35-year-old Wang Ping (pseudonym) had a late-night snack with a friend last weekend. Unexpectedly, he developed severe abdominal pain at 4:00 in the morning. He was rushed to the hospital by 120 for emergency treatment. It was more than 40 times the normal value, and combined with other tests, it was diagnosed as “acute lipogenic pancreatitis”.
It is understood that Wang Ping is an IT man. He is usually very busy with his work. He often works overtime until eleven or twelve at night, and likes to have supper after get off work. Last weekend, Wang Ping got together with three or five friends again, and the barbecue crayfish beer disappeared, and he drank happily until midnight. After the dinner, Xiao Wang took a taxi home and went to sleep. At 4:00 in the morning, Wang Ping felt abdominal pain and nausea. After vomiting, the abdominal pain became more severe, and the whole body was dripping with cold sweats. Seeing this, his family immediately called 120 and sent Wang Ping to Changsha Central Hospital (Changsha Center Affiliated to South China University). hospital) emergency department.
The attending physician Zeng Zhao immediately asked about his medical history, and learned that the patient had suffered from acute pancreatitis a few years ago, and he stopped taking it after he recovered. Rapid breathing, obvious upper abdominal tenderness, combined with a history of eating greasy food and drinking alcohol, highly suspected acute pancreatitis, immediately complete blood test and abdominal CT examination. When the nurse in the emergency department drew blood, they found a chyle-like white oil-like substance floating on the blood collection tube. The doctor highly suspected that the patient had lipogenic pancreatitis. ”: Triglyceride was as high as 73.45mmmol/l (normal value: 0.55-1.7mmol/l), more than 40 times higher than the normal value. Combined with abdominal CT results, the previous judgment was confirmed.
△Blood lipids separated by bedside plasma exchange
Due to his serious condition, Wang Ping was immediately sent to the emergency intensive care unit (EICU) received inpatient observation and treatment, in addition to basic anti-infection, inhibition of pancreatic enzymes, analgesia, fluid replacement and other symptomatic treatment, the medical team also gave plasma exchange treatment for the high blood lipids that exploded. The chyle plasma is separated and replaced with normal plasma, thereby rapidly reducing the content of triglycerides in the blood and achieving the purpose of treating the primary disease. After plasma exchange treatment, the triglyceride content in the patient’s blood was significantly decreased, and the symptoms of abdominal pain were significantly relieved. After 2 days, the patient’s condition was stable, and he was transferred to the emergency observation ward for further treatment.
Acute pancreatitis is an inflammatory reaction of pancreatic tissue autodigestion, edema, hemorrhage and even necrosis caused by the activation of pancreatic enzymes in the pancreas due to various causes. Clinically, it is characterized by acute epigastric pain, nausea, vomiting and increased blood pancreatic enzymes. Mild cases are dominated by pancreatic edema, and a few severe cases have pancreatic hemorrhage and necrosis, often secondary to infection, peritonitis, and shock. Although the current medical level is relatively high, the mortality rate of acute severe pancreatitis is still as high as 15% to 20%. The etiology is mainly related to overeating, biliary disease, hyperlipidemia, etc. Trauma, surgery, etc. can also induce the disease.
“The stimulation of overeating and alcohol will increase the secretion of gastric acid and duodenal secretin, which in turn promotes the increase of pancreatic juice secretion, resulting in increased pressure in the pancreatic duct. In severe cases, it can lead to small pancreatic ducts and glands. The bubble bursts, releasing endogenous active substances, activating trypsinogen, etc., which causes hemorrhage and necrosis of pancreatic tissue.” Li Changluo reminded that the May 1st holiday is coming, and it is inevitable for relatives and friends to gather together with food and wine. Regular, avoid overeating, alcoholism and excessive stress, fatigue. If you have severe abdominal pain, vomiting, abdominal distension, fever and other symptoms after eating, don’t just treat it as stomach pain, just take some medicine and deal with it, you should go to the hospital in time to make a clear diagnosis, so as not to delay the treatment.
Xiaoxiang Morning News reporter Mei Mei correspondent Li Keng Zhu Wenqing
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