الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Acute pancreatitis is one of the most common diseases of the gastrointestinal tract, leading to tremendous emotional, physical, and financial human burden.
Radiologic imaging has become increasingly important in staging and treating acute pancreatitis.
The initial Atlanta classification for acute pancreatitis was introduced as a universally applicable classification system for the various manifestations of acute pancreatitis. This system was designed to facilitate understanding and correlation of findings seen by gastroenterologists, pathologists, radiologists, and surgeons. This approach was to be particularly useful for assessment and treatment of the various fluid collections identified during the course of acute pancreatitis.
The limitations of 1992’s Atlanta classification for acute pancreatitis in recent years stimulated many demands to revise the Atlanta classification.
The revision of the Atlanta classification and definitions 2012 by international consensus has been published and in use for accurate description of the radiological findings which plays a critical role in the evaluation and management of patients with acute pancreatitis, particularly those with severe disease.
The terminology and classification scheme of acute pancreatitis proposed at the initial Atlanta Symposium was reviewed, and a new consensus statement was recently proposed. Major changes include subdividing acute fluid collections in the first 4 weeks into ”acute peripancreatic fluid collection” and ”acute necrotic collection” based on the presence of necrotic debris. Delayed fluid collections have been similarly subdivided into ”pseudocyst” and ”walled-off necrosis.” Correct use of the new terms that describe these collections is important because they lead to different treatment decisions.
This study was carried out on 60 patients presented to the radiology department at Menofia University Hospital and National Liver Institute from October 2017 to October 2019.
All patients were subjected to full Clinical assessment, laboratory investigations, radiological assessment, assessment of severity and follow up strategies for evaluation.
The Results showed that males (73.7%) are more affected than females (26.3%) and most of them are above 40 years old (68.2%).The mean age of patients is (48±18.21) ranged from 21 to 70 years old. Upper abdominal pain is the most common symptom (100%) among all patients. Most of patients presented with history of smoking (63.6%), history of gall stone (54.5%) and alcoholism (18.2%). All patients have elevated serum amylase. Most of patients have elevated serum lipase (63.6%) and elevated serum triglycerides (27.3%).
All patients have elevated serum amylase. Most of patients have elevated serum lipase especially above 40 years old (28) and elevated serum triglycerides (12). (70%) of the patients have interstitial edematous pancreas and (30%) have necrotizing pancreatitis. Acute peripancreatic fluid collection is the most common type among all patients followed by pseudocyst, acute necrotic collection and wall off necrosis.
Summary & Conclusion
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CT characteristics of acute Pancreatitis According to the revised Atlanta classification showed that bulky pancreas was found in about 88.3% while 11.6% had normal size pancreas, Fat stranding and obliterated fat planes was found in 96.6%, while only 3.3% had clear surrounding fat planes.
All patients with acute peripancreatic fluid collection of pancreas have homogenous content with partial capsulation and duration less than four weeks.
All patients with pseudocyst of pancreas have homogenous content with complete capsulation and duration more than four weeks.
All patients with acute necrotic collection of pancreas have heterogeneous content with partial capsulation and duration less than four weeks with necrosis. All patients with wall off necrosis of pancreas have heterogeneous content with complete capsulation and duration more than four weeks with necrosis.
Most of patient (22) with acute peripancreatic fluid collection, (7) with pseudocyst and (2) with acute necrotic fluid collection resolved with conservative treatment with less than two weeks. Two cases with pseudocyst and wall off that need early fine needle aspiration and percutaneous drainage. Only one case with wall off that needs surgical intervention. There is statistically significant difference of type of lesion with age group (P=0.014).
This study confirms that contrast enhanced CT is a reliable and accurate technique to determine type of acute pancreatitis according to The Revised Atlanta classification.
Summary & Conclusion
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Conclusion
The Revised Atlanta classification is designed to precisely describe patients with acute pancreatitis, standardize terminology across specialties, and help in treatment planning.
The most important change in the Atlanta classification is the categorization of the various pancreatic collections.
Treatment planning is based on severity of pancreatitis and presence or absence of infection combined with clinical signs. The revised Atlanta classification system with CT helps guide management and monitor the success of treatment.