Introduction

Pancreatitis commonly occurs in the pediatric population, but it mostly remains undiagnosed. The clinician treating acute cases must have a low threshold to test for the non-specific and common symptoms that occur with this inflammatory process. Often, the symptoms are dismissed as occurring from an acute gastroenteritis or viral infection.

Pancreatitis can be defined as an inflammatory process of the pancreas which occurs in the clinical setting of characteristic abdominal and back pain, accompanied by elevations of the pancreatic enzymes. The different types of pancreatitis can be characterized into five main categories according to the timing of the illness, clinical symptoms, family history and radiographic findings (acute, chronic, hereditary, hemorrhagic and necrotic).

Acute pancreatitis is usually a short, self-limited process characterized by the classic symptoms of nausea, vomiting, anorexia, epigastric pain and back pain. Levels of serum amylase and lipase are markedly elevated in the acute inflammatory response. Although a child may suffer from repeated bouts of acute pancreatitis, the symptoms and enzyme elevations should completely resolve between attacks. Pancreatic function remains intact and the pancreatic morphology is undisturbed.

If the signs and symptoms of inflammation are progressive, this may lead to chronic pancreatitis. Chronicity may be accompanied by either temporary or permanent loss of both exocrine and endocrine function. The severe pain that accompanies this condition can be debilitating and lead to dependence upon narcotics. Within the gland itself, protein plugs may calcify, indicating advanced and chronic disease (Figure 21.1).

Patients with hereditary pancreatitis, by definition, will have a family history of the disease. These diseases are autosomal dominant; affected family members will often present with recurrent bouts of acute pancreatitis starting in childhood.

Hemorrhagic and necrotic pancreatitis are uncommon in the pediatric population, but are a significant cause of morbidity and mortality from the disease. A secondary bacterial infection can occur within the gland, leading to bacteremia, shock and resultant multi-organ system failure.

Figure 21.1 Kidney, ureters and bladder radiograph with calcified pancreas of a 6-year-old female who presented to the emergency department with a 3-month history of abdominal pain and distension due to severe pancreatitis. Plain film revealed ascites and extensive pancreatic calcifications (arrows). Ascitic fluid was markedly hemorrhagic and the endoscopic retrograde cholangiopancreatogram was normal. Patient was later discovered to have two different mutations in the CFTR gene.

Figure 21.1 Kidney, ureters and bladder radiograph with calcified pancreas of a 6-year-old female who presented to the emergency department with a 3-month history of abdominal pain and distension due to severe pancreatitis. Plain film revealed ascites and extensive pancreatic calcifications (arrows). Ascitic fluid was markedly hemorrhagic and the endoscopic retrograde cholangiopancreatogram was normal. Patient was later discovered to have two different mutations in the CFTR gene.

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Dealing With Back Pain

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