There are many causes of pancreatitis in childhood:
- viral etiology including:
..........1. mumps ,
..........2. infectious mononucleosis ,
..........3. influenza A,
..........4. german measles , and
..........5. Coxsackie B virus .
These would produce a clinical picture of acute pancreatitis with severe epigastric pain , severe enough to cause the child to assume a sitting position , radiating to the back , persistent vomiting and fever .If the pancreatitis is due to a viral uncomplicated infection , the prognosis is good .
Other causes include
- abdominal trauma ,
- obstruction of the pancreatic drainage system by biliary duct sludging or pancreatic protein precipitations ,
- hereditary ( familial cases have been reported ) ,
- drugs , and
- numerous systemic diseases which make diagnosing a cause for pancreatitis quite difficult unless other manifestations of the systemic disease are apparent at the same time or prior to the attack .
If your child has had two episodes of pancreatitis , a gastroenterology consult is necessary. A search for other possibilities such as:
- hyperlipidemia ,
- hyperparathyroidism ,
- ascariasis and
- cystic fibrosis is warranted .
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Diagnosing Pediatric Pancreatitis
- Plain abdominal X-rays maybe done ,
- an abdomial ultrasound and or
- an ERCP to exclude pancreatic drainage system obstruction
- (please discuss the need for all these investigations with the gastroenterologist as some may not be indicated in individual cases ).
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Management of an acute episode may include:
- taking nothing by mouth ,
- nasogastric suction ,
- pain medication ,
- IV nutrition ( TPN ),
- very rarely would surgery be required .
- If the cause is unknown , there is little you can do to prevent recurrent pancreatitis.
- A care plan is necessary to be discussed with both the pediatrician and gastroenterologist on when to bring your child for follow-up and when hospitalization is required.
Pain Management in Pediatric Pancreatitis
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Pediatric Pain Update: Presentations at the Fourth International Symposium
on Pediatric Pain in Helsinki
Charles B. Berde, MD, PhD
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Department of Anaesthesia, Harvard Medical School andChildren’s Hospital, Boston, Massachusetts, USA
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The Pediatric Special Interest Group of the IASP sponsored a Fourth International Symposium on Pediatric Pain in Helsinki in early July, 1997. The meeting was well organized, and well attended by a diverse audience. Review and summary of the abstracts presented at this meeting afford an opportunity to review the state of the field.
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At the time of the first symposium in Seattle in 1988, much effort was exerted in demonstrating that infants feel pain, that they can safely receive anesthesia and analgesia, and that pain can be assessed at all in preverbal subjects. In many respects, the field has matured since then.
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McClain and Lee reported on the impact of family stress on the intensity and duration of chronic pain in children. Wheeler et al. reported on a large experience with pancreatitis in children, treated mostly with parenteral opioids. There is a need for better study of the effectiveness of therapies for both acute and chronic pancreatitis, and better clarification of the risks and benefits of opioids for long-term pain. It remains an open question whether newer opioids, agonist-antagonists, or kappa-receptor-selective opioids have any clear benefit over traditional mu agonists, with their known effects on the sphincter of Oddi.
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Conclusion
The abstracts presented at this meeting demonstrate the continued active interest in the field of children’s pain, improvements in the quality of study design and in measurement tools, and impressive advances from the developmental neurobiologists in understanding the ontogeny of pain responses. The meeting organizers did a great job of presenting this rapidly advancing field and are to be commended.
Conditions Associated with Acute and Chronic Pancreatitis in Childhood
- Infections
- Ascaris lumbricoides (duct obstruction)
- Campylobacter fetus
- Clonorchis sinensis (duct obstruction)
- Coxsackie B virus
- Cytomegalovirus
- Echovirus Enterovirus
- Epstein-Barr virus Escherichia coli-verotoxin-producing
- Hepatitis A and B
- Human immunodeficiency virus
- Influenza A and B
- Legionnaire disease
- Leptospirosis
- Malaria
- Measles
- Mumps
- Mycoplasma
- Rubella
- Rubeola
- Typhoid fever
- Varicella
- Yersinia
- Trauma
- Abdominal radiotherapy
- Accidental blunt injury
- Burns
- Child abuse
- Endoscopic retrograde cholangiopancreatography or other ductal imaging using contrast
- Surgical trauma
- Total body cast
- Anatomic
- Absence or anomalous insertion of the common bile duct or pancreatic duct
- Ampullary disease: diverticulum, stenosis
- Annular pancreas
- Anomalous choledochopancreaticoductal junction
- Aplasia of the pancreas
- Biliary tract malformations
- Choledochal cyst
- Choledochocele
- Cholelithiasis
- Duodenal obstruction (diverticulum, hematoma, tumor, stricture)
- Duodenal ulcer-perforated
- Duplication cyst (duodenum, gastropancreatic, common bile duct)
- Dysplasia of the pancreas
- Gastric trichobezoar
- Heterotopic pancreas
- Hypoplasia of the pancreas
- Pancreas divisum
- Pancreatic pseudocyst
- Sclerosing cholangitis
- Sphincter of Oddi dysfunction
- Tumors of the pancreas
- Idiopathic
- Systemic/Metabolic/Hereditary
- Alpha-1-antitrypsin deficiency
- Anorexia nervosa
- Autoimmune diseases
- Brain tumor
- Bulimia
- Collagen vascular diseases
- Congenital partial lipodystrophy
- Crohn's disease
- Cystic fibrosis
- Dermatomyositis
- Diabetes mellitus (ketoacidosis)
- Glycogen storage disease types Ia, Ib
- Head trauma
- Hemochromatosis
- Hemolytic-uremic syndrome
- Henoch-Schonlein purpura
- Hereditary pancreatitis
- Hyperalimentation
- Hypercalcemia
- Hyperlipidemia types I, IV, and V
- Hyperparathyroidism
- Hypertriglyceridemia
- Hypothermia
- Inborn errors of metabolism (organic acidemias, cytochrome c oxidase deficiency)
- Juvenile tropical pancreatitis
- Kawasaki disease
- Malnutrition with or without refeeding
- Periarteritis nodosa
- Peritonitis
- Renal failure with uremia
- Reye syndrome
- Sarcoidosis
- Septic shock
- Systemic lupus erythematosus
- Transplantation (bone marrow, heart, kidney, liver, pancreas)
- Ulcerative colitis
- Wilson disease
To view information on other digestive disease, click on Digestive Diseases Library.
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