Nutrition in the management of necrotizing pancreatitis Stephen J.D O’Keefe, Timothy Broderick, Maryann Turner, Stacie Stevens, J.Sebastian O’Keefe  Clinical Gastroenterology and Hepatology  Volume 1, Issue 4, Pages 315-321 (July 2003) DOI: 10.1016/S1542-3565(03)00137-X

Figure 1 Initial CT scan of moderately severe pancreatitis. Contrast-enhanced axial CT scan shows mild enlargement of the pancreas (p) with irregularity of the contour and peripancreatic soft-tissue stranding (arrows). Note also dissection of peripancreatic fluid into the left (L) and right (R) anterior pararenal spaces. Clinical Gastroenterology and Hepatology 2003 1, 315-321DOI: (10.1016/S1542-3565(03)00137-X)

Figure 2 Relationship between white blood cell count (WBC) and blood glucose concentrations during necrotizing pancreatitis, and the influence of feeding and surgery. The two parameters were significantly associated (P < 0.0001, r = 0.45). Normal laboratory range for WBC is 2.8–11.9 × 109/L and for blood glucose 65–110 mg/dL. Clinical Gastroenterology and Hepatology 2003 1, 315-321DOI: (10.1016/S1542-3565(03)00137-X)

Figure 3 Intermediate CT scan of severe pancreatitis. Contrast-enhanced axial CT scan obtained after transfer reveals progression of pancreatitis with lack of enhancement of the pancreatic head and portion of the body (arrows) consistent with pancreatic necrosis (>30%). The pancreatic tail (p) enhances normally. There is now a large, irregular, low-density fluid collection (f) anterior to the pancreas, which is abutting the posterior wall of the gastric antrum(s). Clinical Gastroenterology and Hepatology 2003 1, 315-321DOI: (10.1016/S1542-3565(03)00137-X)

Figure 4 Results of the measurements of pancreatic enzyme secretion (sum of amylase, lipase, and trypsin) during the acute attack showing stimulation in secretion on conversion from TPN to isocaloric and isonitrogenous enteral feeding. Clinical Gastroenterology and Hepatology 2003 1, 315-321DOI: (10.1016/S1542-3565(03)00137-X)

Figure 5 Comparison of the rate of appearance of newly synthesized trypsin, labeled with 13C-leucine, in duodenal juice in the patient with necrotizing pancreatitis (acute pancreatitis) and a group of 6 normal healthy volunteers (healthy voln) given identical diets. The rate was not slower in the patient. Clinical Gastroenterology and Hepatology 2003 1, 315-321DOI: (10.1016/S1542-3565(03)00137-X)

Figure 6 Late CT scan: severe pancreatitis with extensive pancreatic necrosis. Contrast-enhanced axial CT scan demonstrates pancreatic necrosis with no viable enhancing pancreatic tissue in the head or body of the pancreas. There is a small area of viable enhancing tissue in the pancreatic tail (arrows). The pancreas has been replaced by a large, demarcated fluid collection (so-called “water bag” pancreas) characteristic of extensive pancreatic necrosis (n). There is compression of the contrast-filled antrum of the stomach (s) by the large fluid collection. Note gallbladder (gb) with absence of radiopaque calculi. Clinical Gastroenterology and Hepatology 2003 1, 315-321DOI: (10.1016/S1542-3565(03)00137-X)