A Modified CT Severity Index for Evaluating Acute Pancreatitis and its Correlation with Clinical Outcome

Dr Anshul Agrawal; Dr Sanjeev Agarwal

Volume : VIII, Issue : IV, April - 2019

A Modified CT Severity Index for Evaluating Acute Pancreatitis and its Correlation with Clinical Outcome

Dr Anshul Agrawal, Dr Sanjeev Agarwal

Abstract :

The pancreas is a large flattened gland located in the abdomen. The pancreas is an elongated retroperitoneal organ; 15–20 cm in length; lies against L1 –L2 vertea. It lies posterior to stomach, separated by lesser sac. The pancreas has two main functions; firstly, exocrine releases powerful digestive enzymes into the small intestine to aid the digestion of food. Secondly, endocrine releases the hormones insulin and glucagon into the bloodstream for regulation of blood sugar.1 These hormones also help in converting the food we eat into fuel for the body cells. Pancreatitis is the inflammation of the pancreatic parenchyma. Pancreatic damage happens when the digestive enzymes are activated before they are released into the small intestine and begin attacking the pancreas. There are two forms of pancreatitis: acute and chronic.2 Aim: The paper aims at studying the role of Modified Computed Tomography Severity Index (MCTSI) in cases of Acute Pancreatitis. The study focuses on studying various presentations of Acute Pancreatitis, stratifying the severity and course of Acute Pancreatitis, and to correlate Modified CT Severity with clinical picture in Acute Pancreatitis. Thus the objectives were early identification of patients requiring Surgical Intensive Care Unit monitoring and to avoid aggressive treatment to patients of Acute Pancreatitis identified with mild and moderate disease. Material and Methods: This was a hospital–based prospective study and was carried out in the Department of General Surgery, Geetanjali Medical College and Hospital, Udaipur. Data was collected from various indoor departments of the hospital with a clinical laboratory, and USG findings suggestive of Acute Pancreatitis. For all the patients suffering from acute pancreatitis, the Consecutive and Random Sampling method was used to support the study and carry out the observations among all the 46 patients in a randomized manner and sometimes using the consecutive sampling as well. Results: There were 30 male and 16 female patients with a mean age of 43.33 years. Biliary Pancreatitis was found in the 41% patients (n = 19) followed by Alcoholic Pancreatitis (n = 17). During the study, 4.3% (n = 2) patients had mild MCTSI, 84.7% (n = 39) patients had moderate MCTSI and 11.0% (n = 5) patients had severe MCTSI. Further, there was a statistically significant interaction between Disease Severity and MCTSI. Also, there was a statistically significant interaction between a hospital stay and MCTSI. Higher the MCTSI, higher is the hospital stay of the patient. Conclusion: MCTS score almost correctly assesses the patient having moderate and severe disease but patient having the mild disease are sometimes assessed more aggressively by MCTSI and vigorous treatment is given to them, which is actually appropriate for the patients with moderate severity. The scale of study is very low, but it would be good to conclude on the note that a MCTSI system for Acute Pancreatitis is an essential requirement of present time and it can predict the outcome and progression of the disease more accurately than any individual clinical or earlier CT grading systems