RESUMO
Background: Acute pancreatitis though a self limiting in 80-90% of cases, but in 10-20% cases there is pancreatic necrosis, multi-organ failure & recurring pancreatic injury . A simple accurate, clinical scoring system BISAP (Bed side index for severity in acute pancreatitis) collected data within 24hrs of admission to hospital in predicting patients at risk for developing organ failure, persistent organ failure and pancreatic necrosis. Methods: A prospective study done at SCB MCH, from Aug.2016 to Sept.2018. All patients admitted to the hospital as acute pancreatitis are included in this study which is characterized by acute abdominal pain, increased level of serum amylase and/or lipase, USG/CT/MRI of abdomen and pelvis done within 7days of admission which shows findings consistent with features of acute pancreatitis. Each component of the BISAP scoring system was studied for each patient in first 24hrs & each component was awarded one point .Organ failure is defined as a score of ≥ 2 in one or >3 organ as originally described in Marshall score. Oragn – failure was described as transient (<48hrs) or persistent (>48hrs) from the time of admission. All the datas were collected & analysed for patients developing organ failure, persistent organ failure, pancreatic necrosis and death. Results: In our study, out of 108nos. of patients, 67(62.1%) were males & 41(37.9%) were females. Alcohol being the leading cause in 57(52.8%) followed by gall stone in 32(29.6%) cases & others in19(17.6%) cases. Patients with BISAP score ≥3 had developed organ failure in 10 (34.4%)cases and with BISAP score ≤ 3 in 6(7.6%) cases. Out of 16nos. organ failure cases 12 cases were transient organ failure & 4cases were persistent organ failure all with BISAP score ≥3. Pancreatic necrosis developed in 18nos of cases of which 11nos with BISAP score ≥3 & 7nos with score ≤ 3. Conclusion: The BISAP score is simple & accurate method for early identification of patients at increased risk of developing organ failure, persistent organ failure, pancreatic necrosis within 24hrs of admission to hospital.
RESUMO
Background: To study the effects of early enteral feeding in postoperative patients who have undergone elective abdominal surgeries by both open and laparoscopic method. Methods: Nasogastric tube was removed after patients recovered from anesthesia. Patients were started on a clear fluid diet, 30ml/hour at 24thhour, then 60ml/hour in the next 12 hours and full fluid diet within 48 hours, then semi-solid diet over next 24 hours. Patient who don’t tolerate oral diet, nasogastric tube was reinserted and managed with nil by mouth till the ileus was resolved. Patients were discharged only after they tolerated solid diet for at least 24 hours in intestinal groups and 12 hours in non-intestinal groups. Length of hospitalization or hospital stay was measured in terms of post-operative stay. Results: A total of 100 patients were selected for the study. Under both open (n=56) and laparoscopic surgery group (n=44), patients were categorized into those who underwent intestinal surgeries and those who underwent non-intestinal surgeries. Among open intestinal surgery group, total number of patients were (n=27) and among open non-intestinal surgery group, total number of patients were (n=29). Similarly, among laparoscopic intestinal surgery group, total number of patients were (n=10) and non-intestinal group, total number of patients were (n=34). The most common complication among all the groups was vomiting, 23% in open surgery group and 20% in laparoscopic surgery group. The incidence of nasogastric tube reinsertion among open surgery group was more (29%), among laparoscopic group was 25%. Among open surgery group, 71% patients who had complications, passed first stools within 5 days after operation whereas among laparoscopic surgery group, 73% patients with complications passed first stools within 3 days after surgery, signifying reduced duration of postoperative ileus with early oral feeding. 62% and 66% patients tolerated early oral feeding among open surgery group and laparoscopic surgery group respectively. The rate of early discharges were 77% for open intestinal surgery group patients and 83% for open non-intestinal surgery group patients. Similarly, the rate of early discharges were 80% among laparoscopic intestinal surgery group patients and 85% for laparoscopic non-intestinal surgery group patients. Conclusion: The result of this study suggests that early oral feeding is well tolerated and there is no merit in continuing to keep patients nil by mouth until bowel function is resumed. This study also shows that early oral feeding reduces the length of hospitalization. Significant percentage of patients in both groups had early resolution of bowel function and time to discharge was early. Furthermore, the duration of postoperative ileus was reduced in patients of both groups which led to early discharge. Thus in patients undergoing elective abdominal surgeries, both open and laparoscopic method, early postoperative feeding is well tolerated and reduces the length of hospitalization.