Pancreatic abscess

　　1. Etiology

　　Pancreatic abscess is formed by focal necrosis and liquefaction of necrotic pancreatitis or peripancreatic fat, followed by secondary infection, because necrosis is an ideal place for bacterial growth, and pus accumulates in the pancreas or around the pancreas, containing a small amount or no necrotic pancreatic tissue, and surrounded by a fibrous wall.

　　2. Pathogenesis

　　To clarify the difference between infection and abscess, Rainer Isenmann et al. distinguished between pancreatitis and pancreatic necrosis. From 1982 to 1993, 1300 cases of pancreatitis patients were admitted, 31 cases (2.4%) had one or more abscesses, and there were 77 cases of pancreatitis (5.9%). Additionally, according to clinical data, there is a low correlation between alcoholic pancreatitis and abscess, and there is a high risk after surgery or pancreatic injury.

　　1. Transverse colon perforation:And lower gastrointestinal bleeding is one of the serious complications of pancreatic abscess, which often occurs in the acute stage of the disease. The development process is first secondary infection and hemorrhage of pancreatic abscess or pseudopancreatic cyst, and finally leading to necrosis and perforation of the colon. The mortality rate is above 60%, and 85% of perforations occur in the transverse colon or splenic flexure of the colon.

　　2. Large hemorrhage in the abdomen:Caused by erosion of abscesses into blood vessels, such as splenic artery, left gastric artery, or gastro-duodenal artery, superior mesenteric vein, etc.

　　3. Multiple abdominal abscesses：Due to the spread of pancreatic abscess posterior to the peritoneum to both sides, it can reach below the diaphragm and even the mediastinum, and downward along the paracolic沟 or below the psoas muscle to the inguinal canal.

　　4. Concurrent fistula：Duodenal fistula, jejunal fistula, gastric fistula, pancreatic fistula, etc.

　　5. Others:Gastric emptying delay; diabetes.

　　1. History of severe pancreatitis for 2-3 weeks before onset.

　　2. Persistent high fever, may have chills, persistent upper abdominal pain and left lumbar, back pain, or jaundice and other symptoms.

　　3. Often palpable a cystic mass in the upper left quadrant of the abdomen, fixed and immovable, smooth surface, with fluctuation and marked tenderness.

　　4、实验室检查：血白细胞明显增高。血、尿淀粉酶持续增高。

　　5、X线腹部检查：平片可显示胰腺部有液平面之脓腔影。钡餐造影可见十二指肠弯度扩大，胃、十二指肠或横结肠受外界囊肿压迫而有移位和缺损。

　　6、B超检查可确定包块为囊性。

　　X-ray abdominal examination: The plain film can show the shadow of the fluid cavity in the pancreatic department. Barium meal examination shows dilatation of the duodenal flexure, displacement and defect of the stomach, duodenum, or transverse colon due to external cystic compression.

        What laboratory tests should be done for pancreatic abscess

　　Dietary taboos for patients with pancreatic abscess

　　1. Diet should be simple, clean, and easy to digest. Eat more green bean sprouts, watermelon rind, chrysanthemum brain, and old wheat flour, etc., which are cool foods. At the same time, it is advisable to eat egg flower soup, pork liver soup, lotus root starch, and green bean porridge to increase nutrition. Drink plenty of water and herbal tea during high fever.

　　1. Central-temperature excess heat syndrome:Persistent pain in the left upper quadrant that is resistant to pressure, palpable enlarged mass, persistent high fever, thirst with a desire to drink, nausea and vomiting, constipation, short yellow urine, red tongue with yellow greasy coating, deep and real or wiry and rapid pulse. Clear heat and detoxify, bitter and cold to promote defecation.

　　2. Heat and pus formation:Persistent pain in the left upper quadrant that is resistant to pressure, palpable fluctuating cystic mass, local burning sensation, fever, thirst, red tongue with yellow greasy or decayed coating, and wiry slippery and rapid pulse. Clear heat and drain pus.

　　3. Deficiency and retention of pathogenic factors:Symptoms include: Left upper quadrant pain that is resistant to pressure, persistent fever, or night heat and early coolness, restlessness of the five interiors, decreased appetite, fatigue, weight loss, spontaneous sweating or night sweats, red tongue with little coating, and thready and rapid pulse. Tonify Qi and nourish Yin, clear heat and detoxify.