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Transcript
Internal Medicine
Prognosis
Ranson's 11 prognostic signs help estimate the prognosis of acute pancreatitis.
• Five signs can be documented at admission:
ο Age more than 55 yr
ο Serum glucose over 200 mg/dl (> 11.1 mmol/L),
ο Serum LDH over 350 IU/L
ο AST over 250 units/L and
ο WBC count over 16,000/µL.
• The development of the following within 48 h after admission indicates worsening
prognosis:
ο Hct drop by more than 10%
ο BUN rise greater than 5 mg/dl (> 1.8 mmol Urea/L)
ο Serum Ca less than 8 mg/dl (< 2 mmol/L)
ο Arterial Po2 less than 60 mm Hg
ο Base deficit over 4 meq/l
ο Estimated fluid sequestration more than 6 L
• Mortality increases with the number of positive signs:
ο If fewer than three signs are positive, the mortality rate is less than 5%;
ο If three or four signs are positive, mortality is between 15 to 20%.
ο The presence of 7 – 8 of these criteria is associated with 100% mortality.
•
Acute pancreatitis associated with necrosis and haemorrhage has a mortality rate of
about 10 to 50%. This diagnosis is suggested by
ο
A progressive decrease in Hct,
ο
The presence of hemorrhagic fluid within ascites,
ο
The reduction of serum Ca++ level,
ο
The presence of Grey Turner's and/or Cullen's sign (indicating extravasations of
hemorrhagic exudates to the flanks or umbilical region, respectively).
Treatment
Mild oedematous pancreatitis:
• Keep patient NPO (nothing per os) until manifestations of acute inflammation subside
• Give sufficient intravenous fluids
• Insert nasogastric tube.
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