Classification and severity staging of acute pancreatitis

For clinical use a classification system for acute pancreatitis based on morphological and clinical criteria into four different entities has been proved to be very efficient in clinical practice. These are acute interstitial-edematous pancreatitis, acute necrotizing pancreatitis (sterile or infected), pancreatic abscess and postacute pseudocyst. In acute pancreatitis the first two major steps in the clinical management of these patients is to establish a reliable diagnosis and to stage the disease, that is, to estimate the severity of acute pancreatitis. The discrimination between acute interstitial-edematous and necrotizing pancreatitis has been shown to be the most relevant prognostic criterion. The "gold standard" for discriminating these two forms is by performing contrast-enhanced CT-scanning. For routine clinical use as an alternative to CT serum necrosis indicating parameters such as, C-reactive protein or LDH are useful in this respect. Therefore, CT-scanning for the evaluation of the extent of intra- and extrapancreatic necrosis can be restricted to those patients with increased values of necrosis indicating markers.