Pancreatitis classification

Pancreatitis Main Page
Patient Information
Overview
Causes
Classification Acute Pancreatitis Chronic Pancreatitis Hereditary Pancreatitis Autoimmune Pancreatitis
Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

There are different forms of pancreatitis, which are different in causes and symptoms, and require different treatment.

Classification

Acute Pancreatitis

Acute pancreatitis is a rapidly-onset inflammation of the pancreas. Depending on its severity, it can have severe complications and high mortality despite treatment. While mild cases are often successfully treated with conservative measures, such asNPO (abstaining from any oral intake) and IV fluid rehydration, severe cases may require admission to the ICU or even surgery (often more than one intervention) to deal with complications of the disease process.

Grading of Acute Pancreatitis

The definitions of severity in acute pancreatitis according to the revised Atlanta classification is as follows.

Interstitial edematous acute pancreatitis

There is edema of the pancreas following a bout of acute pancreatitis. The inflammation is more prominent in the parenchyma and tissues surrounding the pancreas. No frank sign of necrosis are seen.

Necrotizing acute pancreatitis

Edema along with necrosis in the parenchyma and tissue surrounding pancreas is seen

Pancreatitis is classified according to severity in the following way:

1.Mild acute pancreatitis

• No organ failure
• No local or systemic complications

2.Moderately severe acute pancreatitis

• Organ failure that resolves within 48 h (transient organ failure) and/or
• Local or systemic complications without persistent organ failure

3. Severe acute pancreatitis

• Persistent organ failure (>48 h)
• Single organ failure
• Multiple organ failure

Chronic Pancreatitis

Chronic pancreatitis is a long-standing inflammatory disease of the pancreas characterized by irreversible change to pancreatic structure and function related to inflammation and fibrosis. Pancreatitis presents as a complex of pain and poor quality of life and, as it advances, develops symptoms related to exocrine and endocrine insufficiency, manifesting asmalabsorption or diabetes.

Hereditary Pancreatitis

Hereditary pancreatitis is a genetic disease affecting enzyme production in the pancreas.

Subtypes of Pancreatitis

• Interstitial Edematous Pancreatitis

▸ Acute inflammation of the pancreatic parenchyma and peripancreatic tissues, but without recognizable tissue necrosis

CECT criteria

▸ Pancreatic parenchyma enhancement by intravenous contrast agent.

▸ No findings of peripancreatic necrosis.

• Necrotizing Pancreatitis

▸ Inflammation associated with pancreatic parenchymal necrosis and/or peripancreatic necrosis

CECT criteria

▸ Lack of pancreatic parenchymal enhancement by intravenous contrast agent

▸ Presence of findings of peripancreatic necrosis.

• Infected Pancreatic Necrosis:

▸ It should be considered in patients with necrotizing pancreatitis who deteriorate or fail to improve after 7–10 days of hospitalization.

▸ It may be presumed by the presence of extraluminal gas on CECT or when fine-needle aspiration is positive for bacteria and/or fungi on Gram stain and culture.

▸ Antibiotics are able to penetrate pancreatic necrosis (such as carbapenems, quinolones, and metronidazole) and may be useful in delaying or sometimes totally avoiding intervention.

References

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