SPECTRUM OF PANCREATITISABSTRACT 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 PANCREATITISInterstitial edematous pancreatitisAcute 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

• STERILE/INFECTED

> 4 WEEKS –PANCREATIC PSEUDO CYST

NECROTIZING TYPENECROTIZING PANCREATITIS

< 4 WEEKS-ACUTE NECROTIC COLECTION

• STERILE/INFECTED

> 4 WEEKS-WALLED OFF NECROSIS

• STERILE/INFECTED

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 COLLECTIONLEFT PLEURAL COLLECTION

SUB CAPSULAR RENAL PSEUDO COLLECTION

MULTI COMPARTMENTAL COLLECTIONLOCULATED SUB HEPATIC

LEFT PARACOLIC GUTTER

MULTI COMPARTMENTAL COLLECTIONLESSER 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

THANK YOU