Discrimination between edematous and necrotizing pancreatitis

Early discrimination between acute interstitial edematous pancreatitis and necrotizing pancreatitis is the most important diagnostic step in patient management. Serum markers and imaging procedures allow early and accurate discrimination ( Table.2). Serum C-reactive protein and lactate dehydrogenase levels as well as contrast-enhanced CT are the clinical gold standards, with an accuracy above 90 per cent in detecting necrotizing pancreatitis. Moreover, helical dynamic CT scanning allows precise volumetric assessment of the amount of intra- and extrapancreatic necrosis or peripancreatic exudate. Guided-needle aspiration with Gram staining and culture of the aspirate should be considered when clinical and laboratory signs of sepsis develop in the course of proved necrotizing pancreatitis to confirm or exclude infection of necrosis. The use of multiple-factor scoring systems (e.g. Ranson or APACHE II scores) may provide additional information in terms of severity stratification of acute pancreatitis.

&Othcniiil mgrtffs fli ™ i C- 'eiln-e prolan > IK- rrg.1 Laclaie def^dttQHH >L>7C1 II.: I PUMpWliflStAS >3.5 lUfl

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Table 2 Discrimination between edematous and necrotizing acute pancreatitis

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