Which of the following is not a prognostic factor for acute pancreatitis :
Correct Answer: Increased serum amylase
Description: Ans. is 'd' i.e. Increased serum amylase. Ranson has identified a series of prognostic signs for early identification of patients with severe pancreatitis.There are 11 objective parameters, 5 are to be measured at the time of admission, whereas the remaining 6 are measured within 48 hours of admission.Morbidity and mortality of the disease are directly related to the number of signs present.Number of Ranson's signs Approximate mortality0-2-0%3-4-15%5-6-50%>6-70-90 % Ranson's Prognostic signs of Acute PancreatitisAt admissionDuring the initial 48hAge > 55 y WBC > 16,000/mm3 Blood glucose > 200 mg/dL Serum LDH> 350IU/L Serum AST > 250 U/dLHematocrit fall >10 points BUN elevation > 5 mg/dL Serum calcium < 8 mg/dL Arterial P02 < 60 mm Hg Base deficit > 4 mEq/L Estimated fluid sequestration > 6 L Also knowThe above given criteria are for Pancreatitis caused by causes other than gallstones.The prognostic criteria for acute gall stone pancreatitis are slightly different. These are: Criteria for gallstone pancreatitis At admissionDuring the initial 48 hAge > 70 y WBC > 18,000/mm3 Blood glucose > 220 mg/dL Serum LDH > 400IU/L Serum AST > 250 U/dLHematocrit fall > 10 points BUN elevation > 2 mg/dL Serum calcium < 8 mg/dL Base deficit > 5 mEq/L Estimated fluid sequestration > 4L
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Surgery
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