What radiologist need to know about Acute Pancreatitis: Updated definitions, dynamic disease process & morphologic features (CT Scan)
What is pancreatitis:
Inflammation of pancreas +/- involvement of extra pancreatic tissue
+/- multiorgan involvement
Severest form: Multiorgan dysfunction (MODS) - high mortality rate
What is revised Atlanta classification:
In 2012 the original Atlanta classification of 1992 was updated in 2012 and called as "revised Atlanta classification". It introduced standardized clinical and radiological nomenclature for acute pancreatitis (AP) and associated complications
Following is the updated information
Defines criteria for diagnosis:
Based on pain, lipase levels & CT Scan findings
Defines onset of AP:
Time of onset is based on the appearance of the 1st symptom and not the time of hospital visit
Provides three grades of severity:
Mild - limited to pancreas
Moderate - local or systemic complications & transient organ failure (<48 hrs)
Severe - persistent organ failure (> 48 hrs)
Defines two phases of the dynamic disease:
Early - usually ends by 1st week from onset of symptoms or may be 2nd week
Late - Persistent signs of inflammation & local complications
Defines systemic inflammatory response syndrome (SIRS) -
due to cytokine cascades & a risk for organ failure
Revised Definition of morphologic features
1. Interstitial oedematous pancreatitis
2. Necrotizing pancreatitis
3. Acute pancreatic fluid collections (APFC)
4. Acute necrotic collections (ANC)
5. Walled off necrotic collection (WON)
6. Pancreatic Pseudocyst
Further readings:
https://gut.bmj.com/content/62/1/102
https://pubs.rsna.org/doi/full/10.1148/rg.2016150097
Prepared by: Dr. Sharad Maheshwari
9.2.2022
Updated: 20.10.2022
excellent!
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