Description

Schneider et al report the M-ANNHEIM system for evaluating a patient with chronic pancreatitis. Clinical staging is a modification of the method reported by Chari and Singer. The system was developed at the the University of Heidelberg in Mannheim, Germany.


Patient selection: chronic pancreatitis

 

Parameters:

(1) asymptomatic vs symptomatic

(2) number of episodes

(3) pancreatic function

(4) severe complications (reversible complications: ascites, bleeding, pseudoaneurysm, obstruction or stricture of ductus choledochus, pancreatic fistula, duodenal stenosis; irreversible complications: portal or splenic vein thrombosis, pancreatic cancer)

 

Clinical Status

Stage

asymptomatic, subclinical

0

symptomatic, without pancreatic insufficiency

I

symptomatic with partial pancreatic insufficiency

II

symptomatic with painful complete pancreatic insufficiency

III

burnout with secondary painless disease

IV

 

Subclasses for Stage 0:

0a: found incidentally

0b: single episode of acute pancreatitis

0c: acute pancreatitis with severe complications

 

Subclasses of Stage I:

Ia: recurrent acute pancreatitis without pain between episodes

Ib: recurrent and/or chronic abdominal pain with or without pain between episodes

Ic: Ia or Ib AND severe complications

 

Subclasses of Stage II:

IIa: isolated endocrine or exocrine insufficiency without pain

IIb: isolated endocrine or exocrine insufficiency with pain

IIc: IIa or IIb AND severe complications

 

Subclasses of Stage III:

IIIa: exocrine and endocrine insufficiency with pain

IIIb: IIIa AND severe complications

 

Subclasses of Stage IV:

IVa: exocrine and endocrine insufficiency without pain AND without severe complications

IVb: exocrine and endocrine insufficiency without pain AND with severe complications


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