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SPECTRUM OF PANCREATITIS
ABSTRACT NO-145
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LEARNING OBJECTIVES To Define acute pancreatitis phases and its types [interstitial edematous and necrotizing] and naming the various fluid collections [APFC,PSEUDOCYST,ANC,WON] as defined by the REVISED NEW ATLANTA CLASSIFICATION.
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The revised Atlanta classification distinguishes an early phase (1st week) in which clinical parameters determine treatment from a later phase (after the 1st week) in which treatment is determined on the basis of clinical parameters and morphologic criteria defined by CT.
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Severe acute pancreatitis is defined in the first phase as organ failure lasting more than 48 hours or death; and during the second phase as persistent organ failure, death, or complications resulting from acute pancreatitis
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TYPE OF PANCREATITIS Interstitial edematous pancreatitis
Acute necrotizing pancreatitis 1.parenchymal necrosis 2.peripancreatic necrosis 3.combined type with or with out infection
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TYPES OF PANCREATITIS – FLUID COLLECTION
INTERSTITIAL EDEMATOUS PANCREATITIS STERILE/INFECTED <4 WEEKS-ACUTE PERI PANCREATIC FLUID COLLECTION > 4 WEEKS –PANCREATIC PSEUDO CYST
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NECROTIZING TYPE NECROTIZING PANCREATITIS
< 4 WEEKS-ACUTE NECROTIC COLECTION STERILE/INFECTED > 4 WEEKS-WALLED OFF NECROSIS
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Intraparenchymal fluid collections due to pancreatitis are referred to as ANCs or WONs, not as pseudo cysts. Pseudo cysts rarely become infected or require intervention For sterile ANC or WON, any need for drainage is based on the clinical information; infected ANCs or WONs usually require intervention
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INTERSTITIAL EDEMATOUS PANCREATITIS
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INTERSTITIAL EDEMATOUS PANCREATITIS
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INTERSTITIAL EDEMATOUS PANCREATITIS
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ACUTE NECROTIZING PANCREATITIS
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PANCREATIC PARENCHYMAL NECROSIS
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PANCREATIC PARENCHYMAL NECROSIS
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PANCREATIC PARENCHYMAL NECROSIS
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PERI PANCREATIC NECROSIS
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PERI PANCREATIC NECROSIS
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COMBINED TYPE-NECROSIS
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COMBINED TYPE-NECROSIS
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ACUTE NECROTIZING-INFECTIOUS
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ACUTE PERI PANCREATIC FLUID COLLECTION
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PANCREATIC PSEUDO CYST
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PANCREATIC PSEUDO CYST
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ACUTE NECROTIC COLLECTION
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ACUTE NECROTIC COLLECTION
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WALLED OFF NECROSIS
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WALLED OFF NECROSIS
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MULTI COMPARTMENTAL COLLECTION
LEFT PLEURAL COLLECTION SUB CAPSULAR RENAL PSEUDO COLLECTION
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MULTI COMPARTMENTAL COLLECTION
LOCULATED SUB HEPATIC LEFT PARACOLIC GUTTER
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MULTI COMPARTMENTAL COLLECTION
LESSER SAC PELVIC
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MULTI COMPARTMENTAL COLLECTION
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TAKE HOME MSG Identification of necrosis & %
Associated findings & complications IEP/ANP Intra pancreatic pseudocyst Pancreatic abscess Acute After 4 weeks Pan / Peri panNecrosis walled of Pan / peri panNecrosis Fluid collection Pseudocyst Infected - Air bubble/ pus aspiration – clinical sepsis CT severity index - prognostication
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THANK YOU
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