The need for a standard classification of acute pancreatitis was formed back in 1992 at a symposium held in Atlanta. The need to develop common methods and stages of development in the classification of the acute course of the disease, during periods of exacerbation was due to the development of unified principles for the treatment of various manifestations of this process.
At present, such a classification is the main one, but in each country there are differences, both in stages and in the forms of a similar disease from the standards. Although many surgeons of modern medicine successfully ignore in everyday practice the division and terminology adopted in Atlanta in connection with new discoveries in the field of determining the forms and stages of acute pancreatitis, at the time of its aggravation they apply their own classification, which differs from the scheme proposed earlier.
Today, for the diagnosis of acute pancreatitis, the patient must have at least two of the three main signs:
- is a strong pain syndrome;
- increase in the content of amylase or lipase in the patient's blood no less than three times from the upper limit of this indicator in the normal state;
- characteristic indications of computed tomography for this disease, during an exacerbation.
Depending on the severity of the disease, during an exacerbation, these symptoms may be very different from those taken in Atlanta. According to severity, this disease is determined by two forms: severe and not severe. Although at different stages of the development of the disease, such a separation can vary in more detail. At different stages of the acute course of pancreatitis and its exacerbations, new forms may appear, depending on the area of the pancreatic gland. Also, the stage of aggravation of the main development of the disease can be characterized by various concomitant diagnoses, such as damage to the circulatory and respiratory system, extensive suppuration, cyst formation, fluid accumulation, and many others. Depending on the stage of acute pancreatitis, CT scores acquire new features, which is why the form of the disease is constantly being specified.
According to the morphology of the spread and defeat process, the classification identifies two forms of development of the acute course of the disease during its exacerbation: interstitial edematous and necrosis. Although with the spread of the inflammatory process, one stage of the disease can change into another. Necrotic lesions can be sterile or infected.
At the present time, the Atlanta classification requires revision on all the main points, since in the light of the possibilities of modern equipment, the form of pancreatitis and its exacerbations, as well as its main features can be diagnosed in more detail.
Code of acute pancreatitis according to ICD 10
According to the International Classification of Diseases of the ICD of the 10th revision, the following forms of the disease exist( code K85).
Pancreatic abscess( formation time - 4-6 weeks, possibly surgical intervention, is a less dangerous form of the disease).
Acute and infectious necrosis in the ICD 10 is due to self-digestion of the gland by enzymes, lipase and trypsin contained in it, as well as partial necrosis of its cells and tissues. Consequences of necrosis is first an abscess of the gland, then the formation of a cyst, and with focal necrosis - the rapid development of the inflammatory process.
Relapse, which for reasons of onset and exacerbation is divided into:
- idiopathic;
- biliary;
- alcoholic;
- is a medicament.
To the same group according to the ICD 10, subacute, purulent, hemorrhagic and without additional refinement of pancreatitis are classified.
Classification of acute pancreatitis Atlanta-2007
With regard to the classification of acute pancreatitis Atlanta-2007, according to the latest implemented changes, the following are distinguished:
- Light acute pancreatitis is the most common form of the disease. It occurs in 85% of patients, usually having congenital pathology or a predisposition to diseases of the gastrointestinal tract. In this case, pancreatic edema( pancreatic necrosis) and the development of organ failure are excluded. The probability of a lethal outcome of mild disease is 0.5%.
- Disease of medium degree - takes one tenth of all cases detected. According to statistics, lethal outcome accounts for 10-15% of all cases of the disease. This form of the disease is characterized by local symptoms and manifestations of the disease, such as a gland abscess, cyst and peripancreatic infiltrate, and the occurrence of organ failure of no more than 48 hours.
- Disease in severe degree according to Atlanta classification 2007 is a rapid process of complicating the disease, in which in most cases pancreonecrosis occurs, and organ failure lasts more than 48 hours. A severe disease is found in five percent of patients. The probability of a lethal outcome with a severe form of the disease is the majority of cases, namely, from 50 to 60%.