SPECTRUM OF PANCREATITIS ABSTRACT 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 PANCREATITIS Interstitial edematous pancreatitis Acute 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 > 4 WEEKS –PANCREATIC PSEUDO CYST

NECROTIZING TYPE NECROTIZING PANCREATITIS < 4 WEEKS-ACUTE NECROTIC COLECTION STERILE/INFECTED > 4 WEEKS-WALLED OFF NECROSIS

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 COLLECTION LEFT PLEURAL COLLECTION SUB CAPSULAR RENAL PSEUDO COLLECTION

MULTI COMPARTMENTAL COLLECTION LOCULATED SUB HEPATIC LEFT PARACOLIC GUTTER

MULTI COMPARTMENTAL COLLECTION LESSER 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

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