Management of Acute Pancreatitis with Search for Reliable Prognostic Indicators

N K Hazra^1, , O B Karki¹, B Sathian², Abhijit De³, Samikshya Ghimire⁴, Rajan Sharma¹, Rajiv Nakarmi¹ and Aman Juneja⁵

¹Department of Surgery, Manipal Teaching Hospital, Pokhara, Nepal

²Department of Community Medicine, Manipal College of Medical Sciences, Pokhara, Nepal

³Medical Officer, Kolkata, India

⁴Medical Officer, Kathmandu, Nepal

⁵Medical Officer, Punjab, India

Cite this paper

N K Hazra, O B Karki, B Sathian, Abhijit De, Samikshya Ghimire, Rajan Sharma, Rajiv Nakarmi and Aman Juneja. Management of Acute Pancreatitis with Search for Reliable Prognostic Indicators. American Journal of Public Health Research. 2015; 3(5A):156-159. doi: 10.12691/AJPHR-3-5A-34

Abstract

Acute pancreatitis is quite common in Nepal. It afflicts male, female, adolescent and old equally. With advent of newer diagnostic tool, medical knowledge, and health awareness the thrust is on controlling the morbidity and mortality, hence search for reliable prognostic indicators. The prospective study was taken up to find out the reliable prognostic indicators from the clinical, biochemical and radiological parameters amongst the patients of acute pancreatitis with a view to optimize treatment protocol. A Cohort of 402 cases treated at Manipal Teaching Hospital from January 2006 to September 2015 were followed up. Age, sex, clinical findings were recorded. Serum amylase, LDH, Total Leucocytes Count (TLC), complete blood count (CBC), blood sugar, serum calcium, pO2, X-ray abdomen (AXR), X-ray chest (CXR), ultra sonogram (USG), and computed tomography (CT) scans were analyzed. Treatment protocol was formulated. Patient’s age ranged from 7–89 years (mean age 48 years; males were 189(47.014%), female 213(52.985%) with M:F ratio1:1.12. Precipitating causes were alcohol 116(28.855%), gall stone 78(19.402%), idiopathic 196(48.756%), mumps 6, ascariasis 4, trauma 1, postoperative 1 (Caesarian). Clinical findings were, pain in the epigastrium radiating to back in 190(47.263), pain abdomen without radiation in 212, (52.736%) vomiting in 186(46.268%) patients. Cullen’s sign was present in one, TLC was raised in 54(13.432%), serum amylase in 378(94.029%), LDH in 70.652% of cases, AXR was noncontributory, CXR showed pleural effusion in 10.778% of cases, USG abdomen done in 389 cases showed AP lesion in 241(61.93%). computed tomography (CT) and contrast enhanced computed tomography (CECT) done in 160 cases showed AP lesion in 159 (99.375%). CECT is probably the best diagnostic tool and indicator; complications encountered were renal failure in 4, ileus in 5, pseudo pancreatic cysts in 3, splenic vein thrombosis in one. Death occurred in 4 cases, Laparotomy was done in one. Diagnostic difficulty was experienced in 4 cases. Average hospital stay was 5 days (prolonged in cases those underwent cholecystectomy). Most of the cases being of mild form could be treated conservatively. Prophylactic antibiotic with cefuroxime was found to be useful. CECT probably is the best form of diagnostic tool as well as prognostic marker.

Keywords

Acute pancreatitis, Contrast Enhanced Computed Tomography, Serum Amylase

Copyright

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