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Critical acute pancreatitis is defined as
persistent organ failure and infected pancreatic necrosis
特別是這三個系統容易被影響 :
Cardiovascular, respiratory, and renal
Complication :
- Shock, ARDS, AKI, DIC
- Pleural effusion, Ascites
- Metabolic : 高血糖, 低血鈣, 高 TG
- Acute fluid collection
- Psuedocyst
- Sterile pancreatic necrosis
- Infection : Necrotizing pancreatitis , abscess
5% to 25% of patients can progress to chronic pancreatitis
* Prognosis (Pancreatitis Scoring Systems):
決定病人預後的重要關鍵包括
有沒有器官衰竭 + 是不是壞死性胰臟炎
初期胰臟炎看似還好, 但可能進展快速 !
APACHE II & Ranson Score - ICU setting, not applicable to ED
SIRS at admission and persistent at 48 hours predicts severe acute pancreatitis
more simply and as accurately as the various scoring systems
Besides SIRS, a number of other clinical findings
at initial assessment are associated with severe disease.
These findings include patient characteristics
(age >55 years, obesity, altered mental status, comorbidities),
laboratory findings (BUN >20 milligrams/dL or rising;
hematocrit >44% or rising; increased creatinine),
and radiologic findings (many or large extrapancreatic fluid collections,
pleural effusions, pulmonary infiltrates).
Ranson criteria :
Hct 下降超過原本的 10%
代表原本 hemoconcentration 嚴重
才能灌水後下降 > 10%
BISAP score
≥ 2 SIRS Criteria :
- Temp >38°C or < 36°C
- Heart rate > 90
- Respiratory rate > 20 or PaCO₂ < 32 mm Hg
- WBC > 12,000/mm³, < 4,000/mm³, or > 10% bands
Patients with a BISAP Score of 0 had < 1% risk of mortality,
and one study stratified patients with a score ≤2, given a mortality risk of 1.9%.
Patients with a BISAP Score > 0 had an increasing risk of mortality,
with mortality increasing significantly with a score of 3 or greater.
A score of 5 had a mortality rate of 22%.
CT severity index (CTSI)
based on degree of pancreatic necrosis seen on CT – may help prognosticate
CTSI - Grading of pancreatitis (Balthazar score)
A : Normal pancreas : 0
B : Enlargement of pancreas : 1
C : Inflammatory changes in pancreas and peripancreatic fat : 2
D : Ill-defined single peripancreatic fluid collection : 3
E : Two or more poorly defined peripancreatic fluid collections : 4
Pancreatic necrosis
None : 0
≤ 30% : 2
> 30-50% : 4
> 50% : 6
The maximum score that can be obtained is 10.
0-3 : Mild acute pancreatitis
4-6 : Moderate acute pancreatitis
7-10 : Severe acute pancreatitis
https://emergencymedicinecases.com/episode-42-mesenteric-ischemia-pancreatitis-3/?fbclid=IwAR2bDK12hxOAdF898MJceJdN-LFMaQtyz0KFtN2K5N7SC8EvYxJs2z7a4dY
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