CRITERIOS DE SEVERIDAD DE BALTHAZAR-RANSON PARA TC A.- Páncreas normal. B.- Agrandamiento focal o. Revised Atlanta Classification of Acute Pancreatitis The table summarizes the CT criteria for pancreatic and peripancreatic fluid The CT severity index (CTSI) combines the Balthazar grade ( points) with the extent. CT is the imaging method of choice for assessing the extent of acute . Grading severity of acute pancreatitis using Balthazar CTSI score.
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Pancreas – Acute Pancreatitis 2.0
Pancreatitis is one of most complex and clinically challenging of all clasiflcacion disorders. USG and abdominal CT are the most commonly used baltazar imaging modalities for the evaluation of pancreas. Computed Tomography CT is highly accurate and sensitive than USG in both diagnosing as well as demonstrating the extent.
Early assessment of the cause and severity of acute pancreatitis is of utmost importance for prompt treatment and close monitoring of patient with severe disease. CT is the imaging method of choice for assessing the extent of acute pancreatitis and for evaluating complications. To assess prognostic correlation and clinical outcome of acute pancreatitis on the basis of CT severity index.
The severity of pancreatitis was scored using CT severity index, modified severity index and revised Atlanta classification and classified into mild, moderate, severe categories. Clinical follow-up of the patients was done in terms of the following parameters: Length of hospital stay, Need for surgery or percutaneous intervention, Evidence of infection in any organ system, Occurrence of organ failure- respiratory, cardiovascular, renal, hepatic and haematological system, death. Majority of the cases were categorized as mild pancreatitis according revised Atlanta classification.
Organ system failure, death were more seen in severe grade in modified CTSI and revised Atlanta classification. Modified CT severity index makes the score easier to calculate and reduces the inter-observer variation. Scores obtained with the modified Mortele index, show a stronger statistical correlation for all clinical outcome parameters in all the patients better than the Balthazar index.
Diseases of pancreas have a very variable presentation and imaging plays an important role in the diagnosis and management of pancreatic diseases. Computed Tomography CT is highly accurate, and sensitive than USG in both diagnosing as well as demonstrating the extent [ 1 ]. CT is a key diagnostic tool in understanding the cause of endocrine and exocrine pancreatic insufficiency in most patients. Pancreatitis is one of most complex and clinically challenging of all abdominal disorders [ 2 ].
As early treatment of patients with severe acute pancreatitis can reduce morbidity and mortality. The combined score of CTSI proved to have a better prognostic accuracy than the Balthazar score but it, too, had some drawbacks. The score obtained with the index did not significantly correlate with the subsequent development of organ failure, extra pancreatic parenchymal complications or peripancreatic vascular complications [ 34 ]. In view of these limitations, a modified and simplified CT scoring system was hypothesized in by Mortele and colleagues so as to determine if the scores obtained with this could be used to predict the clinical outcome more accurately.
Interstitial oedematous pancreatitis and Necrotizing pancreatitis. To assess the prognostic correlation of patient outcome with currently accepted Balthazar and the Modified Mortele Computed Tomography severity indices in acute pancreatitis.
The presence and extent of necrosis in each case was classified into four categories and awarded points from as follows:. The Balthazar CTSI was calculated by adding the above points in each case and the total score was then categorized as:.
The presence and extent of necrosis in each case was scored from as follows:. The Modified CTSI was calculated by summing these values and the total score was then categorized as:. The s everity is classified into three categories based on clinical and morphologic findings according to revised Atlanta classification [ 8 ].
Clinical follow-up of the patients was done in terms of the following parameters:.
pancreatitis aguda experiencia: Topics by
Data analysis was done using SPSS version Symptoms and signs in patients of acute pancreatitis: Findings in patients of acute pancreatitis: Gall stone disease was most common aetiological factor seen; it was more common in females than males. Pleural effusion was the most common extra-pancreatic complication with left pleural effusion being pancrearitis more common.
Balthazar grading in patients with acute pancreatitis: Correlation of Balthazar grade with Degree of necrosis: No necrosis was noted in patients with grade B pancreatitis. The study group consisted of 35 male and 15 female patients with a claskficacion According to Steinberg et al. And also, similar findings concluded in a study by Irshad Ahmad Banday et al. Irshad Ahmad Banday et al. Among vascular complications, venous thrombosis was the most common 3 in portal vein and 1 in splenic vein.
A recent study by Irshad Ahmad Banday et al. Their findings were on the lower side as compared to this study. The possible explanation for this panceratitis the large number of patients having mild pancreatitis in their study group. This was fairly similar to the study conducted by Irshad Ahmad Banday et al. Modified CT scoring system correctly predicted clasificcaion outcome in all the patients who had a shift in their severity grades than Balthazar CTSI.
The change in severity scoring was seen mainly due panncreatitis the presence of extrapancreatic complication. The strong relationship between the Modified CT severity index and the patient outcome in this study corroborates with the findings of Mortele et al. Similar trends in duration of ckasificacion stay, intervention or surgery, evidence of infection, organ failure, and mortality in patients with variable grades of severity of pancreatitis were observed in our study as that seen by Mortele in their study.
This also correlated with the study by Irshad Ahmad Banday et al. Results of our study were also found similar to a study conducted by Shivanand Melkundi et al. Infection, organ system failure and death were significantly associated with severe grade.
Patient outcome in terms of organ failure and death is more accurately assessed by revised Atlanta classification in comparison with Balthazar and modified ct severity index. In patients of derange renal function and pregnant patients contrast CT is contraindicated.
CT Evaluation of Acute Pancreatitis and its Prognostic Correlation with CT Severity Index
Repeated follow-up study was not possible due to cost and radiation exposure. Different treatments were given to patients which changed the patient outcome. Sample size was small which may have affected the result. However, in first week only clinical parameters are useful.
Contrast enhanced Computed Tomography is excellent diagnostic modality to stage the severity of inflammatory process, detect the pancreatic necrosis and depict balthazarr complications and grading of severity of acute pancreatitis. The scores obtained with the modified Mortele index, showed a stronger correlation for all outcome parameters in all the patients better than the Balthazar index.
Revised Atlanta classification is more accurate than modified Mortele index and Balthazar severity index for assessing patient mortality and organ failure. National Center for Biotechnology InformationU.
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This article has been cited by other articles in PMC. Abstract Introduction Pancreatitis is one of most complex and clinically challenging of all abdominal disorders. Aim To assess prognostic correlation and clinical outcome of acute pancreatitis on the basis of CT severity index.
Conclusion Modified CT severity index makes the score easier to calculate and reduces the inter-observer variation. Abdominal computed tomography, Complications, Pancreatic diseases. Introduction Diseases of pancreas have a very variable presentation and imaging plays an important role in the diagnosis and management of pancreatic diseases. Aim To assess the prognostic correlation of patient outcome with currently accepted Balthazar and the Modified Mortele Computed Tomography severity indices in acute pancreatitis.
Normal pancreas 0 Point Grade B: Focal or diffuse enlargement of the pancreas including contour irregularities, non- homogenous attenuation of the gland, dilation of the pancreatic duct and foci of small fluid collections within the gland, as long as there was no evidence of peri-pancreatic disease. Intrinsic pancreatic abnormalities associated with hazy streaky densities representing inflammatory changes in the peri-pancreatic fat.
Single ill defined fluid collection phlegmon. Two or multiple, poorly defined fluid collections or presence of gas in or adjacent to the pancreas. Open in a separate window. Mortele Modified CTSI Scoring Normal pancreas 0 Point Intrinsic pancreatic abnormalities with or without inflammatory changes in peripancreatic fat 2 Points Pancreatic or peripancreatic fluid collection or peripancreatic fat necrosis 4 point. Outcome Parameters Clinical follow-up of the patients was done in terms of the following parameters: Length of hospital stay.
Occurrence of organ failure- respiratory, cardiovascular, renal, hepatic and haematological system. Inclusion Criteria Clinically suspected case of acute pancreatitis of all ages. Exclusion Criteria Patients with chronic pancreatitis suggested by intraductal calculi, ductal stricture and parenchymal calcification. Results Symptoms and signs in patients of acute pancreatitis: Aetiology of acute pancreatitis.
Causes Total Male Female No. Extra pancreatic complications in patient of acute pancreatitis.
The morphological classification according to Revised Atlanta clasificacoon. Acute peripancreatic collection Acute necrotic collection Pseudocyst Walled off necrosis 36 24 0 0. Grading severity of acute pancreatitis using modified mortele CTSI. Severity of acute pancreatitis according to revised Atlanta classification. Axial CT image of abdomen reveals normal anatomy of Pancreas arrows.
Limitations In patients of derange renal function and pregnant patients contrast CT is contraindicated.