COMPUTED TOMOGRAPHIC EVALUATION OF ACUTE PANCREATITIS by Dr. AMOGH.V.N Dissertation submitted to Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the requirements for the degree of M.D. In RADIO-DIAGNOSIS Under the guidance of Prof. Dr. B.V. BALAKRISHNA DEPARTMENT OF RADIO-DIAGNOSIS M.V.J. MEDICAL COLLEGE AND RESEARCH HOSPITAL BANGALORE 2014 1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES DECLARATION I hereby declare that this dissertation titled “COMPUTED TOMOGRAPHIC EVALUATION OF ACUTE PANCREATITIS” is a bonafide and genuine work carried out by me under the supervision and guidance of Prof. Dr. B.V. BALAKRISHNA, M.D. (Radio-diagnosis), Professor of Radio-diagnosis, M.V.J. Medical College and Research Hospital, Bangalore. 2 CERTIFICATE BY THE GUIDE This is to certify that this dissertation titled “COMPUTED TOMOGRAPHIC EVALUATION OF ACUTE PANCREATITIS” is a bonafide research work done by Dr. AMOGH.V.N, in partial fulfillment of the requirement for the degree of M.D. in Radio-diagnosis. 3 CERTIFICATE BY THE CO- GUIDE This is to certify that this dissertation titled “COMPUTED TOMOGRAPHIC EVALUATION OF ACUTE PANCREATITIS” is a bonafide research work done by Dr. AMOGH.V.N, in partial fulfillment of the requirement for the degree of M.D. in Radio-diagnosis. 4 ENDORSEMENT BY THE HEAD OF THE DEPARTMENT This is to certify that the dissertation titled “COMPUTED TOMOGRAPHIC EVALUATION OF ACUTE PANCREATITIS” is a bonafide research work done by Dr. AMOGH.V.N, under the guidance of Prof. Dr. B.V.BALAKRISHNA, M.D (Radio-diagnosis). 5 ENDORSEMENT BY THE HEAD OF THE INSTITUTION This is to certify that the dissertation titled “COMPUTED TOMOGRAPHIC EVALUATION OF ACUTE PANCREATITIS” is a bonafide research work done by Dr. AMOGH.V.N, under the guidance of Prof. Dr. B.V.BALAKRISHNA, M.D (Radio-diagnosis). 6 COPYRIGHT I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka, shall have the rights to preserve, use and disseminate this dissertation in print or electronic format for academic / research purpose. © Rajiv Gandhi University of Health Sciences, Karnataka 7 ACKNOWLEDGEMENTS The work with this dissertation has been exciting and instructive. Without the help, support, suggestions and encouragement from several persons, I would have never been able to finish this work. I express my deep sense of gratitude and heartfelt thanks to Prof. Dr. B.V.BALAKRISHNA, Professor, Department of Radio-diagnosis, M.V.J. Medical College and Research Hospital, Bangalore, for inspiring and encouraging me to have a deeper understanding of the subject, his invaluable comments during the whole work with this dissertation and his support, patience, encouragement through my post graduate studies. I sincerely thank Prof. Dr. B. K. RAMU, Department of Surgery, M.V.J. Medical College and Research Hospital, Bangalore for his timely advice and valuable suggestions in preparing this dissertation and for having permitted me to study the cases under his care. I sincerely thank Dr. NARENDRANATH KUDVA, Professor, Department of Radio- diagnosis, M.V.J. Medical College and Research Hospital, Bangalore for his continuous encouragement and help in preparing this dissertation. I sincerely thank Dr. GEETA SHANKAR, Professor, Department of Radio-diagnosis, M.V.J. Medical College and Research Hospital, Bangalore for her continuous encouragement and help in preparing this dissertation. 8 I sincerely thank Dr. SRINIVAS PRASAD R H, Associate Professor, Department of Radio- diagnosis and Dr. DAYANANDA KUMAR R, Associate Professor, Department of Radio- diagnosis, M.V.J. Medical College and Research Hospital, Bangalore for their continuous encouragement and help in preparing this dissertation. I also express my thanks to the Heads of various surgery units for having permitted me to study the cases under their care. I thank my postgraduate colleagues who helped me in the preparation of this dissertation. I am thankful to all my patients who participated in the study, without whom the study would have been impossible. My keen appreciation goes to all the Radiology Technicians for their valuable assistance in the field. I am extremely thankful to my father Dr. V.L.NANDISH, without whom the dream of Radio- diagnosis would not have been realized. I am very grateful to my loving mother Mrs. VINAYA NANDISH for her unflinching support in my difficult times and her confidence in me. To all my friends and well-wishers for there his love and support during the post- graduate course. Special thanks to my friend Dr. Chethan T.K. LIST OF ABBREVIATIONS USED 9 CECT – Contrast enhanced CT CTSI – CT severity index MCTSI – Modified CT severity index APACHE – Acute Physiology, Age, and Chronic Health Evaluation (APACHE II) index. AP – Acute pancreatitis US – Ultrasound USG – Ultrasonography CT – Computed tomography MRI – Magnetic Resonance Imaging PC – Pseudocyst PE – Pleural effusion As – Ascites IV – Intravenous SIRS – Systemic inflammatory response syndrome APFC – Acute peripancreatic fluid collections ANC – Acute necrotic collection WON – Walled-off necrosis ABSTRACT 10
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