Acute Pancreatitis

Cullen's sign, ecchymosis in the subcutaneous fat around the umbilicus, which isassociated with Grey-Turner's sign (bruising on the flanks). This can indicate pancreatic necrosis with retroperitoneal bleeding.

Cullen's sign, ecchymosis in the subcutaneous fat around the umbilicus, which isassociated with Grey-Turner's sign (bruising on the flanks). This can indicate pancreatic necrosis with retroperitoneal bleeding.

Learning points from conference today:

1) Identifying patients who are at high risk for severe disease is important as this group will require close monitoring and possible intervention. Rather than using one of the scores requiring data at 48 hours (such as Ranson's criteria and the APACHE II score), consider using the "Bedside Index of Severity in Acute Pancreatitis" (BISAP) score in the first 24 hours from this 2008 study published in Gut. The criteria used are:

  • BUN > 25 mg/dL
  • Altered mental status
  • SIRS
  • Age > 60
  • Pleural effusion

More than 2 points = 7 fold risk of organ failure and 10 fold increase in risk of death. Please note the first letters somewhat follow the name of the tool, which makes it easier to remember.

2)  Early nutrition is good and enteral is better than parenteral. A 2004 BMJ meta-analysis of six randomized trials involving a total of 263 patients demonstrated improved outcomes with enteral nutrition including decreased rates of infection and surgical intervention, reduced length of hospital stay, and reduced costs (20 percent of the costs associated with total parenteral nutrition).