Trans abdominal Ultrasonography in Acute Pancreatitis: a cross sectional study

BACKGROUND: Acute pancreatitis (AP) is a common cause of acute pain abdomen. Contrast-enhanced Computed Tomography (CECT) of the abdomen is the imaging method of choice in acute pancreatitis. Ultrasonography can be used as the first, easily available imaging modality for the assessment of the pancreas. This study aims to study the transabdominal USG findings in patients with acute pancreatitis. It will also compare USG findings with CT findings in acute pancreatitis. METHODS: A hospital-based cross-sectional, prospective study comprising of consecutive 55 patients with acute pancreatitis was conducted over a study period of 15 months. Trans abdominal USG findings and CECT abdominal findings in acute pancreatitis were studied and compared. Data analysis was done using SPSS version 20 and a p-value of ≤0.05 was considered significant. RESULTS: Pancreas was visualized by USG in only 69%. Ultrasonography had some pancreatic and/or extrapancreatic findings in patients with acute pancreatitis in 84.2% of patients in whom the pancreas was visualized, whereas, it was 98.2% by CECT abdomen. USG was unable to demonstrate findings in 75% of patients with mild acute pancreatitis. CONCLUSION: Transabdominal ultrasonography detection of pancreatitis was inferior to the CECT. It had a limited role in detecting mild acute pancreatic cases. Nonetheless, detection of etiological factor such as gallstones, and assessment of extra pancreatic fluid collection like ascites and pleural effusion were better visualised with ultrasound. USG is readily available, cheap, noninvasive, and can be utilized as an initial diagnostic tool for acute pancreatitis and ruling out other causes of acute abdomen.

SARS-CoV-2 Infection as a Cause of Acute Pancreatitis in a Child—A Case Report

The novel coronavirus disease (COVID-19) was detected for the first time in China in December 2019. Soon after it was declared a pandemic. Main symptoms include fever, dyspnea, cough, muscle pain, headache, anosmia and ageusia, however a growing body of evidence shows that other organs can be affected. Gastrointestinal manifestations have been observed in a considerable number of patients and include abdominal pain, diarrhea and vomiting. The involvement of liver as well as pancreas has been also described, however there are only a few cases of acute pancreatitis reported in patients with COVID-19. Therefore, we present a case of 6-year-old child with mild acute pancreatitis and COVID-19 pneumonia.

STUDY OF ALBUMIN, CALCIUM AND ALBUMIN CORRECTED CALCIUM WITH SEVERITY OF ACUTE PANCREATITIS

Aim: The purpose of this study to evaluate the level of serum Albumin, Calcium and Albumin corrected calcium with severity of acute pancreatitis. Material and methods:The study was conducted in Department of Biochemistry in association with Department of Gastroenterology, Mahatma Gandhi Medical College & Hospital. In present study out of 133 patients diagnosed for Acute Pancreatitis; total 115 patients (n=115) of either gender of 18 to 65years age groups were enrolled for the study. Patients with history of any acute or chronic illness like: - Hyperparathyroidism, Diabetes Mellitus, Impaired renal function, Malnourished, Pregnant and lactating women and patients on calcium supplements were excluded. Result: Mean level of calcium decreased with progression in disease severity (p≤0.001).The mean Albumin Corrected Calcium was also signicantly lower in the patients presenting with severe and moderate acute pancreatitis compared with the mild acute pancreatitis patients (p≤0.0001). Conclusion: The study recommends hypocalcaemia and hypoalbuminemia as independent risk factors of progression towards severe pancreatitis. Similarly, albumin corrected calcium is suggested as a reliable marker for severity of pancreatitis.

566 A Study to Investigate CRP and WBC As Early Prognostic Tools in Severe Pancreatitis

Aim To establish the prognostic value of raised inflammatory markers on Day 3 in patients with severe acute pancreatitis Method A retrospective study between 01/02/18 till 31/01/19 including all patients with acute pancreatitis. Patient demographics, the aetiology, treatment, severity (as per modified Atlanta's criteria) and inflammatory markers on Day 3 of the hospital admission were included. ROC curves were subsequently generated. Results 127 patients were included with a median age of 59 years. 113 patients were diagnosed with mild acute pancreatitis while 14 patients had severe acute pancreatitis. The ROC curve illustrates that the value of CRP which maximises discrimination was 176 mg, with a sensitivity of 83% and specificity of 76%. For WBC with a value of 12.11 showed 100% sensitivity and 80% specificity. Conclusions This study highlights that elevated CRP and WBC on Day 3 could both be good predictive tools for patients who develop severe pancreatitis.

Ketamine and Xylazine Effects in Murine Model of Acute Pancreatitis

Ketamine and xylazine (Ket/Xyl) are anesthetic agents that target neural pathways and are commonly used in combination in mouse studies. Since neural pathways can modulate acute pancreatitis severity we asked if Ket/Xyl affect disease severity. C57BL/6 mice were treated with six hourly injections of cerulein to induce mild acute pancreatitis. Mice were also treated with and without ketamine, xylazine, and Ket/Xyl prior to pancreatitis induction in vivo and in vitro. Ket/Xyl pre-treatment in vivo increased select parameters of pancreatitis severity such as trypsin activity and edema; these effects were predominantly mediated by xylazine. Ket/Xyl also changed markers of autophagy. These in vivo effects of Ket/Xyl were not attenuated by atropine. The drugs had no little to no effect on pancreatitis responses in isolated pancreatic cells or lobules. These findings suggest that Ket/Xyl administration can have substantial effect on acute pancreatitis outcomes through non-muscarinic neural pathways. Given wide-spread use of this anesthetic combination in experimental animal models, future studies of inflammation and injury using Ket/Xyl should be interpreted with caution.

Bedside index (BISAP) v/s Ranson scores in predicting mortality and severity in patients with acute pancreatitis.

Objective: To determine diagnostic accuracy of BISAP in comparison to Ranson scores in predicting mortalities and severities in patients with acute pancreatitis coming to the emergency department. Methods: Cross-sectional study conducted in Department of Emergency Medicine, Aga Khan University Hospital, Stadium road Karachi, Pakistan. 136 patients were selected via non-probability consecutive sampling technique, those who fulfilled the criteria of inclusion. BISAP score was applied in the emergency department (ED) & the patients were followed in ward/intensive care unit where Ranson scores were calculated in the following 48 hours. Both the scores were calculated and compared for the prediction of severity and mortality for each patient. All the obtained data was recorded in Performa. Results: In this study 136 patients, who fulfill the inclusion criteria were selected. On the basis of BISAP and Ranson score; mild acute pancreatitis to moderate acute pancreatitis (MAP to ModAP) was diagnosed in 123 (90.4%) and 119 (87.5) patients and severe AP (SAP) in 13 (9.6%) and 17 (12.5%) patients respectively. Specificity (Sp) 94.62% vs 91.54%, Sensitivity (Sn) 100.0% vs 100.0%, negative predictive value (NPV) 100.0% vs 100.0%, positive predictive value (PPV) 46.15% vs 35.29% and diagnostic accuracy (DA) 94.85% vs 91.91% of BISAP vs Ranson scores respectively. Conclusion: It was concluded from the study that BISAP and Ranson score are very reliable tool for identification of acute pancreatitis patients at higher risk of severity and mortality. BISAP and Ranson score has same sensitivity but BISAP score has higher specificity than Ranson score. Continuous...