Short and longterm prognosis
Kidney Function Restoration Program
Most cases of acute pancreatitis in childhood are isolated and uncomplicated, persisting for usually less than a week, and rarely progress to chronic pancreatitis. The chances of surviving a severe or complicated course of pancreatitis are directly related to the other organ systems involved. Associated complications can affect virtually all organ systems (Table 21.4).2-4,6,15,17-19,21,23,26,34,36,37,45,53,60-63
The primary morbidity and mortality arise from septic shock, renal failure, respiratory failure and inflammatory masses of the pancreas.
The APACHE-II and Ranson criteria, which have been developed to predict the outcome from acute pancreatitis in adults, are not as reliable in young children. Pediatric studies have shown a mortality rate of 5-17.5% from an initially mild presentation of acute pancreatitis to upwards of 80-100% from hemorrhagic pancreatitis or severe multisystem disorders. After a bout of necrotizing pancreatitis, exocrine and endocrine insufficiency are common. The degree of dysfunction correlates directly with the extent of parenchymal damage.
For patients with traumatic pancreatitis, in the absence of complete duct transection, nonoperative management is believed to be safe, and there are usually no long-term complications.63 Identification of those with hereditary pancreatitis is critical, as affected family members are at increased risk for pseudocysts, pancreatic adenocarcinomas, and exocrine and endocrine failure.
Table 21.4 Complications associated with pancreatitis (from references 2-4,6,15,17-19,21,23,26,34, 36,37,45,53,60-63)
|
Pancreatic |
Systemic/metabolic |
|
Abscess |
Acidosis |
|
Ascites |
Atelectasis |
|
Calculi |
Adult respiratory distress syndrome |
|
Carcinoma |
Disseminated intravascular coagulation |
|
Electrocardiographic changes | |
|
Duct strictures |
Encephalopathy |
|
Exocrine insufficiency |
Fat emboli |
|
Fibrosis |
Fat necrosis |
|
Fistula | |
|
Necrosis |
Hyperkalemia |
|
Phlegmon |
Hypertriglyceridemia |
|
Pseudocyst |
Hypoalbuminemia |
|
Hypocalcemia | |
|
Gastrointestinal/hepatic |
Hypotension |
|
Biliary obstruction |
Mediastinal abscess |
|
Bowel infarction |
Pericardial effusion |
|
Gastritis |
Pleural effusion |
|
Gastrointestinal fistula |
Pneumonitis |
|
Hemorrhage | |
|
Hepatic vein thrombosis |
Renal failure |
|
Hepatorenal syndrome |
Renal vessel thrombosis |
|
Ileus |
Respiratory failure |
|
Jaundice |
Sepsis |
|
Sudden death | |
|
Portal vein thrombosis |
Thrombosis |
|
Splenic vein varices |
Was this article helpful?
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.
Post a comment