gastrointestinal disorders
Acute Pancreatitis
Prognosis for Acute Pancreatitis
The severity of acute pancreatitis is determined by the presence of organ failure, local and systemic complications, or a combination. Using patient-related risk factors to assess severity early in the course of disease can help identify patients at increased risk of developing organ dysfunction and other complications. These patients can then be given maximal supportive therapy at presentation to improve outcomes and decrease morbidity and mortality. Forinitial risk assessment,patient-related risk factors that predict a severe course include the following: Age ≥ 60 years Comorbid health problems Obesity with body mass index > 30 Long-term, heavy alcohol use Presence of systemic inflammatory response syndrome (SIRS) Laboratory markers of hypovolemia (eg, elevated BUN, elevated hematocrit) Presence of pleural effusions and/or infiltrates on admission chest x-ray Altered mental status Severity scoring systemsrequire multiple measurements and may delay appropriate management. Some of these can be done at admission to assist in triage of patients, whereas others are not accurate until 48 to 72 hours after presentation. Ranson criteria: This scoring system is cumbersome and requires data from a 48-hour period to compute but has good negative predictive value. The Critical Care Scoring Systems : This system is complex and cumbersome to use but has good negative predictive value. Systemic inflammatory response syndrome score: This is inexpensive, readily available, and can be applied at the bedside. Bedside index of severity in acute pancreatitis (BISAP) score: This score is simple and calculated during the first 24 hours. Harmless acute pancreatitis score: This simple score is calculated within 30 minutes of admission. Organ failure–based scores: These scores do not directly measure the severity of acute pancreatitis. CT severity index (Balthazar score): This score is based on the degree of necrosis, inflammation, and the presence of fluid collections on CT. The long-term risks after acute pancreatitis include the risks of recurrent attacks and development of Chronic Pancreatitis . Risk factors include the severity and amount of pancreatic necrosis in the initial episode of acute pancreatitis as well as the etiology; long-term, heavy alcohol use and cigarette smoking increase the risk of developing chronic pancreatitis. 