Correlation of clinical and imaging studies in assessing the severity in acute pancreatitis

Shankar, M R (2014) Correlation of clinical and imaging studies in assessing the severity in acute pancreatitis. Masters thesis, K.A.P. Viswanatham Government Medical College, Tiruchirappalli.

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Abstract

INTRODUCTION: Acute pancreatitis is an inflammatory disease of the pancreas that is associated with little or no fibrosis of the gland. The causes are many. Presentation of the disease varies from mild abdominal pain to shock, sepsis, multi organ failure or even death. The exact pathogenesis is not yet clearly understood. This may be due to relative inaccessibility to clinical experimental studies. The usual clinical scenario is a chronic alcoholic presenting with severe epigastric pain radiating to back with vomiting. Most of the patients have hyperamylesia. role of imaging with respect to ultrasound is limited. However, computerized tomography is very useful in diagnosing, assessing the severity and predicting the prognosis of acute pancreatitis. There are many prognostic indicators for acute pancreatitis namely Ranson’s criteria, Modified Glasgow’s criteria, APACHE score and Bedside Index of Severity in Acute Pancreatitis (BISAP). Many studies have been conducted using the above mentioned criterias. Our objective in this study is to combine both clinical (APACHE II) and imaging methods (Computerized tomography of abdomen) to assess the severity and predict the prognosis for acute pancreatitis. Though the APACHE II score is cumbersome to do, it can be done from the first day on a daily basis unlike Ranson’s criteria where there is a delay of 48 hours assessing the patient severity. AIM OF THE STUDY: 1. To assess the severity of acute pancreatits in K.A.P.V. Government Medical College, Trichy. 2. To analyse management and outcome of patients with acute pancreatitis in our hospital. MATERIALS AND METHODS: This is a prospective study of 50 patients admitted with features of Acute Pancreatitis in K.A.P.V. Govt. Medical college Hospital, Trichy from September 2011 to November 2013. This study includes the patients of Trichy district and adjacent districts of Karur, Dindigul and Namakkal who were admitted for acute pancreatitis. A proforma is attached to all the case sheets who were diagnosed as having Acute Pancreatitis. Serum amylase is taken as a routine in all suspected cases. All the data were entered in the proforma and the patients were followed till discharge or death. The details of signs and symptoms, diagnosis, complications and outcome of the patient were entered in the proforma and they were tabulated and analysed. All the data obtained was entered in the master chart and tabulated for comparison and reference. The observations were compared with the recent studies and literature available and conclusions were drawn. Eligibility Criteria: All patients admitted and diagnosed as having acute pancreatitis were analysed and considered for study. This was a prospective study undertaken in K.A.P.V. Government Medical College Hospital, Trichy from September 2011 to November 2013. Exclusion Criteria: 1. Chronic pancreatitis patients. 2. Acute exacerbation of chronic pancreatitis. CONCLUSION: In our study, the main etiologic factor was found to be alcohol. Acute pancreatitis is common in young and middle aged males. Mild pancreatitis as evidenced by CT score < 6and APACHE II score < 8 have better prognosis.. Oral diet is tolerated faster, sepsis is minimal and local complications are lesser. Severe pancreatitis as evidenced by CT scores > 6 and APACHE II score of > 8 have severe metabolic and electrolyte disturbances. Prognosis is guarded specially those who have acute respiratory distress syndrome and features of multi organ dysfunction syndrome. Acute fluid collection, pancreatic ascites, pancreatic effusion eventually subsided on their own. External pancreatic fistula, organized pancreatic necrosis and infected pancreatic necrosis were taken up for surgery (pancreatic necrosectomy and debridement of body and tail respectively). There is a significant correlation between APACHE score > 8, CT score > 6 and complications namely paralytic ileus, metabolic disturbances, acute fluid collection, pancreatic ascites, pancreatic effusion and acute respiratory distress syndrome.

Item Type: Thesis (Masters)
Uncontrolled Keywords: clinical and imaging ; severity ; acute pancreatitis.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 07 Jul 2018 03:31
Last Modified: 07 Jul 2018 03:31
URI: http://repository-tnmgrmu.ac.in/id/eprint/8697

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