Conclusion

Leaky Gut Cure

New Leaky Gut Cure

Get Instant Access

The clinician needs to have a high index of suspicion for pancreatitis in the child who presents with the non-specific but common symptoms of nausea, vomiting and abdominal pain. A thorough history that emphasizes recent infections, medications, trauma and any underlying medical condition may make the diagnosis clearer. The traditional use of enzyme testing alone (serum amylase and lipase) for the diagnosis of both acute and chronic pancreatitis may not be adequate, since the clinical specificity remains suboptimal.

Unlike pancreatitis in adults, in which the majority of cases are due to either gallstone disease or alcoholism, this disease in childhood can be from a variety of disparate causes. No identifying factor is present in up to 25% of cases. Common known etiologies include infection, trauma, medications, abnormal anatomy and hereditary or systemic diseases. A family history of pancreatitis, espe cially occurring at a young age, should prompt the physician to look for evidence of anatomic abnormalities or inherited biochemical defects.

Ultrasound remains the initial radiographic study of choice in acute pancreatitis in childhood, to screen for infection, cholelithiasis, congenital abnormalities and biliary ductal dilatation. If the course of the pancreatitis is complicated or recurrent, further detailed imaging of the biliary system should be performed with ERCP, MRCP or percutaneous or intraoperative cholangiogram.

Treatment of acute, uncomplicated pancreatitis in the pediatric population is basically supportive, and most children will recover without sequelae. Complications, when they occur, can involve every major organ system and be life-threatening. Children with severe or complicated pancreatitis should be managed at a center with expertise in pediatric biliary surgery and non-operative radiological and endoscopic interventions.

REFERENCES

Karne S, Gorelick FS. Etiopathogenesis of acute pancreatitis. Surg Clin North Am 1999; 79: 699-710. Lerner A. Acute pancreatitis in children and adolescents. In Lebenthal E, ed. Gastroenterology and Nutrition in Infancy, 2nd edn. New York: Raven Press, 1989: 897-906.

Robertson MA, Durie PR. Pancreatitis. In Walker WA, Durie PR, Hamilton JS, Walker-Smith JA, Watkins JB, eds. Pediatric Gastrointestinal Disease, 2nd edn. St Louis: Mosby, 1996: 1436-1465. Roy CC, Silverman A, Alagille D. Pancreatitis and pancreatic tumors. In Roy CC, Silverman A, Alagille D, eds. Pediatric Clinical Gastroenterology, 4th edn. St. Louis: Mosby, 1995: 986-1004.

Tietz NW. Support of the diagnosis of pancreatitis by enzyme tests - old problems, new techniques. Clin Chim Acta 1997; 257: 85-98.

Weizman Z. Acute pancreatitis. In Wyllie R, Hyams JS, eds. Pediatric Gastrointestinal Disease. Philadelphia: WB Saunders, 1993: 873-879.

Durie PR. Pancreatitis and mutations of the cystic fibrosis gene. N Engl J Med 1998; 339: 687-688. Werlin SL, Casper J, Antonson D et al. Pancreatitis associated with bone marrow transplantation in children. Bone Marrow Transplant 1992; 10: 65-69. Tissieres P, Simon L, Debray D et al. Acute pancreatitis after orthotopic liver transplantation in children: incidence, contributing factors and outcome. J Pediatr Gastroenterol Nutr 1998; 26: 315-320.

Collins JE, Brenton DP. Pancreatitis and homocystinuria.

J Inherit Metab Dis 1990; 13: 232-233.

Kahler SG, Sherwood G, Woolf D et al. Pancreatitis in patients with organic acidemias. J Pediatr 1994; 124:

239-243.

Lévy P, Menzelxhiu A, Paillot B et al. Abdominal radiotherapy is a cause for chronic pancreatitis. Gastroenterology 1993; 105: 905-909. Keljo DJ, Sugerman KS. Pancreatitis in patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 1997; 25: 108-112.

See Y, Martin K, Rooney M et al. Severe juvenile dermatomyositis complicated by pancreatitis. Br J Rheumatol 1997; 36: 912-916.

Guelrud M, Morera C, Rodriguez M et al. Sphincter of Oddi dysfunction in children with recurrent pancreatitis and anomalous pancreaticobiliary union: an etiologic concept. Gastrointest Endosc 1999; 50: 194-199. Mattioli G, Buffa P, Pesce F et al. Pancreatitis caused by duodenal duplication. J Pediatr Surg 1999; 34: 645-648. Dassopoulos T, Ehrenpreis ED. Acute pancreatitis in human immunodeficiency virus-infected patients: a review. Am J Med 1999; 107: 78-84. Kamelmaz I, Elitsur Y. Pancreas divisum - the role of ERCP in children. W VMed J 1999; 95: 14-16. Lerner A, Branski D, Lebenthal E. Pancreatic diseases in children. Pediatr Clin North Am 1996; 43: 125-156. Carroccio A, Fontana M, Spagnuolo MI et al. Serum pancreatic enzymes in human immunodeficiency virus-

infected children. A collaborative study of the Italian Society of Pediatric Gastroenterology and Hepatology. Scand J Gastroenterol 1998; 33: 998-1001. Brivet FG, Naneau SH, Lemaigre GF et al. Pancreatic lesions in HIV-infected patients. Ballieres Clin Endocrinol Metab 1994; 8: 859-877. Kahn E, Anderson VM, Greco A et al. Pancreatic disorders in pediatric acquired immune deficiency syndrome. Hum Pathol 1995; 26: 765-770. Aboulafia DM. Acute pancreatitis: a fatal complication of AIDS therapy. J Clin Gastroenterol 1997; 25: 640-645. Friedman SL. Kaposi's sarcoma and lymphoma of the gut in AIDS. Ballieres Clin Gastroenterol 1990; 4: 455-475.

Welsh MJ, Tsui LC, Boat TF et al. Cystic fibrosis. In Scriver CR, Beaudet AL, Sly WS, Valle D, eds. The Metabolic and Molecular Basis of Inherited Disease. New York: McGraw-Hill, 1995: 3799-3876. Dodge JA. Paediatric and hereditary aspects of chronic pancreatitis. Digestion 1998; 59 (Suppl 4): 49-59. Uomo G, Manes G, Rabitti PR. Role of hereditary pancreatitis and CFTR gene mutations in the aetiology of acute relapsing pancreatitis of unknown origin. How are they important? J Pancreas (Online) 2001; 2: 368-372.

Rosenstein MG, Cutting GR. The diagnosis of cystic fibrosis: a consensus statement. J Pediatr 1998; 132: 589-595.

Cohn JA, Friedman KJ, Noone PG et al. Relation between mutations of the cystic fibrosis gene and idiopathic pancreatitis. N Engl J Med 1998; 339: 653-658.

Cohn JA, Jowell PS. Are mutations in the cystic fibrosis gene important in chronic pancreatitis? Surg Clin North Am 1999; 79: 723-731.

Sharer N, Schwarz M, Malone G et al. Mutations of the cystic fibrosis gene in patients with chronic pancreatitis. N Engl J Med 1998; 339: 645-652. Elitsur Y, Chertow BC, Jewell RD et al. Identification of a hereditary pancreatitis mutation in four West Virginia families. Pediatr Res 1998; 44: 927-930. Whitcomb DC, Gorry MC, Preston RA et al. A gene for hereditary pancreatitis maps to chromosome 7q35. Gastroenterology 1996; 110: 1975-1980. Gates LK, Ulrich CD II, Whitcomb DC. Hereditary pancreatitis. Surg Clin North Am 1999; 79: 711-722. Whitcomb DC. Hereditary pancreatitis: a model for understanding the genetic basis of acute and chronic pancreatitis. Pancreatology 2001; 1: 565-570. Perrault J. Hereditary pancreatitis. Gastroenterol Clin North Am 1994; 23: 743-752. Uretsky G, Goldschmiedt M, James K, Childhood pancreatitis. Am Fam Physician 1999; 59: 2507-2512. Pfützer RH, Whitcomb DC. SPINK1 mutations are associated with multiple phenotypes. Pancreatology 2001; 1: 457-460.

Pfützer RH, Barmada MM, Brunskill APJ et al. SPINK1/PSTI polymorphisms act as disease modifiers in familial and idiopathic chronic pancreatitis. Gastroenterology 2000; 119: 615-623. Chen JM, Mercier B, Audrezet MP et al. Mutational analysis of the human pancreatic secretory trypsin inhibitor (PSTI) gene in hereditary and sporadic chronic pancreatitis (letter). J Med Genet 2000; 37: 67-69. Rossi L, Pfützer RH, Parvin S et al. SPINK1/PSTI mutations are associated with tropical pancreatitis in Bangladesh: a preliminary report. Pancreatology 2001; 1: 242-245.

Teich N, Ockenga J, Hoffmeister A et al. Chronic pancreatitis associated with an activation peptide mutation that facilitates trypsin activation. Gastroenterology 2000; 119: 461-465.

  1. Sahu S, Saika S, Pai SK et al. L-Asparaginase (Leunase) induced pancreatitis in childhood acute lymphoblastic leukemia. Pediatr Hematol Oncol 1998; 15: 533-538.
  2. Sammett D, Greben C, Sayeed-Shah U. Acute pancreatitis caused by penicillin. Dig Dis Sci 1998; 43: 1778-1783.
  3. Tobias JD, Capers C, Sims P et al. Necrotizing pancreatitis after 10 years of therapy with valproic acid. Clin Pediatr 1995; 34: 446-448.
  4. Oberlander TF, Rappaport LA. Recurrent abdominal pain during childhood. Pediatr Rev 1993; 14: 313-319.
  5. Stevenson RJ, Ziegler MM. Abdominal pain unrelated to trauma. Pediatr Rev 1993; 14: 302-311.
  6. Pieper-Bigelow C, Strocchi A, Levitt MD. Where does serum amylase come from and where does it go? Gastroenterol Clin North Am 1990; 19: 793-810.
  7. Murthy UK, DeGregorio F, Oates RP et al. Hyperamylasemia in patients with the acquired immunodeficiency syndrome. Am J Gastroenterol 1992; 87: 332-336.
  8. Gwodz GP, Steinberg WM, Werner M et al. Comparative evaluation of the diagnosis of acute pancreatitis based on serum and urine enzyme assays. Clin Chim Acta 1990; 187: 243-248.
  9. Agarwal N, Pitchumoni CS, Sivaprasad AV. Evaluating tests for acute pancreatitis. Am J Gastroenterol 1990; 85: 356-360.
  10. Frank B, Gottlieb K. Amylase normal, lipase elevated: is it pancreatitis? A case series and review of the literature. Am J Gastroenterol 1999; 94: 463-469.
  11. Clain JE, Pearson RK. Diagnosis of chronic pancreatitis. Surg Clin North Am 1999; 79: 829-845.
  12. Heiji HA, Obertop H, Schmitz PIM et al. Evaluation of the secretin-cholecystokinin test for chronic pancreatitis by discriminant analysis. Scand J Gastroenterol 1986; 21: 35-42.
  13. Banks PA. Practice guidelines in acute pancreatitis. Am J Gastroenterol 1997; 92: 377-386.
  14. Samavedy R, Sherman S, Lehman GA. Endoscopic therapy in anomalous pancreatobiliary duct junction. Gastrointest Endoscop 1999; 50: 623-627.
  15. Guelrud M, Endoscopic therapy of pancreatic disease in children. Gastrointest Endoscop Clin North Am 1998; 8: 195-219.
  16. Fulcher AS, Turner MA, Capps GW et al. Half-Fourier RARE MR cholangiopancreatography: experience in 300 subjects. Radiology 1998; 207: 21-32.
  17. Hirohashi S, Hirohashi R, Uchida H et al. Pancreatitis: evaluation with MR cholangiopancreatography in children. Radiology 1997; 203: 411-415.
  18. O'Rourke RW, Harrison MR. Pancreas divisum and stenosis of the major and minor papillae in an 8 year old girl: treatment by dual sphincteroplasty. J Pediatr Surg 1998; 33: 789-791.
  19. Abou-Assi S, Craig K, O'Keefe SJ. Hypocaloric jejunal feeding is better than total parenteral nutrition in acute pancreatitis: Results of a randomized, comparative study. Am J Gastroenterol 2002; 97: 2255-2262.
  20. Luiten EJ, Hop WC, Lange JF et al. Differential prognosis of gram-negative versus gram-positive infected and sterile pancreatic necrosis: results of a randomized trial in patients with severe, acute pancreatitis treated with adjuvant selective decontamination. Clin Infect Dis 1997; 25: 811-818.
  21. Holland AJ, Davey RB, Sparnon AL et al. Traumatic pancreatitis: long-term review of initial non-operative management in children. Paediatr Child Health 1999; 35: 78-81.

Was this article helpful?

0 0
Living Gluten Free

Living Gluten Free

A beginners guide that will reveal how living "G" free can help you lose weight today! This is not a fad diet, or short term weight loss program that sometimes makes you worse off than before you started. This is a necessity for some people and is prescribed to 1 out of every 100 people on earth by doctors and health professionals.

Get My Free Ebook


Post a comment