Rajkumar, S (2020) A Study on Evaluation of Intraabdominal Pressure in Acute Pancreatitis. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Acute Pancreatitis is a multi-system disease with an unpredictable course that surgeons are faced with great difficulty to treat. Due to the significant advances in technology, we have learned much about the pathophysiology and natural course of this disease. Conservative treatment still remains the main modality of treatment, while a subset of patients may require surgical intervention. AIM AND OBJECTIVE: Evaluation of intra-abdominal pressure by intra vesical method as a marker of severity in acute pancreatitis and its complications. METHODS: During the time period, 50 patients admitted in the Department of General surgery with a diagnosis of acute pancreatitis were included in the prospective study. Patient demographics, vital parameters, Laboratory investigations, blood gas analysis, APACHE score, Balthazar score were recorded. Intra – abdominal pressure monitoring was done by the intra vesical route, done by catheterization of the urinary bladder using Foley’s attached to a three way stopcock in turn connected to a water manometer every 8th hourly. RESULTS: Patients with intra-abdominal hypertension on admission had a 19% mortality ratio. In this study, male preponderance (84%) compared to female (16%) was observed. etiology of acute pancreatitis was attribute to primarily to alcohol (74%). Gallstone disease (12%), idiopathic (12%) and drug (2%). Out of the 23 patients diagnosed with increased Balthazar score, 18 patients (78%) had intraabdominal hypertension on admission and 12 patients (52%) developed complication of disease. Mean IAP measurement of the survivors was 8.65 mmHg (range from 4.13 to 15.18mm Hg). Non – survivors had a higher IAP mean value of 16.14 mm Hg (range 9.9 to 20mm Hg). Mann Whitney U test showed that IAP had a significant value of 23.16 (p<0.05). Correlation studies between IAP and ICU stay was highly significant (p<0.05).Correlation studies between IAP with clinical severity of the patients showed that higher the IAP, greater is the severity of illness (r value – 0.91) CONCLUSION: This study showed that mortality rates were higher within the first week of illness which is supported by a Scottish study in which the authors conclude that 40-60 % of all acute pancreatitis deaths occurred with the first week. Isenmann et al concluded that patients with acute severe pancreatitis with development of necrosis have a mortality of 40% on day 1. This study corroborates with similar findings that significantly greater day I IAP was seen in non-survivors compared to survivors. The results of this study demonstrate that IAP is a good predictor of mortality and organ failure in acute pancreatitis and correlates well with other validated prognostic scores Measurement of IAP is an easy, effective and inexpensive method. In conclusion IAP serves as a good prognostic marker in acute pancreatitis.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711064 |
| Uncontrolled Keywords: | Evaluation, Intraabdominal Pressure, Acute Pancreatitis. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 09 Feb 2021 01:58 |
| Last Modified: | 09 Feb 2021 01:58 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13952 |
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