Clinical ReviewsAcute Pancreatitis: What's the Score?
Introduction
The incidence of acute pancreatitis (AP) has been on the rise worldwide (1). AP has a yearly incidence of approximately 13–45 new cases per 100,000 per year, with an estimated annual cost of $2.2 billion each year for admissions 2, 3. Although a number of guidelines and scoring systems exist, there is a considerable amount of inconsistency in the diagnosis and management of this disease process, and few physicians are familiar with any tools for risk stratification beyond Ranson criteria.
In 1997, the American College of Gastroenterology produced guidelines for the diagnosis and treatment of AP that have since been updated in 2006 and 2013 4, 5. These guidelines advocate for the rapid determination of hemodynamic status and initiation of resuscitative efforts and risk assessment for the appropriate stratification of patients with AP. Classic risk assessment tools such as Ranson criteria can predict disease severity and dictate treatment in AP, but they have a significant limitation. Many of the criteria are not obtainable at presentation to the emergency department (ED), which makes the job of ascertaining how the patient's disease will progress difficult for emergency physicians. Evidence-based guidelines need to be in place to best risk-stratify patients early in the disease course. This article will briefly review the clinical features, diagnosis, and management of AP and familiarize readers with predictors of severe disease and readmission other than Ranson criteria.
Section snippets
Pathophysiology
The disease process in AP is described in three phases (6). The first phase is due to leakage of pancreatic enzymes into pancreatic tissue secondary to injury or disruption of the pancreatic acini. The leaked enzyme, trypsinogen, becomes activated into trypsin, causing subsequent edema, vascular damage, hemorrhage, and necrosis of the pancreas. The second and third phases of AP are characterized by intrapancreatic and extrapancreatic inflammation, respectively.
The two most common and important
Conclusion
AP is a common presentation in the ED, with potentially serious complications. Health care providers must quickly identify those patients at highest risk for severe AP and decompensation for effective treatment and disposition. Multiple scoring systems have been developed over the past few decades, each with distinct drawbacks and strengths. Modern scoring systems such as BISAP, Panc 3, HAPS, and JSS have been shown to effectively predict the severity of AP based on various data points at
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