1. Dr. Jorge Alejandro Gracia Pech
R2CG

3.  En individuos sanos el pancres produce el
40-45% de la amilasa circulante. (P
isoamilasa)
 Inicia la elevación a las 6-12 hr
 Vida media de 10 hr
 25% depurado por riñon
Risk and Markers of Severe Acute Pancreatis. Georgios I. Papachristou, Gastroenterol Clin N Am 36 (2007) 277–296

4.  Se puede detectar 3- 5dias
 Sensibilidad de 85%
 Se puede encontrar normal en paciente con
hipertrigliceridemia o con pancreatitis
crónica.
Risk and Markers of Severe Acute Pancreatis. Georgios I. Papachristou, Gastroenterol Clin N Am 36 (2007) 277–296

5.  50% de los pacientes con elevación de
amilasa cursar sin pancreatitis
 Se debe contar con una elevación de 3 veces
por encima del valor normal
Risk and Markers of Severe Acute Pancreatis. Georgios I. Papachristou, Gastroenterol Clin N Am 36 (2007) 277–296
Risk and Markers of Severe Acute Pancreatis. Georgios I. Papachristou, Gastroenterol Clin N Am 36 (2007) 277–296

6.  En las pancreatitis aguda la razón
amilasa/creatinina urinarias se eleva del 3%
al 10%.
 La isoamilasa puede elevarse de 7- 14 días
Risk and Markers of Severe Acute Pancreatis. Georgios I. Papachristou, Gastroenterol Clin N Am 36 (2007) 277–296

9.  La sensibilidad y especificad va del 85-96%
 Elevación desde el primer dia
 Elevación tres veces por encima
Risk and Markers of Severe Acute Pancreatis. Georgios I. Papachristou, Gastroenterol Clin N Am 36 (2007) 277–296

10.  Elevación del 7-14 días
Risk and Markers of Severe Acute Pancreatis. Georgios I. Papachristou, Gastroenterol Clin N Am 36 (2007) 277–296

13.  ESTUDIOS DE IMAGEN

15. RADIOGRAFIA
 Asa entrecortada
 Imagen de asa en C
 Derrame pleural
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

18.  Uso limitado
 Visualización inadecuada e el 30%
 Determinación de origen
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

19.  Imagen hipoecogenica
 Determinación de colecciones (espacios
pararrenales)
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

21.  Disminuye las complicaciones relacionadas
con la CPRE (71%)
 Muestra una mayor eficacia en el diagnóstico
que la RM (51-20%)
 Menor eficacia en pacientes con
colecistectomía previa
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

22.  Tienes adecuada correlación con los criterios
de Atlanta en los siguientes casos.
1.- edema peripancreático
2.- dilatación da via biliar
3.- ascitis
4.- Edema peripancreático
Mayor utilidad en fases tempranas.
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

24.  La sensibilidad, especifidad y valor predictivo
positivo y negatico para pancreatitis severa
basado en hallazgos tomográficos fue de
91,100%, 100% y 83 %

26.  Utilidad en :
 Diagnostico
 etiologia
 Estadificacion y pronóstico

27.  La clasificación morfológica se divide en
- P. edematosa intersticial
- P necrotica
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

28.  Se emplea con mayor frecuencia la
tomografia contrastada
 Vigilancia de pacientes en sospecha de
pancreatitis hemorragica
 Utilización de tomografía multidetector
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

29.  En la TAC contrastada se puede emplear 900
to 1000 mL de medio de contraste neutro
oral of neutral oral contrast (agua)
 la sensibilidad:
 Necrosis extensa: 100% E 87%
 Necrosis escasa: 50% especifidad 100%
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

30.  El pancreas cuenta con densidades de 40-50
UH.
 Se espera la elevacion a 100-150 UH
 Menor de 30 UH necrosis
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

31.  En las primeras 12 hr solo inflamación difusa
 Se debe realiza en las 24-48 hr
 Mayor diagnóstico 2-3 dias
 22% páncreas normal con colecciones.
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

32. Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

33.  Parénquima homogéneo
 Aumento focalizado o localizado
 Realce normal
 Sin alteración de lo tejidos peripancreático o
retroperitoneales
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

35.  1.- necrosis parénquima y peripancreatica
 Necrosis parenquima únicamente
 Necrosis peripancreática sin necrosis
pancreatica
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

36.  En las primeras 2 semana aprece como zona
sin realce
 Posterior a las 4 semanas se observa
homogeneo con discreta atenuacion
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

37.  Zonas de necrosis menores de 5 cm

38.  Representa el 20%
 Resultado de la extensión a partir de la
superficie pancreática
 Mayor utilidad del USG o de la RM
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

43. Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

45. Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

47. Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

49. Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

51. Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

54.  Comparable para visualizar cambios
morfológicos
 Ideal para paciente que no pueden recibir
contraste iodados por alergia o falla renal
 Evitar exposicion a radiación

56.  A nivel de T2 en Fast spin echo se visualizan
colecciones, psudoquiste y hemorragias
 A nivel T1 se visualiza edema pancreatico
 Fase arterial (20-40 seg), venosa (40-80 seg)
y estabilización 180 seg
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

58.  Consiste en:
 Cortes delgado coronales
 Cortes gruesos oblicuos-coronales
 El segundo obtiene imágenes de anatomia de
via biliar y del páncreas.
 El primero anatomía de órganos sólidos.
Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation, Balthazar E. Radiology 2002; 223:603–613
Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification Thomas L. Bollen, Radiol Clin N Am 50 (2012) 429–445
Cross-Sectional Imaging in Acute Pancreatitis Anuradha Saokar , Chad B. Rabinowitz, Dushyant V. Sahani. Radiol Clin N Am 45 (2007) 447–46

59.  La sangre obtenida es anticuagulada con citrato
 Se disuelve con hydroxyethylstarch al 6%
 Se realiza centrifugación
 Se agrega Tcexametazina
 Eficacia de 25-60%
 Technetium-99m-Labeled White Blood Cells. Jens Werner. ANNALS OF SURGERY Vol. 227, No.
1, 86-94

61.  Estudio prospectivo de 84 pacientes
 Comparación de resultados con la TAC, y los
scores

62.  Resultados :
 11 pancreatitis necrótica
 Marcaje de leucoticos en 38 pac (45%)
 Sensibilidad de 91%
 Especifidad de 88%

63.  VPP 53%
 VPN 98%
 Paciente con grado II.III 71 veces mas
probable de pancreatitis necrótica

65.  166 pacientes evaluados
 2009 a 2010
 C. exclusión
- Embarazo
- Infección
- Obesidad
-

66.  Esteblece una imagen de base en modo B de
la región (15-20mm)
 Un pulso acústico (100 microsegundo)
 Distensibilidad de 1-20 microns

67.  En pacientes con sintomatologia los valores
por encima de 2.2 m/s se asocian a
pancreatitis

68.  eSie elastograma
Utiliza compresion gentil y monitoreo continuo
de pulsos