Acute pancreatitis is classified into three forms based on the severity. Mild acute pancreatitis, which is characterized by the absence of organ failure and local or systemic complications; Moderately severe acute pancreatitis, which is characterized by transient organ failure (resolves within 48 hours and without persistent organ failure >48 hours) and/or local or systemic complications; and Severe acute pancreatitis, which is characterized by persistent organ failure that may involve one or multiple organs. Patients present with mild to severe steady and boring pain in the epigastrium and periumbilical region. Pain may radiate to the flanks, back, chest and lower abdomen. Nausea, vomiting, and abdominal distension frequently accompany. Physical examination reveals an anxious patient with low-grade fever, and tachycardia, with or without hypotension. Jaundice is infrequent. Abdominal examination may reveal a tender, guarded abdomen. Cullen’s sign and Turner’s sign may be present in severe cases. Pancreatitis is broadly classified into mild and severe varieties. Mild pancreatitis is usually self-limiting. Severe acute pancreatitis has a high mortality (about 20%-30% as compared to overall mortality of 2-5% in acute pancreatitis). Since there is high mortality in severe acute pancreatitis hence, we should determine the severity in the emergency ward itself so that patient triage can be done. Patients with mild disease can be treated in the general ward and those with severe diseases can be managed by more aggressive treatment in specialized center with good intensive care facilities, anesthesia, endoscopic lab and surgical facilities. Therefore, arose the necessity of prognostic factors that allow the clinician to accurately predict the severity of disease. Nowadays many scoring systems are available to assess the severity of acute pancreatitis, e.g., Ranson’s criteria, acute physiology and chronic health evaluation (APACHE II) and computed tomography severity index (CTSI). These scoring methods of risk stratification in acute pancreatitis have important limitations, especially in developing countries like ours. Most hospitals cannot afford the requirements of Ranson’s and Modified Glasgow Score Index. In addition, both these scoring systems take 48 hours for complete evaluation. APACHE II determines the disease severity on the day of admission but it is very complex. CTSI is based on the use of the CECT abdomen. CECT is not available in all hospitals in our country. Moreover, it is not used as a basis of clinical decision-making. Thus, there is a need to find a scoring system that can prognosticate the disease at the earliest, which is cheap, quick, simple, accurate and easily reproducible and can be used comfortably in our country. In 2008, Wu et al developed a clinical scoring system using classification and regression tree analysis for prediction of in-hospital mortality of acute pancreatitis. This is the Bedside Index for Severity in Acute Pancreatitis (BISAP) score. On this score, several studies have been done in Western countries. In India, only a few studies have been done. We conducted this prospective observational study, to evaluate the BISAP score in predicting the outcome of acute pancreatitis, in our part of the country.
Author(s) Details:
Kanwar Singh Goel
Department of General Surgery, SGT Medical College, SGT University, Budhera, Gurugram, Haryana,
India.
Nikhil Goel
Department of Psychiatry, Shaheed Hasan Khan Mewati Government Medical College, Nuh, India.
Sapna Singla
Department of Pathology, Shaheed Hasan Khan Mewati Government Medical College, Nuh, India.
Recent Global Research Developments in Acute Pancreatitis in a Tertiary Care Surgery Department
Prevalence and Importance:
Acute pancreatitis is a common cause of hospital admissions related to gastrointestinal diseases in the United States, with approximately 300,000 emergency department visits annually [1].
Risk stratification, fluid management, and follow-up care are crucial for better outcomes.
Predictive Scoring Tools:
Several scoring systems help assess disease severity and mortality risk. Examples include the Bedside Index of Severity in Acute Pancreatitis (BISAP) and the Acute Physiology and Chronic Health Evaluation (APACHE) II tools.
However, no single tool works well for all forms of acute pancreatitis.
Fluid Resuscitation and Nutrition:
Early and aggressive fluid resuscitation is associated with lower mortality rates and fewer infectious complications.
Optimal fluid type and rate remain areas of ongoing research.
Etiology Investigation:
Identifying the underlying cause of acute pancreatitis is essential for effective management.
Risk-reduction strategies, such as cholecystectomy and alcohol cessation counseling, should be implemented during and after hospitalization.
Clinical Judgment and Care:
While scoring systems are helpful, clinical judgment remains crucial.
Adequate fluid management and nutrition play pivotal roles in acute pancreatitis care.
References
- Mederos, M. A., Reber, H. A., & Girgis, M. D. (2021). Acute pancreatitis: a review. Jama, 325(4), 382-390.