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Background: Of all abdominal emergencies, pancreatitis is one of the most complicated and clinically dif?cult. The preferred imaging technique for determining the severity of acute pancreatitis and its consequences is computed tomography (CT). To evaluate the clinical outcome of acute pancreatitis and prognostic Aim: correlation based on the CT severity index. We included 30 patients with suspected acute pancreatitis Settings and Design: attending department of Radio Diagnosis, KVG medical college and hospital during the study period (January 2022 to May 2022). All the patients were evaluated by contrast enhanced CT. The severity of pancreatitis was scored using CT severity index (Balthazar), modi?ed severity index (Mortele) and revised Atlanta classi?cation and the cases were classi?ed into mild, moderate and severe. The outcome parameters studied were Length of hospital stay, Need for surgery or percutaneous intervention, incidence of infection or organ failure and death. The age group of patients was 16 to 69 years with Results: maximum patients (36%) between 25 and 35 years. Majority were males (81%). According to Modi?ed CT Severity Index, 15% patients had mild, 42% patients had moderate and 43% had severe pancreatitis. Majority of the cases (44%) were categorized as severe pancreatitis according modi?ed Mortele CT score. Majority of the cases were categorized as mild pancreatitis according Balthazar CTSI score and revised Atlanta classi?cation. 38% patients are considered to have end organ failure. Hepatic failure is the most common system failure seen in 22% patients. 36% patients had evidence of systemic infection. 10% patients required surgical interventions. The score is simpler to calculate and the inter-observer variability is Conclusions: decreased using the modi?ed CT severity index.
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Objective To investigate the dynamic change of fatty liver (FL) in patients with fatty liver-related acute pancreatitis (FLAP) and related influencing factors. Methods A total of 136 FLAP patients who were admitted to The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, from December 2017 to December 2021 were enrolled as subjects. With the first CT examination after admission as the starting point and the last CT examination before discharge as the ending point, the subjects were divided into FL aggravation group (FLAG group), FL mild mitigation group (FLMMG group), and FL significant mitigation group (FLSMG group) according to the degree of change in FL. General information and clinical data were compared between groups. General information included age, sex, length of hospital stay, etiology of acute pancreatitis (AP), and changes in body weight and temperature, and clinical data included treatment modality and the changes in laboratory markers and AP severity. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t -test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Mann-Whitney U test with Bonferroni correction was used for further comparison between two groups. Dynamic changes of data were expressed as the difference from the starting point to the ending point, and a covariance analysis was used for comparison of data with dynamic changes. The Spearman correlation analysis was used to investigate the correlation of indices with significant changes with the degree of change in FL. Results Among the 136 FLAP patients, 61 achieved mild mitigation of FL, 59 achieved significant mitigation of FL, and 16 experienced aggravation of FL at the ending point of the study. There were significant differences between the three groups in the length of hospital stay ( χ 2 =16.215, P < 0.001) and the change in body weight ( F =3.908, P < 0.05), and the FLSMG group had a greater reduction in body weight and a longer length of hospital stay. There were also significant differences between the three groups in the number of fasting days ( χ 2 =11.020, P =0.004) and the degree of changes in C-reactive protein (CRP) ( F =8.589, P < 0.001), white blood cell count (WBC) ( F =5.448, P =0.005), and CT severity index (CTSI) ( F =7.544, P =0.001), and the FLSMG group had greater reductions in CRP, WBC, and CTSI and a longer duration of fasting. Length of hospital stay, number of fasting days, and changes in CRP and CTSI were significantly correlated with the change in FL ( r =0.352, 0.372, -0.365, and -0.350, all P < 0.001). Conclusion Most FLAP patients tend to have mitigation of FL, and its dynamic changes are closely associated with the changes in CRP and CTSI.
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Background: Acute biliary pancreatitis (ABP) is one of the most serious complications of gall stone disease with a high risk of morbidity and mortality. Hence accurate diagnosis and prompt management of ABP is very crucial. Different management strategies exist regarding indications and timing for interventions, endoscopic retrograde cholangio-pancreaticography (ERCP) and cholecystectomy.Methods: Ours is a prospective observational study of the different clinical presentations and management strategies and their respective outcomes in our hospital. All cases of ABP admitted over a period of one year were included in the study. The clinical presentation, severity and course of the disease, imaging studies, duration of ICU and hospital stay and timing of ERCP and cholecystectomy were studied.Results: A total of 56 cases were included in the study. Average age was 45 years. Pain abdomen was the most common symptom at presentation. About 82% patients had mild to moderate disease while the rest had severe disease. The mean duration of intensive care unit stay was 8 days. ERCP was done in 6 cases. Cholecystectomy during the same admission was dine in 20 cases. There were 2 deaths during the course of the study.Conclusions: Early intervention definitely reduces morbidity, mortality and recurrent admissions in cases of acute biliary pancreatitis. Same admission laparoscopic cholecystectomy is preferable in mild ABP. All cases of severe ABP must undergo early ERCP irrespective of biliary obstruction. This also helps in reducing readmissions due to pancreatic-biliary complications and is cost-effective.
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Background: Acute pancreatitis is an acute abdominal emergency condition that need immediate hospital stay and intensive care. In 80% of cases it runs a mild course and rest of the patients have severe pancreatitis. It's severity is assessed by using Ranson's scoring system and Modified CT severity index. This study was carried out to evaluate role of Ranson's scoring system and modified CT severity index in assessing severity of acute pancreatitis. Methods: - This is a prospective observational study which is conducted on patients with acute pancreatitis admitted in Department of Surgery, Geetanjali Medical College and Hospital, Udaipur. 30 patients of acute pancreatitis enrolled. Ranson's criteria and modified CT severity index apply to all of them. Results: Out of 30 patients, 20 patients have mild pancreatitis. 4 patients have moderate pancreatitis. 6 patients have severe pancreatitis. Conclusion: We conclude that Ranson's criteria and modified CT severity index have significant role in predicting the severity of acute pancreatitis and the chances of developing complications as regards morbidity and mortality.
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Background: Acute pancreatitis is a common condition with wide clinical variation, ranging from mild self-limiting pancreatic inflammation to extensive pancreatic necrosis with life-threatening consequences. The present study aimed to assess the clinical profile of acute pancreatitis in Malwa region of Punjab where there increased prevalence of alcoholism and gall stone disease and to assess the efficacy of Ranson’s score and Balthazar Computed tomography severity index (CTSI) in predicting the prognosis. Materials and methods: 50 patients with proven acute pancreatitis were included and data was collected to study their clinical, laboratory and radiologic profile to obtain prognostic indices Ranson’s score and CTSI which were then compared with outcome. Results: Mean age recorded was 43.40 ±12.004 years with a range of 19-64 years and male to female ratio 2.12:1. 62% of patients had alcohol induced pancreatitis and 32% had gall stone pancreatitis. Observed morbidity rate was 44% and mortality rate was 6%. Most common complications encountered were pleural effusion (18%), Hypocalcemia (20%) and sterile pancreatic necrosis (20%). 18 patients had Ranson’s score more than 3, whereas 11 patients had CTSI more than 7 indicating severe acute pancreatitis. On correlation Ranson’s score was found to be more sensitive while CTSI was more specific for an adverse outcome. Conclusion: Severe acute pancreatitis remains a significant cause of morbidity and mortality due to increased prevalence both alcoholism and gall stone disease in Malwa region of Punjab. In our setup Ranson’s score and CTSI when used in combination showed improved sensitivity for detection severe acute pancreatitis.
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Objective To explore the four criteria,including bedside index for severity in acute pancreatitis(BISAP),Ranson score,modified CT severity index(MCTSI) and acute physiology and chronic health evaluation scoring system Ⅱ (APACHE Ⅱ) in assessment of severity and prognosis of hyperlipidemic acute pancreatitis.Methods A total of 326 patients with hyperlipidemic acute pancreatitis were studied retrospectively from August 2006 to July 2015.The discrepancy of the four criteria in assessment of severity and prognosis of hyperlipidemic acute pancreatitis was compared with chi-square test and receiver operating characteristic curve.Results The incidences of moderately severe acute pancreatitis and severe acute pancreatitis,local complications and mortality of patients with BISAP score ≥3,Ranson score ≥3,APACHE Ⅱ score≥8 and MCTSI score≥4 were significantly higher than BISAP score ＜ 3,Ranson score ＜ 3,APACHE Ⅱ score ＜ 8 and MCTSI ＜ 4 respectively (all P ＜ 0.05).As far as severity was concerned,the sensitivity and AUC of APACHE Ⅱ were 57％ and 0.814,which were higher than the other systems.The second most sensitive criterion was BISAP.In assessment of local complications,the sensitivity and AUC of MCTSI were 68％ and 0.791,which were higher than the other three.The most sensitive criterion to predict mortality was BISAP with sensitivity 89％ and AUC 0.867,which was followed by APACHE Ⅱ.Conclusions All four criteria can be used to determine the severity,local complications and mortality.Generally,BISAP is simple and easy to practice,and better than the other three.
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Objective To study the change of serum diamine oxidase (DAO) level in patients with severely acute pancreatitis (SAP) in order to explore the role of DAO in assessing the severity of SAP and the magnitude of gastrointestinal dysfunction.Methods From January 2012 through December 2013,56 SAP patients with 33 male and 23 female and average age (45-± 14) years admitted within 3 days after onset were enrolled for this study.At admission,serum diamine oxidase (DAO) was detected,and APACHE Ⅱ score,computed tomography severity index (CTSI) score and Balthazar grading and gastrointestinal dysfunction score were calculated.And at the corresponding time,serum procalcitonin (PCT) was detected.The correlations between serum DAO level and 4 other markers were analyzed.Results The high level of serum DAO was found at admission in SAP patients correlating positively with serum PCT concentrations (r =0.516,P＜ 0.01),APACHE Ⅱ score (r =0.631,P＜ 0.01),CTIS score (r=0.640,P ＜ 0.01),and the degree of gastrointestinal dysfunction (r =0.730,P ＜ 0.01).Conclusions The role of serum DAO in assessing the severity of SAP and magnitude of gastrointestinal dysfunction in SAP patients is really valid.
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Objective To investigate the prognostic value of CD 4+CD25+/high CD127 low/-and CD14+HLA-DRlow/-for evaluating the severity of acute pancreatitis .Methods The percentages of CD4+CD25+/highCD127low/-and CD14+HLA-DRlow/-and the CD64 index were measured by flow cytometry in pa-tients with acute pancreatitis ( including 43 cases of mild acute pancreatitis and 24 cases of severe acute pan-creatitis).Moreover, the levels of C-reactive protein (CRP), acute physiology and chronic health evaluationⅡ( APACHEⅡ) score and CT severity index ( CTSI ) were detected for a correlation analysis .Results The percentages of CD4+CD25+/highCD127low/-and CD14+HLA-DRlow/-and the CD64 index in patients with severe and mild acute pancreatitis were significantly higher than those in healthy subjects .Patients with se-vere acute pancreatitis showed higher percentages of CD 14+HLA-DRlow/-than patients with mild acute pan-creatitis.With the disease progression, the CD64 index and the levels of CD4+CD25+/highCD127low/-, CD14+HLA-DRlow/-and CRP were significantly dropped after an initial increase in patients with mild acute pancrea -titis, while these indexes were continuously elevated in patients with severe acute pancreatitis .The percent-age of CD14+HLA-DRlow/-was positively correlated with CD64 index, CRP level, APACHEⅡ score and CTSI.Conclusion CD14+HLA-DRlow/-level was closely related to the severity of acute pancreatitis , which could be used as immune parameter for the estimation of the clinical severity of acute pancreatitis .
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PURPOSE: The progression of mortality of acute pancreatitis occurs in two different phases. One occurs earlier in the course of the disease and results from systemic complications such as renal failure and ARDS. Another occurs later and results from local complications such as a pancreatic abscess, an infected phlegmon or a pseudocyst. The values of the Ranson score, the Glasgow (Imrie) score, the Acute Physiology and the Chronic Health Evaluation (APACHE II) score and computerized tomography severity index (CTSI) of Balthazar were compared in an evaluation and monitoring of acute pancreatitis, in which we mainly predicted the occurrence of systemic and local complications of the attacks in 31 patients. METHODS: Between January 1997 and December 1999, 31 patients who had a clinical diagnosis of acute pancreatitis which was supported by the presence of a serum amylase that exceeded 200 IU/L and the presenting clinical symptoms were included in this study. We reviewed their medical records and their abdominal CT imaging scans. We calculated the CTSI based on the CT imaging findings with the assistance of a radiologist. RESULTS: Among the 31 patients, systemic complications had developed in 10 patients and local complications had occurred in 12 patients. In all of the scoring systems including the CTSI, the mean scores of the group who had systemiccomplications were higher than the group with no complication. The accuracy of the Glasgow score (>or=4) and the APACHE II score (48 hours after admission, >or=10) was greater than that of the others. However, only the CTSI was accurately predicted the occurrence of local complications. CONCLUSION: These results suggest that CTSI should be considered as being a predicting factor when it is combined with multiple scoring systems such as the Ranson score, the Glasgow score or the APACHE II score in order to obtain accurate prediction of the prognosis and the mortality rate in acute pancreatitis.