Post on 21-Jan-2016
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SPECTRUM OF PANCREATITISABSTRACT NO-145
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.
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.
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
TYPE OF PANCREATITISInterstitial edematous pancreatitisAcute necrotizing pancreatitis 1.parenchymal necrosis 2.peripancreatic necrosis 3.combined type with or
with out infection
TYPES OF PANCREATITIS – FLUID COLLECTION
INTERSTITIAL EDEMATOUS PANCREATITIS
• STERILE/INFECTED
<4 WEEKS-ACUTE PERI PANCREATIC FLUID COLLECTION
• STERILE/INFECTED
> 4 WEEKS –PANCREATIC PSEUDO CYST
NECROTIZING TYPENECROTIZING PANCREATITIS
< 4 WEEKS-ACUTE NECROTIC COLECTION
• STERILE/INFECTED
> 4 WEEKS-WALLED OFF NECROSIS
• STERILE/INFECTED
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
INTERSTITIAL EDEMATOUS PANCREATITIS
INTERSTITIAL EDEMATOUS PANCREATITIS
INTERSTITIAL EDEMATOUS PANCREATITIS
ACUTE NECROTIZING PANCREATITIS
PANCREATIC PARENCHYMAL NECROSIS
PANCREATIC PARENCHYMAL NECROSIS
PANCREATIC PARENCHYMAL NECROSIS
PERI PANCREATIC NECROSIS
PERI PANCREATIC NECROSIS
COMBINED TYPE-NECROSIS
COMBINED TYPE-NECROSIS
ACUTE NECROTIZING-INFECTIOUS
ACUTE PERI PANCREATIC FLUID COLLECTION
PANCREATIC PSEUDO CYST
PANCREATIC PSEUDO CYST
ACUTE NECROTIC COLLECTION
ACUTE NECROTIC COLLECTION
WALLED OFF NECROSIS
WALLED OFF NECROSIS
MULTI COMPARTMENTAL COLLECTIONLEFT PLEURAL COLLECTION
SUB CAPSULAR RENAL PSEUDO COLLECTION
MULTI COMPARTMENTAL COLLECTIONLOCULATED SUB HEPATIC
LEFT PARACOLIC GUTTER
MULTI COMPARTMENTAL COLLECTIONLESSER SAC PELVIC
MULTI COMPARTMENTAL COLLECTION
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
THANK YOU