How Is The Severity Of Acute Pancreatitis Assessed Clinically

Surgery Essay

How is the severity of acute pancreatitis assessed clinically? What is the value of such classification? Assessment of the severity of acute pancreatitis is carried out by a multifactorial scoring system such as Ranson’s scoring system. Alternatively, measurement of the C-reactive proteins particularly if carried out as repeated measurements can also provide an accurate assessment of severity. In Ranson’s Criteria, one point is given for each variable, 3 or more points indicate severe pancreatitis. 1. At admission a.

Age greater than 55 years

b. Blood glucose >11mmol/l c. Serum LDH >500 IU/l d. AST >200 IU/l e.

White blood cell count >16x109/l

2. At 48h after admission a. Haematocrit fall of > 10% b. Blood urea >16mmol/l c. Serum Calcium <2mmol/l d. Arterial pO2 <8kPa e. Base deficit <4mmol/l 1

Surgery Essay

Early assessment of severity is worthwhile as these patients will need constant monitoring. The patient’s urine output must be monitored and kept more than 30ml/h by resuscitation of patient with intravenous fluids. Fluid balance charts should also be checked. The patient should also be monitored for signs of renal and respiratory failures as these worsen the prognosis. If pancreatitis is found to be severe, antibiotic prophylaxis should be given, to prevent a necrotic pancreas becoming infected, as this carries a high mortality. The agents in common usage are ciprofloxacin and cefuroxine. Also if pancreatitis is severe, and the aetiology is gallstones, the patient should be considered for urgent ERCP and endoscopic spinchterotomy. 09/02/09

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