Sunday, 7 February 2016

ACUTE PANCREATITIS

RansonRanson’s Criteria on Admission :
age greater than 55 years
a white blood cell count of > 16,000/µL
blood glucose > 11 mmol/L (>200 mg/dL)
serum LDH > 350 IU/L
serum AST >250 IU/L

Ranson’s Criteria after 48 hours of admission :
fall in hematocrit by more than 10 percent
fluid sequestration of > 6 L
hypocalcemia (serum calcium < 2.0 mmol/L (<8.0 mg/dL))
hypoxemia (PO2 < 60 mmHg)
increase in BUN to >1.98 mmol/L (>5 mg/dL) after IV fluid hydration base deficit of >4 mmol/L

The prognostic implications of Ranson’s criteria are as follows :
Score 0 to 2 : 2% mortality
Score 3 to 4 : 15% mortality
Score 5 to 6 : 40% mortality
Score 7 to 8 : 100% mortality

APACHE
“Acute Physiology And Chronic Health Evaluation” (APACHE II) score > 8
points predicts 11% to 18% mortality
Hemorrhagic peritoneal fluid
Obesity
Indicators of organ failure
Hypotension (SBP <90 mmHG) or tachycardia > 130 beat/min
PO2 <60 mmHg
Oliguria (<50 mL/h) or increasing BUN and creatinine
Serum calcium < 1.90 mmol/L (<8.0 mg/dL) or serum albumin <33 g/L
(♥.2.g/dL)>

Balthazar Scoring for the Grading of Acute Pancreatitis
Grade A – normal CT
Grade B – focal or diffuse enlargement of the pancreas
Grade C – pancreatic gland abnormalities and peripancreatic inflammation
Grade D – fluid collection in a single location
Grade E – two or more collections and/or gas bubbles in or adjacent to pancreas

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