Prospective study on haematological and coagulation changes in acute pancreatitis.

Shafique, A (2013) Prospective study on haematological and coagulation changes in acute pancreatitis. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Acute pancreatitis was defined in the Atlanta symposium as an acute inflammatory process involving the pancreas that further involve peripancreatic tissues and organs remote from the pancreas. Criteria had been defined for severity which include organ failure (Pulmonary insufficiency, shock and renal failure) and /or complications involving locally which include pseudocyst. pancreatic necrosis and pancreatic abscess. The diagnosis of the disease requires 2 out of the following 3 features: 1) Abdominal pain characteristic of acute pancreatitis. 2) serum amylase and /or lipase which is _ 3 times the upper limit of normal and 3) characteristics findings in Imaging ( USG/CT scan).The severity of acute pancreatitis does not correlate with the rise in level of serum lipase and amylase.Risk factors of severity of acute pancreatitis at admission include older age,obesity and organ failure. Tests at admission which distinguish mild from severe acute pancreatitis include APACHE-11 score(_8-suggestive of severe AP) and serum haematocrit ( <44 suggests mild acute pancreatitis). A high CRP level measured within 72hours correlates with formation of pancreatic necrosis. Pancreatic necrosis and persistent organ failure were the most important factors responsible for severity in acute pancreatitis. The most important investigation to distinguish interstitial from necrotizing type of acute pancreatitis is CECT abdomen and it is more sensitive and specific especially if taken 2-3 days after the onset of illness. Mortality rate increases to >40% when the multisystem organ failure coexistent with necrotizing type of acute pancreatitis. AIM OF THE STUDY : To Study the Haematological and coagulation changes prospectively in patients with acute pancreatitis and correlating the changes to its severity. CONCLUSION : The study titled Prospective study on haematological and coagulation changes in acute pancreatitis was conducted in 50 patients in Madras Medical college and Rajiv Gandhi Government general hospital, Chennai and following conclusions were made. 1. Haematological and coagulation abnormalities were more common in severe acute pancreatitis. 2. Though evidence of full blown Disseminated Intravascular Coagulation is seen in few patients, the cases which were impending Disseminated Intravascular Coagulation and cases which have high potential to develop Disseminated Intravascular Coagulation were recognised and could be managed effectively. 3. The difference between variables comparing haematological and coagulation indices with severity of pancreatitis were not statistically significant except for the increase in FDP value which was statistically significant . 4. Therapeutic regimens like Activated protein C, Anti thrombin 111, Platelet activating factor modulating agents, Factor V11a inhibitors could be tried in near future to improve the clinical outcome of patients with severe coagulatory disturbance in acute pancreatitis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: haematological ; coagulation ; acute pancreatitis ; Prospective study.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:11
Last Modified: 13 Jul 2017 04:11

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