Pancreatitis Pediatric

2006-10-27T08:43:00.000-07:00

Pancreatitis Pediatric

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 .

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 ).

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

..
Pediatric Pain Update: Presentations at the Fourth International Symposium
on Pediatric Pain in Helsinki
Charles B. Berde, MD, PhD

..
Department of Anaesthesia, Harvard Medical School andChildren’s Hospital, Boston, Massachusetts, USA

..
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.

..
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.

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.

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

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