PANCREATITIS AGUDA

1. Balthazar score

Is a subscore within the CT severity index (CTSI) for grading of acute pancreatitis.

The CTSI sums two scores:

- Balthazar score: grading of pancreatitis (A-E)

- Grading the extent of pancreatic necrosis

The Balthazar score was originally used alone, but the addition of a scores for pancreatic
necrosis improved correlation with clinical severity scores

Grading of pancreatitis (Balthazar score):

A Normal Pancreas 0

B Enlargement of pancreas 1

C In ammatory changes in 2
pancreas and peri pancreatic fat

D Ill-de ned single peri pancreatic 3

uid collection

E Two or more poorly de ned 4

peripancreatic uid collections

Pancreatic necrosis:

None 0

≤30% 2

>30-50% 4

>50% 6

The maximum score that can be obtained is 10

Strati cation of pancreatitis severity:

1. Mild pancreatitis: also known as interstitial pancreatitis, Balthazar B or C, without

pancreatic or extra pancreatic necrosis

2. Intermediate pancreatitis: also known as exudative pancreatitis, Balthazar D or E, without

pancreatic necrosis; peripancreatic collections are due to extra pancreatic necrosis

3. Severe pancreatitis: also known as necrotizing, necrosis of the pancreas (non-enhancing

areas in te pancreas on contrast-enhanced CT)

Images:

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Balthazar E Balthazar E Balthazar C

Balthazar E
 APACHE II SCORE

- APACHE II is the most widely used ICU mortality prediction score

- It di ers from the original APACHE score in some ways: the number of variables is
decreased and the weight of some of the variables is adjusted

- APACHE III and APACHE IV scores were also developed but are not commonly used
because their statistical method is under copyright control

- The score was derived in a general ICU population and may be less precise when applied to
speci c populations such as liver failure or HIV patients

- Since APACHE II was studied on patients newly admitted to the ICU, it is not accurate when
dealing with patients transferred form another unit or another hospital, This is kwon as lead
time bias and is addressed in APACHE III

- There are other indices of severity of acute pancreatitis. Among them with mentioning, apart
of the Ranson Scale, the Atlanta, apache, glasgow, banks agarwald and pitchman scores.
None of them is ideal, but they are helpful tools that improves the exclusively clinical
assessment that only identi es 35-45% of the severe pancreatitis. They usually require al
seats 48h for evaluation and don’t even present high sensitivity or speci city rates

- From all of them, the most accurate predictor is the so called APACHE (Acute Physiology
And Chronic Health Evaluation), which emerged in 1981 as a system that allows quantify the
severity of the disease through 34 physiological variables that express the intensity of the
disease. Although it was initially used in patients admitted to the ICU, it was later proposed
for other units

- APACHE II uses 12 parameters of the 34 of the Acute Physiology Score. In order to obtain an
index that re ects the level of services received. So therefore, to calculate the score, the 12
physiological variables are added, the score obtained by age and the one obtained by
chronic disease. This system is being perfected continuously with the appearance of new
versions, adapted to be used as measurement techniques for patients admitted to
hospitalization units.

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RANSONS CRITERIA

Walled-o necrosis:

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Acute preipancreatic collection:

Acute necrotic collection:

Pancreatic pseudocyst: