Scoring Pancreatitis

8/10/2019 Scoring Pancreatitis

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Balthazar scoring

Developed in the early 1990s by Emil J. Balthazar et al. the ComputedTomography Severity Index (CTSI) is a grading system used todetermine the severity of acute pancreatitis. The numerical CTSI has a

maximum of ten points, and is the sum of the Balthazar grade pointsand pancreatic necrosis grade points:

Balthazar Grade

BalthazarGrade

Appearance on CT CT Grade Points

Grade A Normal CT 0 points

Grade B Focal or diffuse enlargement of the pancreas 1 point

Grade C Pancreatic gland abnormalities and peripancreatic inflammation 2 points

Grade D Fluid collection in a single location 3 points

Grade E Two or more fluid collections and / or gas bubbles in or adjacentto pancreas

4 points

Necrosis Score

NecrosisPercentage

Points

No necrosis0points

0 to 30% necrosis2points

30 to 50% necrosis 4points

Over 50% necrosis6points

CTSI's staging of acute pancreatitis severity has been shown by anumber of studies to provide more accurate assessment than APACHEII, Ranson, andC-reactive protein(CRP) level

Glasgow criteria

The Glasgow criteria is valid for both gallstone and alcohol induced

pancreatitis, whereas the Ranson score is only for alcohol inducedpancreatitis. If a patient scores 3 or more it indicates severe pancreatitisand the patient should be transferred to ITU. It is scored through themnemonic, PANCREAS:

P - PaO2 55 years old

N - Neutrophilia - WCC >15x10(9)/L

C - Calcium 16mmol/L

E - Enzymes: LDH >600iu/L; AST >200iu/L A - Albumin


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S - Sugar: blood glucose >10mmol/L

Ranson criteria

Parameters used:

At admission:

age in years > 55 years

white blood cellcount > 16000 cells/mm3

blood glucose> 10 mmol/L (> 200 mg/dL)

serumAST> 250 IU/L

serumLDH> 350 IU/L

At 48 hours:

1.

Calcium (serum calcium < 2.0 mmol/L (< 8.0 mg/dL)

2.

Hematocritfall > 10%3.

Oxygen (hypoxemiaPO2< 60 mmHg)

4.

BUNincreased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluidhydration

5.Base deficit (negativebase excess)> 4 mEq/L

6.Sequestration of fluids > 6 L

The criteria for point assignment is that a certain breakpoint be met atanytime during that 48 hour period, so that in some situations it can becalculated shortly after admission. It is applicable to non-gallstonepancreatitis. For gallstone pancreatitis, the parameters are:

At admission:

1.age in years > 70 years

2.white blood cellcount > 18000 cells/mm3

3.blood glucose> 12.2 mmol/L (> 220 mg/dL)

4.serumAST> 250 IU/L

5.serumLDH> 400 IU/L

At 48 hours:

1.

Calcium (serum calcium < 2.0 mmol/L (< 8.0 mg/dL)2.

Hematocritfall > 10%

3.

Oxygen (hypoxemiaPO2< 60 mmHg)

4.

BUNincreased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluidhydration

5.Base deficit (negativebase excess)> 5 mEq/L

Sequestration of fluids > 4 L
http://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/Blood_glucosehttp://en.wikipedia.org/wiki/Blood_glucosehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Lactate_dehydrogenasehttp://en.wikipedia.org/wiki/Lactate_dehydrogenasehttp://en.wikipedia.org/wiki/Lactate_dehydrogenasehttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hypoxemiahttp://en.wikipedia.org/wiki/Hypoxemiahttp://en.wikipedia.org/wiki/Hypoxemiahttp://en.wikipedia.org/wiki/BUNhttp://en.wikipedia.org/wiki/BUNhttp://en.wikipedia.org/wiki/BUNhttp://en.wikipedia.org/wiki/BUNhttp://en.wikipedia.org/wiki/Base_excesshttp://en.wikipedia.org/wiki/Base_excesshttp://en.wikipedia.org/wiki/Base_excesshttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/Blood_glucosehttp://en.wikipedia.org/wiki/Blood_glucosehttp://en.wikipedia.org/wiki/Blood_glucosehttp://en.wikipedia.org/wiki/Blood_glucosehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Lactate_dehydrogenasehttp://en.wikipedia.org/wiki/Lactate_dehydrogenasehttp://en.wikipedia.org/wiki/Lactate_dehydrogenasehttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Hypoxemiahttp://en.wikipedia.org/wiki/Hypoxemiahttp://en.wikipedia.org/wiki/Hypoxemiahttp://en.wikipedia.org/wiki/BUNhttp://en.wikipedia.org/wiki/BUNhttp://en.wikipedia.org/wiki/BUNhttp://en.wikipedia.org/wiki/BUNhttp://en.wikipedia.org/wiki/Base_excesshttp://en.wikipedia.org/wiki/Base_excesshttp://en.wikipedia.org/wiki/Base_excesshttp://en.wikipedia.org/wiki/Base_excesshttp://en.wikipedia.org/wiki/BUNhttp://en.wikipedia.org/wiki/Hypoxemiahttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Lactate_dehydrogenasehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Blood_glucosehttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/Base_excesshttp://en.wikipedia.org/wiki/BUNhttp://en.wikipedia.org/wiki/Hypoxemiahttp://en.wikipedia.org/wiki/Hematocrithttp://en.wikipedia.org/wiki/Lactate_dehydrogenasehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Blood_glucosehttp://en.wikipedia.org/wiki/White_blood_cell


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Scoring Pancreatitis