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Acute Pancreatitis not forget to assess the severity every time

Updated: Jan 23

Acute Pancreatitis is a condition characterized by inflammation of the pancreas. It can range from mild to severe, potentially leading to life-threatening complications. "When writing a report on Acute Pancreatitis, do not forget to assess the severity every time. It is crucial because if it is severe, it can be life-threatening."

Diagnostic Criteria for Acute Pancreatitis:

Clinical Presentation:

  • Abdominal Pain: Typically, the pain is in the upper abdomen and may radiate to the back. It is often severe and persistent.

  • Nausea and Vomiting: Frequently accompanying the abdominal pain.

Laboratory Tests:

  • Serum Amylase and Lipase: Levels more than three times the upper limit of normal are highly suggestive of acute pancreatitis.

  • Liver Function Tests: May show abnormalities, especially in gallstone pancreatitis.

Imaging:

  • Abdominal Ultrasound or CT Scan: These can reveal gallstones, pancreatic swelling, and other changes indicative of pancreatitis.

Two of these three features (abdominal pain consistent with the disease, elevated enzyme levels, and radiologic findings) are generally required for diagnosis.

Premature Activation of Pancreatic Enzymes:

  • Normally, pancreatic enzymes are activated in the small intestine. In pancreatitis, these enzymes (like trypsin) become activated within the pancreas itself, leading to autodigestion and inflammation.

Inflammatory Response:

  • The activation of enzymes triggers an inflammatory response. This results in edema, necrosis, and hemorrhage within the pancreas.

Etiological Factors:

  • Gallstones and Alcohol: These are two common causes. Gallstones can block the pancreatic duct, while alcohol can directly induce pancreatic injury.

  • Hypertriglyceridemia, Medications, and Infections: Less common causes that can lead to the development of pancreatitis.

Hypertriglyceridemia and Acute Pancreatitis:

Alcohol and Acute Pancreatitis:


Local and Systemic Complications:

  • Locally, pancreatitis can lead to cyst formation, necrosis, or pseudocysts. Systemically, it can result in systemic inflammatory response syndrome (SIRS) and multi-organ failure.

Resolution or Progression:

  • In mild cases, the inflammation may resolve without significant damage. In severe cases, ongoing inflammation can lead to chronic pancreatitis or irreversible damage.

 

Atlanta Criteria for Severity of Acute Pancreatitis:

The Atlanta classification categorizes acute pancreatitis into three categories based on clinical presentation, laboratory findings, and imaging results:

Mild Acute Pancreatitis

Moderately Severe Acute Pancreatitis

Severe Acute Pancreatitis

Absence of organ failure.

Transient organ failure: Organ failure that resolves within 48 hours.

Persistent organ failure: Organ failure that lasts for more than 48 hours.

Absence of local or systemic complications.

Local complications such as pancreatic necrosis, pseudocyst, or acute fluid collections.

It may involve one or more organ systems (respiratory, cardiovascular, renal).


Usually self-limiting, patients recover without specific interventions other than supportive care.

Systemic complications may occur but are less severe than acute pancreatitis.

High risk of mortality and requires intensive care management.

Local Complications Include:

  • Acute Peripancreatic Fluid Collection (APFC): Occurs early in the disease, often resolving spontaneously.

  • Pancreatic Pseudocyst: Encapsulated fluid collection with a well-defined wall, usually developing after 4 weeks.

  • Acute Necrotic Collection (ANC): Occurs within the first 4 weeks, containing both fluid and necrotic tissue.

  • Walled-off Necrosis (WON): Mature, encapsulated collection of pancreatic and/or peripancreatic necrosis that has developed a well-defined inflammatory wall.

Systemic Complications:

  • These can include systemic inflammatory response syndrome (SIRS), respiratory distress syndrome, renal failure, and other organ dysfunctions.

SIRS Criteria

Organ Failure Assessment:

  • The Modified Marshall Scoring System can be used to assess the severity of organ failure. It evaluates respiratory, cardiovascular, and renal systems.


BISAP Score:

The BISAP score is a more straightforward tool for early mortality risk prediction in the first 24 hours of hospital admission for acute pancreatitis. It includes five parameters:

  1. B: BUN (Blood Urea Nitrogen) > 25 mg/dL.

  2. I: Impaired Mental Status.

  3. S: Systemic Inflammatory Response Syndrome (SIRS) criteria.

  4. A: Age > 60 years.

  5. P: Pleural Effusion on imaging.

Each positive parameter scores one point, with a maximum score of 5. A higher BISAP score indicates a higher risk of mortality.

Comparison:

 

How we might write medical orders for managing each category

Management of Mild Acute Pancreatitis

Management of Moderately Severe Acute Pancreatitis:

Management of Severe Acute Pancreatitis:

 

Chronic Pancreatitis Cutoff Time six months


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