Acute pancreatitis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Overview

Acute pancreatitis may be classified according to the severity of disease into 2 subtypes: mild (interstitial or edematous) and severe (necrotizing or organ failure) pancreatitis.

Classification

The definitions of severity in acute pancreatitis according to the revised Atlanta classification are as follows.[1]

Atlanta criteria (1993) Atlanta Revision (2013)
Mild acute pancreatitis Mild acute pancreatitis
 Absence of organ failure  Absence of organ failure
Absence of local complications Absence of local complications
Severe acute pancreatitis Moderately severe acute pancreatitis
1. Local complications AND/OR 1. Local complications AND/OR
 2. Organ failure 2. Transient organ failure (< 48 h)
GI bleeding (> 500 cc/24 hr) Severe acute pancreatitis
ShockSBP ≤ 90 mm Hg Persistent organ failure > 48 h
PaO2 ≤ 60%
Creatinine ≥ 2 mg/dl

The revised Atlanta classification for acute pancreatitis classifies it as:[2][3][4][5][6][7][8][9]

Acute pancreatitis is further distinguished clinically into:

  • Early phase (1st week).
  • Late phase (after the 1st week).

Subtypes of Acute Pancreatitis:

  • Interstitial Edematous Pancreatitis
▸ Acute inflammation of the pancreatic parenchyma and peripancreatic tissues, but without recognizable tissue necrosis
CECT criteria
▸ Pancreatic parenchyma enhancement by intravenous contrast agent.
▸ No findings of peripancreatic necrosis.
  • Necrotizing Pancreatitis
▸ Inflammation associated with pancreatic parenchymal necrosis and/or peripancreatic necrosis
CECT criteria
▸ Lack of pancreatic parenchymal enhancement by intravenous contrast agent
▸ Presence of findings of peripancreatic necrosis.
  • Infected Pancreatic Necrosis:
▸ It should be considered in patients with necrotizing pancreatitis who deteriorate or fail to improve after 7–10 days of hospitalization.[1]
▸ It may be presumed by the presence of extraluminal gas on CECT or when fine-needle aspiration is positive for bacteria and/or fungi on Gram stain and culture.[11]
▸ Antibiotics are able to penetrate pancreatic necrosis (such as carbapenems, quinolones, and metronidazole) and may be useful in delaying or sometimes totally avoiding intervention.[12][13]

References

  1. 1.0 1.1 Banks, PA.; Bollen, TL.; Dervenis, C.; Gooszen, HG.; Johnson, CD.; Sarr, MG.; Tsiotos, GG.; Vege, SS.; Acosta, JM. (2013). "Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus". Gut. 62 (1): 102–11. doi:10.1136/gutjnl-2012-302779. PMID 23100216. Unknown parameter |month= ignored (help)
  2. Bradley EL (1993). "A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992". Arch Surg. 128 (5): 586–90. PMID 8489394.
  3. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS (2013). "Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus". Gut. 62 (1): 102–11. doi:10.1136/gutjnl-2012-302779. PMID 23100216.
  4. Busquets J, Fabregat J, Pelaez N, Millan M, Secanella L, Garcia-Borobia F, Masuet C, García LM, Martinez-Garcia L, Lopez-Borao J, Valls C, Santafosta E, Estremiana F (2013). "Factors influencing mortality in patients undergoing surgery for acute pancreatitis: importance of peripancreatic tissue and fluid infection". Pancreas. 42 (2): 285–92. doi:10.1097/MPA.0b013e318264664d. PMID 23357922.
  5. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ (1995). "Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome". Crit. Care Med. 23 (10): 1638–52. PMID 7587228.
  6. Tenner S (2004). "Initial management of acute pancreatitis: critical issues during the first 72 hours". Am. J. Gastroenterol. 99 (12): 2489–94. doi:10.1111/j.1572-0241.2004.40329.x. PMID 15571599.
  7. Banks PA, Freeman ML (2006). "Practice guidelines in acute pancreatitis". Am. J. Gastroenterol. 101 (10): 2379–400. doi:10.1111/j.1572-0241.2006.00856.x. PMID 17032204.
  8. Perez A, Whang EE, Brooks DC, Moore FD, Hughes MD, Sica GT, Zinner MJ, Ashley SW, Banks PA (2002). "Is severity of necrotizing pancreatitis increased in extended necrosis and infected necrosis?". Pancreas. 25 (3): 229–33. PMID 12370532.
  9. Bakker OJ, van Santvoort H, Besselink MG, Boermeester MA, van Eijck C, Dejong K, van Goor H, Hofker S, Ahmed Ali U, Gooszen HG, Bollen TL (2013). "Extrapancreatic necrosis without pancreatic parenchymal necrosis: a separate entity in necrotising pancreatitis?". Gut. 62 (10): 1475–80. doi:10.1136/gutjnl-2012-302870. PMID 22773550.
  10. Thoeni RF (2012). "The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment". Radiology. 262 (3): 751–64. doi:10.1148/radiol.11110947. PMID 22357880. Unknown parameter |month= ignored (help)
  11. Banks, PA.; Gerzof, SG.; Langevin, RE.; Silverman, SG.; Sica, GT.; Hughes, MD. (1995). "CT-guided aspiration of suspected pancreatic infection: bacteriology and clinical outcome". Int J Pancreatol. 18 (3): 265–70. doi:10.1007/BF02784951. PMID 8708399. Unknown parameter |month= ignored (help)
  12. Petrov, MS.; Shanbhag, S.; Chakraborty, M.; Phillips, AR.; Windsor, JA. (2010). "Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis". Gastroenterology. 139 (3): 813–20. doi:10.1053/j.gastro.2010.06.010. PMID 20540942. Unknown parameter |month= ignored (help)
  13. van Santvoort, HC.; Bakker, OJ.; Bollen, TL.; Besselink, MG.; Ahmed Ali, U.; Schrijver, AM.; Boermeester, MA.; van Goor, H.; Dejong, CH. (2011). "A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome". Gastroenterology. 141 (4): 1254–63. doi:10.1053/j.gastro.2011.06.073. PMID 21741922. Unknown parameter |month= ignored (help)



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