Evaluation of Patients with Acute Pancreatitis in the Emergency Department

Öz

Objective: The aim of this study was to assess the demographic and clinical features, diagnostic methods and outcomes of patients diagnosed as acute pancreatitis in the emergency department (ED). Materials and Methods: This study was designed retrospectively by examining medical records of the patients (age≥18 years) who were diagnosed as acute pencreatitis in the ED, between January 2007 and January 2008. Results: A total of 61 patients (31 male [50.8%], mean age 60,6±15,4) diagnosed as acute pancreatitis were enrolled the study. Nausea and abdominal pain were common complaints on admission. Clinical severity was mild in 32 patients (61.5%) and was severe in 20 patients (38.5%). CT severity index (CTSI) was determined in these patients. The sensitivity, specificity, positive predictive value, negative predictive value were calculated for the CTSI>3 (90%, 97%, 95%, 94%) for identifying the severe pancreatitis. Fifty patients (%82) were hospitalized. There was a correlation between duration of hospitalization and CTSI in these patients (p=0.001, r=0.497). Conclusion: Early identification of clinical severity is crucial for planning of therapeutic strategies of acute pancreatits in the ED. Abdomen CT is an effective method in the diagnosis, assessment of clinical severity and complications of acute pancreatitis.

Anahtar Kelimeler

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Acil Serviste Akut Pankreatit Tanısı Alan Hastaların Değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı acil serviste (AS) akut pankreatit tanısı alan olguların demografik ve klinik özelliklerini, tanısal yaklaşımlarını ve klinik sonuçlarını tartışmaktır. Gereç ve Yöntemler: Ocak 2007 ve Ocak 2008 tarihleri arasında hastanemiz AS'inde akut pankreatit tanısı alan hastaların (yaş≥18) kayıtları geriye dönük olarak incelendi. Bulgular: Çalışmaya akut pankreatit tanısı alan 61 hasta (31 erkek [%50,8], ortalama yaş 60,6±15,4) dahil edildi. Başvuru anında karın ağrısı ve bulantı sık görülen şikayetler idi. Hastaların 32'sinde (%61,5) klinik hafif iken, 20'sinde (%38,5) şiddetli idi. Bu hastalarda BT şiddet skoru (BTŞS) değerlendirildi. BTŞS >3 değerinin şiddetli pankreatiti tanımadaki duyarlılık, özgüllük, pozitif öngörü değeri, negatif öngörü değeri sırasıyla (%90, %97, %95, %94) hesaplandı. Hastalardan 50'si (%82) hastaneye yatırılmıştı. Yatan hastaların BTŞS'si ile yatış süreleri arasında korelasyon mevcuttu (p=0.001, r=0.497). Sonuç: Acil serviste akut pankreatit tanısı alan hastalarda klinik şiddetin erken dönemde tanımlanması uygun tedavi stratejisinin belirlenmesine katkı sağlar. Batın BT akut pankreatit tanısında, klinik şiddetin ve komplikasyonların belirlenmesinde etkili bir yöntemdir.

Anahtar Kelimeler

• Akut pankreatit, acil servis, BT şiddet skoru

Kaynakça

1. 1. Carroll JK, Herrick B, Gipson T, Lee SP. Acute pancreatitis: diagnosis, prognosis, and treatment. Am Fam Physician. 2007; 75: 1513-20.
2. 2. Sargent S. Pathophysiology, diagnosis and management of acute pancreatitis. Br J Nurs. 2006; 15: 999-1005
3. 3. Mitchell RM, Byrne MF, Baillie J. Pancreatitis.Lancet. 2003; 361: 1447-55.
4. 4. Maher MM, Lucey BC, Gervais DA, Mueller PR. Acute pancreatitis: the role of imaging and interventional radiology. Cardiovasc Intervent Radiol. 2004; 27: 208-25.
5. 5. Vlodov J, Tenner SM. Acute and chronic pancreatitis. Prim Care. 2001; 28: 607-28.
6. 6. Yousaf M, McCallion K, Diamond T. Management of severe acute pancreatitis. Br J Surg. 2003; 90: 407-20.
7. 7. Kaya E, Dervisoglu A, Polat C. Evaluation of diagnostic findings and scoring systems in outcome prediction in acute pancreatitis. World J Gastroenterol. 2007; 13:3090-4.
8. 8. Kim YS, Lee BS, Kim SH, et al. Is there correlation between pancreatic enzyme and radiological severity in acute pancreatitis? World J Gastroenterol. 2008; 14:2401-5.

9. 9. Elmas N. The role of diagnostic radiology in pancreatitis. European Journal of Radiology 2001; 38:120-132
10. 10. Bollen TL, van Santvoort HC, Besselink MG, et al. The Atlanta Classification of acute pancreatitis revisited. Br J Surg. 2008; 95: 6-21.
11. 11. Alhajeri A, Erwin S. Acute pancreatitis: value and impact of CT severity index. Abdom Imaging. 2008; 33: 18-20.
12. 12. Gürleyik G, Emir S, Kiliçoglu G, Arman A, Saglam A. Computed tomography severity index, APACHE II score, and serum CRP concentration for predicting the severity of acute pancreatitis. JOP. 2005; 6: 562-7.
13. 13. Koizumi M, Takada T, Kawarada Y, et al. JPN Guidelines for the management of acute pancreatitis: diagnostic criteria for acute pancreatitis. J Hepatobiliary Pancreat Surg. 2006; 13: 25-32
14. 14. Vissers RJ, Abu-Laban RB. Acute and chronic pancreatitis. In: Tintinalli JE, Kelen GD, Stapczynski JS (eds.), Emergency medicine. A comprehensive study guide. 5th edition, New York: McGraw-Hill, 2000: 588-592.
15. 15. Karaca E, Oktay C. Travma dışı akut pankreatit olgularında prognostik kriterlerin sonuç üzerine etkisi. Türkiye Acil Tıp Dergisi 2008; 8:18-25.
16. 16. DiMagno MJ, DiMagno EP. New advances in acute pancreatitis. Curr Opin Gastroenterol. 2007; 23: 494-501.
17. 17. Ayten R, Çetinkaya Z, Yeniçerioğlu A. Akut Pankreatitli Olgularımızın Retrospektif Değerlendirilmesi. F.Ü. Sağ. Bil. Derg. 2007: 21:133 -136.
18. 18. Lankisch PG, Burchard-Reckert S, Lehnick D. Underestimation of acute pancreatitis: patients with only a small increase in amylase/lipase levels can also have or develop severe acute pancreatitis. Gut. 1999; 44: 542-4.
19. 19. Hirota M, Takada T, Kawarada Y, et al. JPN Guidelines for the management of acute pancreatitis: severity assessment of acute pancreatitis. J Hepatobiliary Pancreat Surg. 2006; 13:33- 41.
20. 20. De Waele JJ, Delrue L, Hoste EA, et al. Extrapancreatic inflammation on abdominal computed tomography as an early predictor of disease severity in acute pancreatitis: evaluation of a new scoring system. Pancreas. 2007;34:185-90.
21. 21. Pezzilli R, Uomo G, Zerbi A, et al. Diagnosis and treatment of acute pancreatitis: the position statement of the Italian Association for the study of the pancreas. Dig Liver Dis. 2008; 40:803-8.
22. 22. Vriens PW, van de Linde P, Slotema ET, Warmerdam PE, Breslau PJ. Computed tomography severity index is an early prognostic tool for acute pancreatitis. J Am Coll Surg. 2005; 201: 497-502.
23. 23. Taylor SL, Morgan DL, Denson KD, Lane MM, Pennington LR. A comparison of the Ranson, Glasgow, and APACHE II scoring systems to a multiple organ system score in predicting patient outcome in pancreatitis. Am J Surg. 2005; 189:219-22.
24. 24. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990; 174:331-6.
25. 25. Vriens PW, van de Linde P, Slotema ET, Warmerdam PE, Breslau PJ. Computed tomography severity index is an early prognostic tool for acute pancreatitis. J Am Coll Surg. 2005; 201:497-502.