Pankreatitis Akut (Kriteria Ranson) Kriteria Ranson (Faktor yg berpengaruh buruk pada kehidupan pasien pankreatitis akut) A.

Pada saat masuk rumah sakit: 1. Usia > 55 tahun 2. Leukositosis > 16.000/ml 3. Hiperglikemia > 11 mmol/L (>200 mg%) 4. LDH serum > 400 IU/L 5. AST (SGOT) serum > 250 IU/L

B. Selama 48 jam perawatan: 1. Penurunan hematokrit > 100% 2. Sekuestrasi cairan > 4000 ml 3. Hipokalsemia < 1,9 mmol/L (<8,0 mg%) 4. PO2 arteri < 60 mmHg 5. BUN meningkat > 1,8 mmol/L (> 5 mg%) setelah pemberian cairan iv 6. Hipoalbuminemia < 3,2 g%

Interpretasi klinik Kriteria ranson: Kriteria awal menggambarkan beratnya proses inflamasi,sedangkan kriteria akhir waktu 48 jam menggambarkan efek sistemik aktifitas enzim terhadap organ target,seperti paru dan ginjal. Bila score <> 6, mortalitas > 50% biasanya sesuai dengan pankreatitis nekrotikan.

Indikator penting yang harus diperhatikan: 1. Hipotensi (<90> 130 x/mnt 2. PO2 < 60 mmHg 3. Oliguria (< 50 ml/jam) atau BUN, kreatinin yang meningkat 4. Metabolik / Ca serum < 8,0 mg% atau albumin serum < 3,2 g%

Glasgow kriteria Kriteria Glasgow: Sistem asli yang digunakan 9 elemen data. Ini kemudian dimodifikasi untuk 8 elemen data, dengan penghapusan penilaian untuk tingkat transaminase (baik AST (SGOT) atau ALT (SGPT) lebih besar dari 100 U / L). Pada Penerimaan 1. Usia> 55 thn 2. WBC Hitung> 15 x10 9 / L 3. Darah Glukosa> 200 mg / dL (No Sejarah Diabetes) 4. Urea serum> 16 mmol / L (Tidak ada tanggapan terhadap cairan IV) 5. Saturasi Oksigen Arteri <76 mmHg Dalam waktu 48 jam 1. Kalsium serum <2 mmol / L 2. Albumin serum <34 g / L 3. LDH> 219 unit / L APACHE "Acute Physiology And Chronic Health Evaluation" (APACHE II) score > 8 points predicts 11% to 18% mortality

Hemorrhagic peritoneal fluid Obesity Indicators of organ failure Hypotension (SBP <90 mmHG) or tachycardia > 130 beat/min PO2 <60 mmHg Oliguria (<50 mL/h) or increasing BUN and creatinine Serum calcium < 1.90 mmol/L (<8.0 mg/dL) or serum albumin <33 g/L (<3.2.g/dL)>

Balthazar scoring Developed in the early 1990s by Emil J. Balthazar et al.,[20] the Computed Tomography Severity Index (CTSI) is a grading system used to determine the severity of acute pancreatitis. The numerical CTSI has a maximum of ten points, and is the sum of the Balthazar grade points and pancreatic necrosis grade points:

Balthazar Grade Balthazar Grade Grade A Grade B Grade C Grade D Grade E Necrosis Score Necrosis Percentage Points No necrosis 0 points 0 to 30% necrosis 2 points 30 to 50% necrosis 4 points Over 50% necrosis 6 points CTSI's staging of acute pancreatitis severity has been shown by a number of studies to provide more accurate assessment than APACHE II, Ranson, and C-reactive protein (CRP) level. However, a few studies indicate that CTSI is not significantly associated with the prognosis of hospitalization in patients with pancreatic necrosis, nor is it an accurate predictor of AP severity.AST / ALT> 96 unit / L Appearance on CT Normal CT Focal or diffuse enlargement of the pancreas Pancreatic gland abnormalities and peripancreatic inflammation Fluid collection in a single location Two or more fluid collections and / or gas bubbles in or adjacent to pancreas CT Grade Points 0 points 1 point 2 points 3 points 4 points

Model for End-Stage Liver Disease

The Model for End-Stage Liver Disease, or MELD, adalah sistem penilaian untuk menilai tingkat keparahan penyakit hati kronis. Pada awalnya dikembangkan untuk memprediksi kematian dalam tiga bulan operasi pada pasien yang telah menjalani transjugular intrahepatic portosystemic shunt (TIPS) procedure, dan ditemukan berguna untuk mengetahui prognosis dan prioritas untuk menerima transplantasi hati. Penilaian ini sekarang digunakan oleh the United Network for Organ Sharing (UNOS) dan Eurotransplant untuk prioritas transplantasi hati dibanding penggunaan Child-Pugh score. MELD menggunakankadar serum bilirubin, serum creatinine, dan international normalized ratio for prothrombin time (INR) pasien untuk memprediksi survival. Kemudian, akan dikalkulasi berdasarkan formula beriku: MELD = 3.78[Ln serum bilirubin (mg/dL)] + 11.2[Ln INR] + 9.57[Ln serum creatinine (mg/dL)] + 6.43 UNOS telah membuat modifikasi dari penilaian ini, yakni:

Jika pasien telah didialisis 2 kali dalam waktu 7 hari, maka nilai serum kreatinin yang digunakan adalah 4.0

Nilai apapun yang kurang dari satu menggunakan nilai 1 sebagai ganti(contoh, jika bilirubin adalah 0.8, nilai 1.0 yang digunakan) untuk mencegah hasil dibawah 0 (the natural logarithm of 1 is 0, and any value below 1 would yield a negative result)

Interpretasi MELD Score in hospitalized patients, the 3 month mortality is:

40 or more 71.3% mortality 3039 52.6% mortality 2029 19.6% mortality 1019 6.0% mortality <9 1.9% mortality

Child-Pugh score
The score employs five clinical measures of liver disease. Each measure is scored 1-3, with 3 indicating most severe derangement. Measure Total bilirubin, mol/l (mg/dl) Serum albumin, g/l PT INR Ascites Hepatic encephalopathy 1 point <34 (<2) >35 <1.7 None None 2 points 34-50 (2-3) 28-35 1.71-2.30 Mild Grade I-II (or suppressed with medication) 3 points >50 (>3) <28 > 2.30 Moderate to Severe Grade III-IV (or refractory)

Different textbooks and publications use different measures. Some older reference works substitute PT prolongation for INR. In primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC), the bilirubin references are changed to reflect the fact that these diseases feature high conjugated bilirubin levels. The upper limit for 1 point is 68 mol/l (4 mg/dl) and the upper limit for 2 points is 170 mol/l (10 mg/dl).

Interpretation
Chronic liver disease is classified into Child-Pugh class A to C, employing the added score from above.
Points 5-6 7-9 10-15 Class A B C One year survival 100% 81% 45% Two year survival 85% 57% 35%