Introduction: More than a century after its comprehensive description, Acute Pancreatitis remains acommon disorder with devastating consequences.1Pancreatitis is a unique disease with protean presentation which is difficult to diagnose and manage. Diagnosis of AP is most often established by clinical symptoms and laboratory testing. Contrast-enhanced computed tomography (CECT) and / or magnetic resonance imaging (MRI) of the pancreas is reserved for patients in whom the diagnosis is unclear or who fail to improve clinically. It is important to assess the condition of the patient and predict its severity early to minimise the cost of expensive investigations and prevent invasive procedures as a large number of such patients tend to run a benign course. To achieve this a number of scoring procedures have been devised. It thus becomes imperative to study the clinical presentation of AP at time of presentation, impact of investigations, predict the course it would likely to run using various scoring methods, its complications and their outcomes.
Aims & Objectives:
1. To study the clinical presentation and complications of Acute Pancreatitis and their impact on outcome.
2. To compare the Glasgow score with Atlanta score for accuracy to predict prognosis.
Material and Methods: This prospective study was conducted between June 2012 to June 2013 on patients admitted to Hindu Rao Hospital, Delhi. 40 patients with Acute Pancreatitis were enrolled for the study.
The diagnostic criteria included atleast one of the following:
1. Serum Amylase more than 4 times the upper limit of normal2
2. Serum Lipase more than 2 times the upper limit of normal.2
3. Ultrasound or C.T. scan suggestive of acute pancreatitis. On admission a detailed history and a thorough physical examination was done. During the first 48 hours, patients were stratified according to the Glasgow On discharge or death, patients were stratified into mild or severe according to the Atlanta classification.3Acomparison between classification of patients by Glasgow score at time of admission and by Atlanta score at time of discharge was noted and the two were then compared. Data was collected on complications, investigations and interventions undertaken, outcome, duration of stay in hospital and ICU and mode of nutritional support. Prediction of severity by Glasgow criteria was compared with severity stratification by Atlanta classification. Descriptive statistics analysis was carried out in SPSS 17 and graph excel, continuous variables are presented as mean, median. Categorical variables are expressed as frequencies and percentages.
Results: Male predominance (67.5%) with a median age of 39 years was observed. Pain was the most common presenting symptom (93%) followed by vomiting (60%). Other symptoms included fever (20%), abdominal distention (15%), and jaundice (7.5%). 28% of the patients were hypertensive while 20% were diabetic.47.5% had biliary pancreatitis while 25% had alcohol induced pancreatitis. No cause could be found in 15%.Sr. Lipase supported the diagnosis in 80% while for Sr Amylase it was 52%. CECT had a sensitivity of 100%. 20% had acute fluid collection while 17.5% had acute necrosis. Pleural effusion was seen in 30% of the cases. On comparing Glasgow score with Atlanta score it was found that Glasgow scores predicted 65% of the patientscorrectly in mild cases while its predictive value was only 35% in severe cases. ARDS was seen in 15% while ARF in 12.5%. 5% patient died. Of the 19 patients of Biliary pancreatitis, 12 (84%) underwent cholecystectomy and 4 had ERCP with sphincterotomy. Other surgical procedures performed were abscess drainage and necrosectomy (5%). Mean average stay was 13.5 days in severe cases and 10 days in mild cases.
Conclusions: Acute Pancreatitis is found in younger males usually with a biliary pathology. When both Sr. Amylase and Sr. Lipase are used as investigation the sensitivity is about 80%. All patients should be stratified within 48 hours of admission and this helps in identifying patients who are likely to have a severe attack. These patients may require surgical intervention to manage the cause and complications of the disease and may require ICU management to survive. About 5% patients die despite best possible support. Glasgow scores predicted 65% of the patients correctly in mild cases while its predictive value was only 35% in severe cases. Early management of Gall stones and avoiding alcohol can prevent attacks of AP.
