The most common etiologies of pancreatitis are trauma, systemic disease, structural anomalies of the pancreatic–biliary system, drugs, infections, and idiopathic causes.
The most common symptoms in children are abdominal pain, nausea, and irritability.
Amylase and lipase levels are low at birth and thus not helpful in infants. Elevated amylase and lipase has a sensitivity of 81% in pediatric pancreatitis.
The critical goal of treatment is to provide supportive care through aggressive fluid resuscitation, early nutritional support, and pain control.
Ranson criteria, Glasgow score, and pediatric acute pancreatitis severity (PAPS) scoring system show limited ability to predict severity in children with acute pancreatitis.
Approximately 25% of children with acute pancreatitis develop a complication, but less than 6% of children develop multiorgan dysfunction.
The mortality rate reported in children with pancreatitis varies between 4% and 10%.
Acute recurrent pancreatitis can be caused by genetic mutations, hypercalcemia, structural abnormalities, or hypertriglyceridemia.
Chronic pancreatitis leads to irreversible changes of the pancreatic parenchyma and often presents as acute pancreatitis followed by recurring abdominal pain. Amylase and lipase may not be elevated.
Pancreatitis is inflammation within the parenchyma of the pancreas. This is characterized by the presence of acute inflammatory cells, interstitial edema, and varying degrees of necrosis, apoptosis, and hemorrhage within the pancreas.1
Pancreatitis is a disease process with multiple possible causes (Table 75-1). The most common etiologies are trauma, systemic disease, structural anomalies of the pancreatic–biliary system, drugs, infections, and idiopathic causes.2–4
| Trauma | Motor vehicle accident Bicycle handlebar injury Child abuse Post-ERCP |
| Systemic diseases | Sepsis/shock Hemolytic–uremic syndrome Henoch–Schonlein purpura Kawasaki syndrome Systemic lupus erythematosus Sickle cell disease Crohn disease Reye syndrome |
| Structural abnormalities of pancreatic-biliary system | Annular pancreas Pancreas divisum Choledochal cyst Choledochocele Gallstones |
| Medications | Analgesics: acetaminophen, salicylates, sulindac, indomethacin Anticonvulsants: phenytoin, valproic acid Antimicrobials: tetracycline, erythromycin, sulfonamides, trimethoprim-sulfamethoxazole, isoniazid, metronidazole, nitrofurantoin Chemotherapeutics: L-asparaginase, cytarabine Diuretics: furosemide, thiazides Illicit drugs: amphetamines, cocaine, heroin Immunomodulators: sulfasalazine, 5-aminosalicyclic acid medications, 6-mercaptopurine, azathioprine, corticosteroids |
| Infections | Mumps Measles Hepatitis A virus Hepatitis B virus Hepatitis E virus Influenza A Rotavirus Varicella Adenovirus Coxsackie virus Epstein–Barr virus Cytomegalovirus Mycoplasma pneumonia Moraxella catarrhalis Mycoplasma Ascariasis |
| Toxins | Boric acid Ethanol and methanol Insecticides Scorpion bite |
| Metabolic | Hypertriglyceridemia Hypercalcemia Diabetic ketoacidosis Uremia |
| Miscellaneous | Genetic mutations in PRSS-1, SPINK-1, CFTR, or CTRC genes Idiopathic Post-liver transplant Postsurgery |
The most common cause of pancreatitis in children is blunt trauma, which accounts for 10% to 40% of cases.2–4 Motor vehicle crashes, sports injuries, accidental falls, and child abuse account for the majority of cases. However, it should be noted that in trauma patients, the amylase levels might be elevated due to intestinal perforation.
The systemic diseases most commonly associated with pancreatitis are sepsis, shock, hemolytic–uremic syndrome, and systemic lupus erythematous.2,3 In children younger than 3 years of age, pancreatitis was often associated with one of these systemic diseases.4
Structural defects, such as pancreas divisum (dorsal and ventral pancreatic ducts fail to fuse), are found in 5% to 10% of the population, thus it is unclear if this also causes pancreatitis. Gallstones or sludge found in the bile duct can lead to pancreatitis.2–5
Several medications have been linked to pancreatitis.2–4,6,7 The most common medications are valproic acid, asparaginase, azathioprine, prednisone, and 6-mercaptopurine. No clear mechanism has been delineated for the development of medication-induced pancreatitis. Most of the drugs are implicated due to the cause-and-effect relation observed between drugs and pancreatitis.
Infectious causes are seen in approximately 10% of patients.2–4 Infectious causes associated with pancreatitis include mumps virus,2 hepatitis A virus,2 rotavirus,8 hepatitis E virus,9 and varicella.10 Other infections include adenovirus, Coxsackie virus, mycoplasma pneumonia, and Moraxella catarrhalis.2
Metabolic causes are rare and occur in approximately 1% to 5% of patients.2–4 These include diabetic ketoacidosis, hypertriglyceridemia, and hypercalcemia.
Hereditary causes are seen in about 2% to 8% of patients.2–4 Mutations are most commonly found in the cationic trypsinogen gene (PRSS1), the pancreatic secretory trypsin inhibitor gene (SPINK1), the cystic fibrosis transmembrane conductance regulator (CFTR) gene, and the chymotrypsin C (CTRC) gene.2,11 A review by Whitcomb provides details on the loss of protective mechanisms due to genetic defects.12 It remains to be determined to what extent genetic factors are involved in the pathogenesis of idiopathic acute pancreatitis.
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