1. Ranson and Glasgow score
2. APACHE score
3. MELD score
4. Modified Marshall score
Select the correct answer using the code given below.
Scoring Systems for Severity Assessment in Acute Pancreatitis
Acute pancreatitis can range from mild, self-limiting disease to severe necrotizing pancreatitis with multi-organ failure. Several validated scoring systems have been developed to stratify severity and predict prognosis, most of which rely on clinical, laboratory, and physiological parameters rather than liver-specific markers.
Analysis of Each Statement
- 1. Ranson and Glasgow (Imrie) score — Correct. This is the original, disease-specific scoring system for acute pancreatitis. It uses a set of clinical and biochemical criteria assessed at admission and at 48 hours (Ranson) or within the first 48 hours (Glasgow/Imrie) — including age, WBC count, glucose, LDH, AST, calcium, PaO2, base deficit, and fluid sequestration — to predict severity and mortality.
- 2. APACHE II score — Correct. The Acute Physiology and Chronic Health Evaluation (APACHE II) score is a general ICU severity-of-illness score that is also validated and widely used specifically in acute pancreatitis. Its advantage over Ranson/Glasgow is that it can be calculated at any time point (not just at 24–48 hours), allowing continuous monitoring of severity during the hospital course.
- 3. MELD score — Incorrect in this context. The Model for End-Stage Liver Disease (MELD) score is calculated from bilirubin, creatinine, and INR, and is used to assess the severity of chronic liver disease and prioritize patients for liver transplantation. It is not a standard tool for grading the severity of acute pancreatitis.
- 4. Modified Marshall score — Correct. The Modified Marshall scoring system assesses organ dysfunction across the respiratory, renal, and cardiovascular systems. It is the scoring system specifically recommended by the revised Atlanta classification to define and grade organ failure (and hence severity) in acute pancreatitis, and is used to distinguish mild, moderately severe, and severe disease.
Conclusion
Of the four systems listed, the Ranson and Glasgow score, APACHE score, and Modified Marshall score (statements 1, 2, and 4) are all established tools for assessing severity in acute pancreatitis, whereas the MELD score (statement 3) is used for chronic liver disease severity and transplant allocation, not pancreatitis.
Therefore, the correct answer is Option C: 1, 2 and 4.
Important Questions from Hepatobiliary & Pancreatic Surgery
Which among the following are complications of liver trauma?
1. Liver abscess
2. Biliary fistula
3. Portal thrombosis
4. Liver failure
Select the correct answer using the code given below.
Which of the following are local complications of acute pancreatitis?
1. Pseudocyst
2. Pleural effusion
3. Ileus
4. Acute fluid collection
Select the correct answer using the code given below.
Which of the following are risk factors for the development of pancreatic cancer?
1. Cigarette smoking
2. Diabetes mellitus
3. Caucasian ethnicity
4. Male gender
Select the correct answer using the code given below.
Which of the following are options for management of a pancreatic pseu- docyst?
1. Pancreaticoduodenectomy
2. Cystogastrostomy
3. Percutaneous drainage
4. Endoscopic drainage
Select the correct answer using the code given below :
- Which of the following statements regarding hepatic adenomas are correct? 1. They are almost exclusively seen in females aged 25-50 years 2. They are associated with use of oral contraceptive pills 3. They do not have any malignant potential 4. Majority are detected incidentally on imaging Select the correct answer using the code given below :
