscle tension:Most patients have abdominal tenderness, mainly in the upper abdomen, with tense abdominal muscles, but the degree is not as severe as that in gastrointestinal perforation or cholecystectomy. Some patients show signs of diffuse peritonitis.

　　2, Shock:部分病人脉搏加快，血压降低，呼吸加快，面色苍白，肢端厥冷，表情淡漠或烦躁不安。

　　Some patients have an increased heart rate, decreased blood pressure, increased breathing, pale complexion, cold extremities, and indifference or restlessness.3. Hemorrhagic signs:

　　The exuded pancreatic juice reaches the subcutaneous fat along the tissue space, causing capillary rupture and bleeding, making the local skin purple. It can be seen at the waist, the anterior lower abdominal wall, or around the umbilicus.4. Intestinal obstruction and shifting dullness:

　　How to prevent gallstone acute pancreatitis

　　1. This disease is caused by biliary tract diseases, so actively treating biliary tract diseases can effectively prevent the occurrence of this disease. For example, preventing intestinal ascaris, timely treating biliary tract stones, and avoiding acute attacks of biliary tract diseases are important measures to prevent acute pancreatitis.

　　1. Blood test

　　This disease often has hypovolemic shock and complicated infection, with an increase in white blood cell count, hemoglobin, and hematocrit, a decrease in carbon dioxide combining power, increased blood glucose in the early stage of attack, lasting for several hours to several days, and the blood calcium in acute necrotizing pancreatitis begins to decrease from the 2nd to 5th day. If it is below 1.75 mmol, it indicates severe illness. The increase in serum amylase is one of the important diagnostic criteria for pancreatitis. 70% to 95% of patients with acute pancreatitis show increased serum amylase, reaching its peak in 24 hours, and returning to normal within 5 days. Those who continue to increase for more than 12 days indicate the presence of complications. The increase in urinary amylase appears slightly later and lasts longer. Serum lipase increases to more than 1.5 Komsomolsky units within 24 hours of onset.

　　2. Abdominal puncture

　　In cases of acute necrotizing pancreatitis, abdominal puncture often results in cloudy fluid, and fat droplets may be seen. In case of concurrent infection, it may become purulent. The amylase in peritoneal fluid is often increased, often higher than that in serum amylase, and the duration is 2 to 4 days longer than that of serum amylase.

　　3. Abdominal X-ray

　　Two-thirds of patients with acute pancreatitis can show abnormalities, such as: enlargement of the pancreatic shadow, unclear edges, increased density, localized intestinal paralysis, transverse colon resection sign (the hepatic flexure of the colon and the splenic flexure are inflated when lying flat, while the middle segment of the transverse colon is not inflated).

　　4. Chest X-ray

　　It can be seen that the left diaphragm is elevated, with moderate amount of pleural effusion on the left side, or atelectasis of the lower lobe of the left lung.

　　5. B-ultrasound examination

　　It can be found that the pancreas is diffusely swollen and enlarged, with the outline line slightly bulging in an arc, with a positive rate of up to 45% to 90%, and biliary tract diseases can also be found.

　　6. CT scan

　　It is a modern sensitive non-invasive diagnostic method. 70% to 90% of patients have abnormal findings: focal or diffuse pancreatic enlargement, uneven density, irregular shape, fluid accumulation around the pancreas, etc.

　　I. Diet for gallstone acute pancreatitis:

　　Lotus Seed Pear Rock Sugar Water

　　Ingredients: lotus seeds, pear, rock sugar

　　Method:

　　1、将干莲子泡发后放在煲里用慢火煮。

　　1. Soak the dried lotus seeds and place them in a pot to cook over low heat.

　　2. When the lotus seeds are almost soft, add the peeled pear meat, and after the pear is stewed, add a moderate amount of brown sugar and boil for 2 minutes!

　　Benefits:

　　Sugarcane: it is a crystalline substance obtained after refining sugarcane juice, containing more impurities, but the nutrients are well preserved. In addition to sucrose, it also contains trace amounts of iron, calcium, and carotene. It releases energy quickly and has a high nutritional absorption and utilization rate. Traditional Chinese medicine believes that brown sugar has the effects of invigorating Qi, warming the middle, strengthening the spleen and warming the stomach, transforming food and stopping pain, activating blood circulation and removing blood stasis, and expelling cold.

　　Second, what foods are good for biliary acute pancreatitis:

　　(1) It is advisable to eat light and nutritious, fluid foods such as congee, vegetable soup, lotus root starch, egg flower soup, and noodles.

　　(2) In addition to liquid food, it also includes congee, plain noodles, soy noodles, dumplings, bread, biscuits (low in oil), and a small amount of chopped soft vegetables and fruits, etc.

　　(4) It is appropriate to increase sieved porridge, steamed egg white, and a small amount of soy milk soup food.

　　(5) Choose vegetable oils, and most commonly use methods such as boiling, steaming, cold dressing, roasting, braising, pickling, and stewing.

　　Third, what foods should not be eaten for biliary acute pancreatitis:

　　1. Absolutely avoid alcohol: it usually takes 2-3 months to recover, and to prevent recurrence, it is necessary to avoid eating foods rich in fat for a relatively long period of time.

　　2. Avoid oily foods. Oily foods are difficult to digest and can promote bile secretion, and bile can activate digestive enzymes in the pancreas, making the condition worse. Therefore, foods rich in fat, such as lard, peanuts, sesame seeds, oil-fried snacks, fried foods, etc., should be prohibited.

　　3. Avoid foods containing fat, such as meat broth, fish broth, chicken broth, milk, egg yolk, etc.

　　4. Avoid spicy and刺激性 seasoning, such as chili, Sichuan pepper, curry powder, etc.

　　First, traditional Chinese medicine treatment methods for biliary acute pancreatitis

　　Traditional Chinese medicine treatment

　　In terms of traditional Chinese medicine diagnosis and treatment for the differentiation of this disease, there is currently no unified standard in clinical practice, and the literature reports are quite inconsistent. In general, it can be divided into three types: liver and gallbladder depression, heat and dampness in the liver and gallbladder, and internal accumulation of toxic heat.

　　(1) Liver and gallbladder depression: due to the gallbladder not functioning properly, Qi circulation is blocked, the liver fails to release, and the spleen fails to maintain healthy function, leading to the disease. Common in the early stage of acute edematous pancreatitis. Symptoms include intermittent abdominal pain, pain radiating to the chest and hypochondrium, abdominal distension, nausea, bitter mouth, lack of appetite, thin coating and wiry pulse. Treatment principle: Relieve the liver and gallbladder, and resolve depression. Prescription: Chaihu Shugan San. Commonly used herbs include: Bupleurum, Radix paeoniae alba, Cyperus rotundus, Scutellaria baicalensis, Polygonum cuspidatum, Citrus reticulata Blanco, Curcuma, etc.

　　(2) Heat and dampness in the liver and gallbladder: due to the liver and gallbladder not releasing properly, internal heat and dampness accumulate and do not disperse, leading to the disease by steaming the liver and gallbladder. Symptoms include abdominal pain, fever, jaundice, bitter mouth, yellow urine, constipation, red tongue with thick yellow greasy coating, and slippery and rapid pulse. Treatment principle: Clear heat and transform dampness, relieve the liver and promote bile flow. Prescription: Da柴胡汤. Commonly used herbs include: Bupleurum, rhubarb, Scutellaria baicalensis, Gardenia, Pinellia ternata, Taraxacum mongolicum, Prunus serotina, etc.

　　(3) Internal Heat-toxin Accumulation: The dampness and heat of the liver and gallbladder do not disperse, heat transforms from fire, endogenous fire-toxin is produced, which can not only rot flesh into pus but also consume qi and blood, even lead to separation of yin and yang.

　　Symptoms include persistent high fever, pain that is resistant to palpation, persistent pain, rigid abdominal muscles, dry mouth and dry lips, red face, or deep yellow skin, constipation, yellow urine, red tongue with dry yellow or gray-black fur, thin and rapid pulse. In cases where heat invades the nutrient and blood, skin petechiae and gingival bleeding may be seen. In cases where heat sinks into the pericardium, there may be confusion or delirious excitement. In cases where yin and yang are injured and separated, there may be cold limbs and profuse sweating. The treatment principle is to clear heat, reduce fire, and detoxify. The prescription is modified Huanglian Jiedu Decoction, commonly used drugs include: Coptis, Scutellaria, Rehmannia, Moutan bark, Gardenia, etc. For those with constipation and pain that is resistant to palpation, add Dahuang Xiegu Decoction. For those with heat invading the nutrient and blood, add Qingying Decoction. For those with heat sinking into the pericardium, add An Gong Niuhuang Pill. For those with yin and yang exhaustion, Shenfu Decoction, Shenmai Powder, and Dushen Decoction can be used.

　　Secondly, Western Medical Treatment for Biliary Acute Pancreatitis

　　This disease often requires a combination of traditional Chinese and Western medicine, especially for acute hemorrhagic necrotizing pancreatitis, it is necessary to cooperate with measures such as anti-shock, anti-infection, symptomatic treatment, supportive therapy, and surgery.

　　1. Drug Treatment:

　　(1) Diet Control and Gastrointestinal Decompression: For those with mild symptoms, eat a small amount of light liquid food; when nausea, vomiting, and abdominal distension are obvious, gastrointestinal decompression is required, and traditional Chinese medicine can be infused through the gastric tube.

　　(2) Supportive Therapy: Intravenous electrolyte supplementation, maintaining sufficient circulating blood volume, supplementing sufficient and comprehensive nutrition, is very important for improving the efficacy of this disease.

　　(3) Application of Antibiotics: Mainly to inhibit the growth of intestinal bacteria, prevent and control secondary infection. Broad-spectrum antibiotics are often used.

　　(4) Antiprotease Therapy: Measures to inhibit pancreatic secretion can be applied.

　　2. Surgical Treatment: There are many disputes about the timing and method of surgery for this disease. The current trend is to perform delayed surgery after the acute symptoms of the patient have been relieved on the basis of active symptomatic and supportive therapy, usually around 7 days after the acute attack. However, for patients with uncertain diagnosis and progressive deterioration of the condition despite the use of various supportive therapies, timely surgical treatment should be performed. The surgical method should be selected according to the different lesions of the bile duct. For the treatment of the pancreas itself, procedures such as pancreatic drainage and pancreatic resection can be adopted.