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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.


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