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 are abdominal pain, nausea, and irritability.
Amylase and lipase levels are low at birth and slowly increase over several months.
The mainstay of treatment is to provide supportive care through fluid resuscitation, pain control, and nutritional support.
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%.
Hypercalcemia, hypertriglyceridemia, structural abnormalities, and genetic mutations can cause recurrent pancreatitis.
Chronic pancreatitis often presents as acute pancreatitis followed by recurring abdominal pain.
Pancreatitis is defined as inflammation within the parenchyma of the pancreas. This is a reversible process 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 74-1). The most common etiologies are trauma, systemic disease, structural anomalies of the pancreatic-biliary system, drugs, infections, and idiopathic causes.2–4
TABLE 74-1Etiologies of acute pancreatitis2–13 ||Download (.pdf) TABLE 74-1 Etiologies of acute pancreatitis2–13
Motor vehicle accident
Bicycle handle-bar injury
Systemic lupus erythematosus
Sickle cell disease
Structural abnormalities of pancreatic-biliary system
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
Hepatitis A virus
Hepatitis B virus
Hepatitis E virus
Ethanol and methanol
Post liver transplant
The most common cause of pancreatitis in children is blunt trauma, which accounts for 10% to 40% of cases.2–5 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 ...