American Journal of Public Health Research
ISSN (Print): 2327-669X ISSN (Online): 2327-6703 Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Public Health Research. 2015, 3(5A), 156-159
DOI: 10.12691/ajphr-3-5A-34
Open AccessResearch Article

Management of Acute Pancreatitis with Search for Reliable Prognostic Indicators

N K Hazra1, , O B Karki1, B Sathian2, Abhijit De3, Samikshya Ghimire4, Rajan Sharma1, Rajiv Nakarmi1 and Aman Juneja5

1Department of Surgery, Manipal Teaching Hospital, Pokhara, Nepal

2Department of Community Medicine, Manipal College of Medical Sciences, Pokhara, Nepal

3Medical Officer, Kolkata, India

4Medical Officer, Kathmandu, Nepal

5Medical Officer, Punjab, India

Pub. Date: October 28, 2015
(This article belongs to the Special Issue Health Scenario 2015; Millennium Development Goals)

Cite this paper:
N K Hazra, O B Karki, B Sathian, Abhijit De, Samikshya Ghimire, Rajan Sharma, Rajiv Nakarmi and Aman Juneja. Management of Acute Pancreatitis with Search for Reliable Prognostic Indicators. American Journal of Public Health Research. 2015; 3(5A):156-159. doi: 10.12691/ajphr-3-5A-34


Acute pancreatitis is quite common in Nepal. It afflicts male, female, adolescent and old equally. With advent of newer diagnostic tool, medical knowledge, and health awareness the thrust is on controlling the morbidity and mortality, hence search for reliable prognostic indicators. The prospective study was taken up to find out the reliable prognostic indicators from the clinical, biochemical and radiological parameters amongst the patients of acute pancreatitis with a view to optimize treatment protocol. A Cohort of 402 cases treated at Manipal Teaching Hospital from January 2006 to September 2015 were followed up. Age, sex, clinical findings were recorded. Serum amylase, LDH, Total Leucocytes Count (TLC), complete blood count (CBC), blood sugar, serum calcium, pO2, X-ray abdomen (AXR), X-ray chest (CXR), ultra sonogram (USG), and computed tomography (CT) scans were analyzed. Treatment protocol was formulated. Patient’s age ranged from 7–89 years (mean age 48 years; males were 189(47.014%), female 213(52.985%) with M:F ratio1:1.12. Precipitating causes were alcohol 116(28.855%), gall stone 78(19.402%), idiopathic 196(48.756%), mumps 6, ascariasis 4, trauma 1, postoperative 1 (Caesarian). Clinical findings were, pain in the epigastrium radiating to back in 190(47.263), pain abdomen without radiation in 212, (52.736%) vomiting in 186(46.268%) patients. Cullen’s sign was present in one, TLC was raised in 54(13.432%), serum amylase in 378(94.029%), LDH in 70.652% of cases, AXR was noncontributory, CXR showed pleural effusion in 10.778% of cases, USG abdomen done in 389 cases showed AP lesion in 241(61.93%). computed tomography (CT) and contrast enhanced computed tomography (CECT) done in 160 cases showed AP lesion in 159 (99.375%). CECT is probably the best diagnostic tool and indicator; complications encountered were renal failure in 4, ileus in 5, pseudo pancreatic cysts in 3, splenic vein thrombosis in one. Death occurred in 4 cases, Laparotomy was done in one. Diagnostic difficulty was experienced in 4 cases. Average hospital stay was 5 days (prolonged in cases those underwent cholecystectomy). Most of the cases being of mild form could be treated conservatively. Prophylactic antibiotic with cefuroxime was found to be useful. CECT probably is the best form of diagnostic tool as well as prognostic marker.

Acute pancreatitis Contrast Enhanced Computed Tomography Serum Amylase

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Banks P, Freeman M; Freeman. Practice Parameters Committee of the American College of Gastroenterology “Practice guidelines in acute pancreatitis”. Am J Gastroenterol 2006; 101 (10): 2379-400.
[2]  Pederzoli P, Bassi C, Vesentini S, Campedelli A; Bassi; Vesentini; Campedelli. “A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem”. Surgery, gynecology & obstetrics. 1993; 176 (5): 480-3. PMID 8480272.
[4]  Anthony JK,Renz W, Willson BK,Worthley C, Reece J,Bessell J, Thomas D. Evaluation of amylase and lipase in the diagnosis of acute pancreatitis. ANZ Journal of Surgery.
[5]  Steinberg, William M, Goldstein SS, Davis ND, Shamma'a J, Anderson K. “Diagnostic Assays in Acute Pancreatitis”. Annals of Internal Medicine 1985;102 (5): 576-80.
[6]  Khuroo MS, Zargar SA, Mahajan R: Hepatobiliary and pancreatic ascariasis in India. Lancet 1990; 335:1503-1506.
[7]  Gardner, Timothy B.; Vege, SanthiSwaroop; Chari, Suresh T.; Petersen, Bret T.; Topazian, Mark D.; Clain, Jonathan E.; Pearson, Randall K.; Levy, Michael J.; Sarr, Michael G. “Faster Rate of Initial Fluid Resuscitation in Severe Acute Pancreatitis Diminishes In-Hospital Mortality”. Pancreatology 2009; 9 (6): 770-6.
[8]  Wu, Bechien U.; Hwang, James Q.; Gardner, Timothy H.; Repas, Kathryn; Delee, Ryan; Yu, Song; Smith, Benjamin; Banks, Peter A.; Conwell, Darwin L. “Lactated Ringer's Solution Reduces Systemic Inflammation Compared with Saline in Patients with Acute Pancreatitis”. Clinical Gastroenterology and Hepatology 2011; 9 (8): 710-717.e1.
[9]  Gardner, Timothy B.; Vege, SanthiSwaroop; Pearson, Randall K.; Chari, Suresh T. “Fluid Resuscitation in Acute Pancreatitis”. Clinical Gastroenterology and Hepatology 2008; 6 (10): 1070-6.
[10]  Haydock, Matthew D.; Mittal, Anubhav; Wilms, Heath R.; Phillips, Anthony; Petrov, Maxim S.; Windsor, John A. “Fluid Therapy in Acute Pancreatitis”. Annals of Surgery 2013; 257 (2): 182-8.
[11]  Ranson JHC, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surgery Gynecology and Obstetrics. 1974; 139(1):69-81. [PubMed]
[12]  Leese T, Shaw D. Comparison of three Glasgow multifactor prognostic scoring systems in acute pancreatitis. Br J Surg. 1988 May; 75(5):460-2. PubMed PMID: 3390678.
[13]  Larvin M, McMahon M; McMahon “APACHE-II score for assessment and monitoring of acute pancreatitis”. Lancet 1989;2 (8656): 201-5.
[14]  KnausWA,Draper EA, Wagner DP et al. APACHE II: a severity of disease classification. Crit Care Med 1985;13:818
[15]  Georgios I Papachristou, Venkata Muddana, Dhiraj Yadav, Michael O’Connell, Michael K Sanders, Adam Slivka and David C WhitcomComparison of BISAP, Ranson's, APACHE-II, and CTSI Scores in Predicting Organ Failure, Complications, and Mortality in Acute Pancreatitis Am J Gastroenterol 2010; 105:435-441.
[16]  Blamey SL, Imrie CW, O'Neill J, Gilmour WH, Carter DC. Prognostic factors inacute pancreatitis. Gut. 1984 Dec; 25(12): 1340-6. PubMed PMID: 6510766; PubMed Central PMCID: PMC1420197
[17]  Kajunori T. Japanese guideline for management of AcutePancreatitis: issues in Japanese Criteria for severity assessment in acute pancreatitis. Pancreas Jul 2007-vol35 issue1 p88.
[18]  Ueda T, Takeyama Y, Yasuda T, Kamei K, Satoi S, Sawa H, Shinzeki M, Ku Y, Kuroda Y, Ohyanagi H. Utility of the new Japanese severity score and indications for special therapies in acute pancreatitis. J Gastroenterol. 2009; 44(5):453-9.
[19]  Lankisch PG, Weber-Dany B, Hebel K, Maisonneuve P, Lowenfels AB. The harmless acute pancreatitis score: a clinical algorithm for rapid initial stratificationofnonsevere disease. ClinGastroenterolHepatol. 2009 Jun;7(6):702-5; quiz 607.
[20]  Wu BU, Johannes RS, Sun X et al. the early prediction of mortality in acute pancreatitis: a large population based study. Gut 2008;57:1698-703.
[21]  Marshall JC, Cook DJ, Christou NV et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995; 23: 1638-52.
[22]  Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002; 223(3): 603-613. [PubMed].
[23]  Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH; Robinson; Megibow; Ranson. “Acute pancreatitis: value of CT in establishing prognosis”. Radiology 1990; 174 (2): 331-336.
[24]  Vriens PW, van de Linde P, Slotema ET, Warmerdam PE, Breslau PJ, Van De L, Warmerdam BS. “Computed tomography severity index is an early prognostic tool for acute pancreatitis”. J Am CollSurg2005; 201 (4): 497-502.