Sat27November0556PM 22

A patient is admitted with acute pancreatitis. Which of the following is used as a prognostic indicator using the bedside index for severity in acute pancreatitis (BISAP) score?

True / False

Pleural effusions Correct

Blood glucose more than 15 mmol/L Incorrect answer selected

An elevated haematocrit Incorrect answer selected

Age more than 60 years Correct

Impaired mental sate Correct

Explanation

Acute pancreatitis is an autodigestive disease process, where pancreatic proteolytic enzymes are activated and subsequently destroy the pancreatic parenchyma.

The gland can be destroyed by oedema, haemorrhage and fat necrosis, which release exudates into the peritoneal cavity causing peritonitis. Sepsis, respiratory and renal failure may occur which increases the mortality from this disease.

The bedside index for severity in acute pancreatitis (BISAP) is a scoring system used to predicting the severity and prognoses of acute pancreatitis. It compares favourably with other methods of prognostication sch as APACHEII, Ranson, and computed tomography severity index (CTSI) scores. This scoring system has the advantage of being of being simple and quick to calculate.

The components of a BISAP score are:

Serum urea >25 mg/mL (8.82 mmol/L)

Impaired mental status

2 or greater SIRS criteria

Age greater than 60, and

Pleural effusions.

Data is gathered within 24 hours of admission. The best cutoff value for BISAP was 2 for predicting pancreatic necrosis and organ failure, and 3 for predicting mortality.

Ranson's Criteria for pacreatitis severity based on admission variables include:

White cell count >15,000

Age more than 55-years

Glucose >10 mmol/L, and

Raised AST and LDH.

Additional variables are scored after 24 hours admission including:

Haematocrit drop of greater than 10%

Urea increase of >5 mmol/L from admission

Hypocalcaemia

Hypoxia

Increased base deficit, and

Massive fluid requirements.

A Ranson score of 3 or more or an APACHE II score of 8 or more is commonly used to classify a patient as having severe disease.

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