PDA

View Full Version : [Gastrointestinal] Acute Pancreatitis



TomHsiung
Thu 1st December '16, 8:08pm
Diagnostic Criteria
At least two of the following three diagnostic features:
1) Abdominal pain consistent with acute pancreatitis
2) Serum lipase or amylase levels that are at least 3 times the upper limit of the normal range
3) Findings of acute pancreatitis on cross-sectional imaging (CT or MRI)

Etiology
639

Classification
According to a recent international consensus, the classifications of moderately severe pancreatitis and severe pancreatitis are defined by the presence of complications that are systemic, local, or both.

1) Systemic complications: failure of an organ system (respiratory, cardiovascular, or renal), exacerbation of a preexisting disorder.
2) Local complications: peripancreatic fluid collections or pseudocysts and pancreatic or peripancreatic necrosis, whether sterile or infected.

In this classification system, the presence of both persistent organ failure and infected pancreatic necrosis ("critical" pancreatitis) is associated with the highest mortality.

Prediction of Severity
Prediction of severity has been accomplished through careful observation by an experienced clinician, with symptoms, signs, and the results of routine laboratory and radiographic testing taken into account. Besides, a host of predictors, including clinical and laboratory markers and various scoring systems, have been developed to improve clinical judgement.

Clinical factors that increase the risk of complications or death among patients with acute pancreatitis include

Advanced age (>=60 years)
Numerous and severe coexisting conditions (a score of >=2 on the Charlson comorbidity index)
Obesity (BMI >30)
Long-term, heavy alcohol use
Elevated blood urea nitrogen and creatinine levels and elevated hematocrit, particularly if they do not return to the normal range with fluid resuscitation

PS: The degree of elevation of the serum amylase or lipase level has no prognostic value.

Scoring systems

APPACHE II
APACHE combined with scoring for obesity (APACHE-O)
Glasgow scoring system
Harmless Acute Pancreatitis Score (HAPS)
PANC 3
the Japanese Severity Score (JSS)
Pancreatitis Outcome Prediction (POP)
the Bedside Index for Severity in Acute Pancreatitis (BISAP)


PS: However, these scoring systems all have a high false positive rate, which is an unavoidable consequence of the fact that in most patients, severe disease does not develop. The scoring systems are complex and cumbersome and not routinely used.