Acute biliary pancreatitis

　　Acute biliary pancreatitis (ABP) is a disease caused by bile duct stones and inflammation, leading to pancreatic duct obstruction, damage to the pancreatic mucosal barrier, leakage of pancreatic juice, and self-digestion of pancreatic tissue. More than 80% of the causes of acute pancreatitis are related to biliary diseases and alcohol intake, and 10% of patients with gallstones may develop acute pancreatitis.

　　Acute biliary pancreatitis has more complications than pancreatitis caused by other reasons. Common complications include:
　　1. Local complications: include acute cholangitis, pancreatic abscess, pancreatic pseudocyst, pancreatic necrosis, portal vein thrombosis, duodenal obstruction, and others.
　　2. Systemic complications: Severe systemic complications such as respiratory failure, pleural effusion, acute renal failure, gastrointestinal bleeding, pancreatic encephalopathy, sepsis, diabetes, disseminated intravascular coagulation, and others may occur within a few days after the onset of severe pancreatitis.

　　The clinical manifestations of acute biliary pancreatitis mainly include the following aspects:
　　1. Abdominal pain This is the main symptom of the disease, starting in the upper abdomen and appearing early. Typical cases often have a sudden pain in the upper left quadrant of the umbilicus, which is persistent and may increase acutely, cutting-like, often radiating to the shoulder, flank, 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 This is an early symptom of the disease, almost appearing at the same time as abdominal pain. Initial attacks are more frequent, often explosive, containing food and bile; in the late stage, intestinal paralysis may occur, and fecal-like substances may be vomited.
　　3. Abdominal bloating This is a common symptom of the disease, the degree of bloating is related to the degree of pancreatic inflammation. Mild cases may last for 2 to 3 days, severe cases may last for more than 7 days, often accompanied by flatulence and interruption of defecation.
　　4. Jaundice Generally mild, mostly obstructive, but in a few cases of hemorrhagic necrotic patients, jaundice is a manifestation of liver function damage caused by severe intra-abdominal infection.
　　5. Other Fever, gastrointestinal bleeding, shock, and other symptoms may occur in some patients.
　　

　　Acute biliary pancreatitis is caused by biliary tract diseases, therefore, active treatment of biliary tract diseases can effectively prevent the occurrence of the disease. People who are accustomed to heavy drinking due to chronic alcoholism and malnutrition may suffer damage to organs such as the liver and pancreas, with decreased ability to resist infection. On this basis, acute pancreatitis may occur due to a single heavy drinking episode, so it is necessary to pay attention to active prevention.

　　The diagnosis of acute biliary pancreatitis, in addition to relying on clinical manifestations and signs, also requires indispensable means such as laboratory tests and auxiliary examinations. Common examinations include the following:

　　1. Laboratory examination
　　White blood cell count is usually elevated, hemoglobin and hematocrit increase; carbon dioxide binding power decreases; blood sugar increases during the attack, lasting several hours to several days; acute necrotizing blood calcium begins to decrease 2 to 5 days after onset. If it is below 1.75 mmol, it indicates a severe condition; elevated blood and urine amylase are one of the important diagnostic criteria for pancreatitis. About 70% to 95% of patients with acute pancreatitis show increased serum amylase, reaching a peak within 24 hours and returning to normal within 5 days. Those who continue to increase for more than 12 days indicate complications. Urinary amylase increases later and lasts longer. Serum lipase increases 24 hours after onset.

　　2. Abdominal puncture
　　In cases of acute necrotizing pancreatitis, abdominal puncture often yields cloudy fluid, and fat droplets may be seen. In the presence of infection, it may present as purulent. Starchase in abdominal fluid is often increased, often higher than serum amylase, and lasts 2 to 4 days longer than serum amylase.

　　3. Abdominal plain film
　　Two-thirds of patients with acute pancreatitis can show abnormalities. Specific manifestations include increased pancreatic shadow, unclear edges, increased density, localized intestinal paralysis, and transverse colon截断征 (visible when lying down, where the liver flexure and spleen flexure of the colon are aerated, but the middle segment of the transverse colon has no air).

　　4. Chest Radiography
　　Radiography shows elevation of the left diaphragm, moderate amount of left pleural effusion, or atelectasis of the left lower lung.

　　5. Ultrasound Examination
　　It can be found that the pancreas is diffusely swollen and enlarged, the contour line is slightly arched, and the positive rate can reach 45% to 90%, and bile duct diseases can also be found.

　　6. CT Examination
　　Modern sensitive non-invasive diagnostic methods show abnormal findings in 70% to 90% of patients, such as focal or diffuse pancreatic enlargement, uneven density, irregular shape, fluid accumulation around the pancreas, etc.

　　Acute cholecystic pancreatitis patients should eat more foods rich in high-protein, vegetables, and fresh fruits. It is forbidden to eat high-cholesterol and high-fat foods such as animal internal organs, egg yolks, preserved eggs, chocolate, fatty meat, fried foods, cakes, pastries, fried dough sticks, and as well as spicy and刺激性 spices, tobacco, and alcohol.

　　The treatment of acute cholecystic pancreatitis includes non-surgical treatment and surgical treatment. The specific treatment methods are as follows:

　　1. Control Diet and Gastrointestinal Decompression
　　For those with mild symptoms, it is advisable to eat small amounts of light, fluid foods; when nausea, vomiting, and abdominal distension are obvious, gastrointestinal decompression is required.

　　2. Supportive Therapy
　　Ventricular electrolyte supplementation, maintenance of sufficient circulating blood volume, and sufficient and comprehensive nutrition supplementation are very important for improving the efficacy of the disease.

　　3. Application of Antibiotics
　　Mainly to inhibit the growth of intestinal bacteria, prevent and control secondary infection.

　　4. Antiproteinase Therapy
　　Measures to inhibit pancreatic secretion can be applied.

　　5. Surgical Treatment
　　The timing and method of surgery for this disease are currently controversial. The current trend is to perform delayed surgery after the patient's acute symptoms are relieved on the basis of active symptomatic and supportive therapy. Surgery is usually performed about 7 days after the acute attack. However, for those with uncertain diagnosis and progressive deterioration of the condition despite various supportive therapies, timely surgical treatment should be carried out. The method of surgery should be selected according to the different lesions of the bile duct. For the treatment of necrotic pancreas, procedures such as pancreatic drainage and partial pancreatectomy can be adopted.