Editing Acute pancreatitis (section)

== '''Scoring systems''' probably don't have clinical relevance ==

* Lots of systems, conflicting evidence
* The most useful approach:
** During admission, use a three-dimensional approach to predict risk:
*** Risk factors (age, comorbidity, BMI)
*** Clinical risk stratification (persistent SIRS)
*** Monitoring response to initial therapy (persistent SIRS, BUN, creatinine)
** Use BISAP, Atlanta or even just SIRS criteria
** Apache II can be useful if patient is in ICU
** Ignore Ranson/Glasgow
* SIRS criteria
** Persistent SIRS from admission = mortality 25%
** SIRS at admission but not persistent 8%
** No SIRS 0%
**[[File:SIRS.png|frameless|468x468px]]
* BISAP predicts mortality, quite simple, easy to use, performs on par with more extensive scores
** Factors at admission (one point for each): BISAP
*** BUN: Urea >8.92mmol/L
*** Impaired mental status
*** SIRS criteria >=2
*** Age >60
*** Pleural effusion present
** 0-2 points: mortality <2%
** 3 or more points: mortality >15%
* Modified Atlanta:
** [[File:Revised-Atlanta-Criteria-for-Severity-of-PEP.png|frameless]]

* Atlanta radiographic classification:
** Interstitial oedematous
** Necrotising
** Acute peripancreatic fluid
** Pancreatic pseudocyst

* CT severity index
**[[File:CTSI.png|frameless|409x409px]]
* APACHE II
** Predicts ICU mortality, really only useful with ICU-style investigations e.g. arterial BP
* Glasgow-Imrie criteria (1984) predicts severity, but requires values from 48 hours after admission
** Similar to Ranson
** Not used any more
* Ranson predicts mortality (published 1974)
** Disadvantage - needs scores at 0 and 48 hours post admission
** Mainly used to rule out severe pancreatitis, but low PPV
**[[File:Ranson non-gallstone.png|frameless]]
**[[File:Ranson gallstone.png|frameless]]

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