推 Kupffer:推 02/20 18:56
推 pippen2002:高手!! 02/21 21:22
推 taller:這篇真的太威了 推一個 02/22 10:06
※ 引述《Copper (退潮)》之銘言：
: ※ 引述《doctoja ( )》之銘言：
: : 什麼情況下需要作？
: : 謝謝
根據 American Journal of Gastroenterology 2006;101:2379-2400
Practice Guidelines in Acute Pancreatitis
For Diagnosis:
Acute pancreatitis diagnosis: Two of the following three features:
1) Abdominal pain characteristic of acute pancreatitis,
2) Serum amylase and/or lipase > 3 times the upper limit of normal,
3) Characteristic findings of acute pancreatitis on CT scan
In a patient with abdominal pain characteristic of acute pancreatitis and
serum enzyme levels that are lower than 3 times the upper limit of normal,
a CT scan must be performed to confirm a diagnosis of acute pancreatitis.
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Anyway，國情不同, 所以國內也不是大家都照這個 guideline 走。
國內大概都是會排 Abdominal echo，只是大家要了解：
Abdominal echo was to access for gallstones as the etiology
rather than to establish the diagnosis of acute pancreatitis.
而如果要排除其他診斷，Guideline 建議的是 non-contrast CT:
Indication for a CT scan at admission
(but not necessarily a CT with IV contrast) is to distinguish
acute pancreatitis from another serious intra-abdominal condition,
such as a perforated ulcer.
Contrast-enhanced CT也可以用來評估 severity，
看是不是 necrotizing pancreatitis，
但是是在住院2~3天後，病情仍舊穩定不下來，而不是一開始：
Indication for a contrast-enhanced CT scan a few days after admission
is to distinguish interstitial from necrotizing pancreatitis
when there is clinical evidence of increased severity.
(much more readily on the second or third day after admission
rather than at the time of admission )
Level of evidence: III
另外如果住院 1~2 個禮拜後要懷疑 infective necrosis，可以安排
CT-guided aspiration，或是更晚要懷疑 pseudocyst formation，CT也是indication:
CT-guided percutaneous aspiration with Gram’s stain and culture is
recommended when infected necrosis is suspected. The initial aspiration
is usually performed during the second or third week of illness.
Level of evidence: III
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