Acute Pancreatitis Lecture Notes PDF

Acute Pancreatitis Ass.Prof.Dr. Burak Kankaya Istanbul Aydin University Department of General Surgery  Non-bacterial inflammation of the pancreas, activation of the gland by its own enzymes, interstitial release and consequent damage to the gland 5-10/100000 in Western c...

Acute Pancreatitis Ass.Prof.Dr. Burak Kankaya Istanbul Aydin University Department of General Surgery  Non-bacterial inflammation of the pancreas, activation of the gland by its own enzymes, interstitial release and consequent damage to the gland 5-10/100000 in Western countries 20% severe Etiologies Loading…  Diagnosis Sudden onset, severe epigastric pain radiating to the back, Nausea and vomiting, Tachycardia-postural hypotension, Normal or slightly elevated fever  Diagnosis Distension or generalized tenderness Decreased bowel sounds Mass due to pancreatic phlegmon, abscess or pseudocyst Loading… Gray Turner and Cullen signs (retroperitoneal bleeding) Cullen Sign  Enzyme elevation (3-fold or more increase in amylase) and laboratory tests Amylase 40% pancreatic, 60% salivary gland origin Pancreatic isoamylase is more specific It is also increased in acute cholecystitis, duodenal ulcer perforation, intestinal obstruction, mumps, cirrhosis, diabetic ketoacidosis, abdominal surgery, acute appendicitis, mesenteric ischemia, CRF and MI.  Lipase (more specific, less sensitive) Leukocytosis Hematocrit ALT, AST, ALP, GGT, Bilirubin… Trypsinogen, elastase reflect pancreatic damage more sensitively and specifically than amylase.  Radiological examinations PA Lung X-ray Abdominal X-ray CT USG EUS, ERCP, MRCP, MR  Management of Acute Pancreatitis Diagnosis (abdominal pain, enzyme elevation (>3x), CT if necessary) Pain management (narcotics if necessary, Loading… except morphine) Fluid resuscitation Prognostic assessment and evaluation of systemic response  Here’s a detailed explanation of each scoring system related to acute pancreatitis and critical illness: 3. HAPS (Harmless Acute Pancreatitis Score): 1. Ranson Criteria: Purpose: Identifies mild cases of acute pancreatitis early. Parameters: Purpose: Predicts the severity and mortality of acute pancreatitis, especially in cases caused by alcohol. 1. Absence of peritonitis (no rebound tenderness) 2. Normal hematocrit (no hemoconcentration) Parameters: 3. Normal serum creatinine ( 55 years 4. SIRS (Systemic Inflammatory Response Syndrome): 2. White blood cell count > 16,000/mm³ Purpose: Detects inflammation that may lead to sepsis. 3. Blood glucose > 200 mg/dL Parameters: Must meet at least 2 of 4 criteria: 1. Temperature < 36°C (96.8°F) or > 38°C (100.4°F) 4. Serum LDH > 350 IU/L 2. Heart rate > 90 beats/min 5. AST > 250 IU/L 3. Respiratory rate > 20 breaths/min or PaCO₂ < 32 mmHg 4. White blood cell count < 4,000/mm³ or > 12,000/mm³, or >10% immature (band) forms Measured within 48 hours: Significance: Presence of SIRS with an infection indicates sepsis, which can complicate pancreatitis. 1. Hematocrit drop > 10% Ranson criteria 5. SOFA (Sequential Organ Failure Assessment): 2. Blood urea nitrogen (BUN) rise > 5 mg/dL 3. Serum calcium < 8 mg/dL Purpose: Assesses organ dysfunction in critically ill patients, including those with acute pancreatitis. Parameters: Evaluates 6 organ systems: 4. Base deficit > 4 mEq/L 1. Respiratory: PaO₂/FiO₂ ratio 5. Fluid sequestration > 6 liters 2. Coagulation: Platelet count 3. Liver: Bilirubin levels 6. Partial pressure of oxygen (PaO₂) < 60 mmHg APACHE II 4. Cardiovascular: Hypotension, need for vasopressors Scoring: The more criteria met, the higher the severity. Mortality increases significantly with a score ≥3. 5. Central Nervous System: Glasgow Coma Scale (GCS) 6. Renal: Serum creatinine or urine output Scoring: Higher scores correlate with greater organ dysfunction and higher mortality risk. 2. APACHE II (Acute Physiology and Chronic Health Evaluation II): 6. BISAP (Bedside Index for Severity in Acute Pancreatitis): Purpose: Assesses the severity of general critical illness, including acute pancreatitis. Purpose: Early predictor of severity and mortality in acute pancreatitis. HAPS score Parameters: 12 physiological variables like: Parameters: 1. B: BUN > 25 mg/dL 1. Body temperature 2. I: Impaired mental status (GCS < 15) 2. Mean arterial pressure 3. S: SIRS present 4. A: Age > 60 years 3. Heart rate 5. P: Presence of pleural effusion 4. Respiratory rate Scoring: Score of 0-5. A score ≥3 is associated with higher risk of complications or death. SIRS 5. Oxygenation (PaO₂ or A-a gradient) 7. CTSI (Computed Tomography Severity Index for Acute Pancreatitis): 6. pH Purpose: Uses CT imaging to assess the severity of acute pancreatitis. 7. Serum sodium and potassium Parameters: 8. Creatinine 1. Extent of pancreatic inflammation (mild to severe). 2. Presence of pancreatic necrosis (none, 50%). 9. Hematocrit 3. Presence of fluid collections or other complications. SOFA 10. White blood cell count Scoring: Higher scores correlate with more severe disease and worse outcomes. Score is calculated by adding scores from pancreatic inflammation (0–4 points) and necrosis (0–6 points), for a Also includes patient’s age and any chronic health conditions. total possible score of 10. Scoring: A higher score (max 71) indicates more severe illness and higher mortality risk. These scoring systems help clinicians predict prognosis, guide treatment, and monitor patient progress in cases of acute pancreatitis and critical illness. Each has its specific use depending on the situation or desired assessment focus. Bedside Index for Severity of Acute Pancreatitis (BISAP) Computed Tomography Severity Index for Acute Pancreatitis (CTSI)  Urine output CRP Nutrition Antibiotics Determination of etiology