Pancreatitis
Basics
Description
- Inflammation within the pancreas characterized by three phases: (i) early trypsin activation within acinar cells; followed by (ii) surrounding intrapancreatic inflammation; and finally, (iii) extrapancreatic inflammation with systemic inflammatory responses
- Classified into acute and chronic
- Acute pancreatitis (AP)
- Variable presentation; most often characterized by acute onset of abdominal pain, nausea, and vomiting with elevation of pancreatic enzymes
- Nonverbal children may present with irritability; infants may present with lethargy and fever.
- Often self-limited, with reversible changes but can progress if not appropriately managed
- Severe AP is rare in children; however, a high suspicion should always be maintained, as severe disease can progress rapidly and result in significant morbidity and mortality.
- Chronic pancreatitis (CP)
- Characterized by irreversible morphologic changes and fibrotic replacement of the pancreatic parenchyma
- Clinically characterized by recurrent abdominal pain or evidence of exocrine and/or endocrine insufficiency
- Often the result of a persistent and continued pancreatic inflammation secondary to acute attacks
- Acute pancreatitis (AP)
Etiology
- Biliary tract disease
- Gallstones
- Medications
- L-asparaginase, azathioprine/6-MP, mesalamine, sulfonamides, thiazides, furosemide, tetracyclines, valproic acid, corticosteroids, estrogens, procainamide, ethacrynic acid, and others
- Toxins
- Alcohol, organophosphates, scorpion poison, snake poison
- Trauma
- Bicycle handle injuries
- Motor vehicle collisions
- Child abuse
- Postoperative
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Systemic disease
- Shock/hypoxemia/sepsis
- Inflammatory bowel disease (IBD)
- Cystic fibrosis
- Idiopathic
- Less common
- Infections
- Bacterial: typhoid, mycoplasma
- Viral: measles, mumps, Epstein-Barr virus, coxsackie B, rubella, influenza, echovirus, hepatitis A and B
- Parasites: Ascaris lumbricoides, Echinococcus granulosus, Cryptosporidium parvum, Plasmodium falciparum
- Metabolic diseases:
- Hyperlipidemia
- Hypercalcemia
- Diabetic ketoacidosis
- Uremia
- Inborn errors of metabolism
- Systemic diseases:
- Hemolytic uremic syndrome (HUS)
- Celiac disease
- Diabetes mellitus
- Vasculitis: systemic lupus erythematosus (SLE), Henoch-Schönlein purpura, Kawasaki disease
- Infections
- Rare causes:
- Autoimmune pancreatitis: rare condition divided into two subtypes
- Type I often grouped with IgG4-related disease and systemic manifestations.
- Type II does not have IgG4 association, however, is more common in younger patients and associated with IBD.
- Congenital anomalies:
- Pancreatic divisum
- Annular pancreas
- Anomalous pancreaticobiliary junction
- Biliary tract malformations
- Duplication cyst of the duodenum/gastropancreatic/common bile duct (CBD)
- Gene mutations
- PRSS1: trypsinogen
- SPINK1: serine protease inhibitor of Kazal type 1
- CFTR: cystic fibrosis transmembrane regulator
- CTRC: chymotrypsin C
- CASR: calcium-sensing receptor
- Autoimmune pancreatitis: rare condition divided into two subtypes
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Citation
Cabana, Michael D., editor. "Pancreatitis." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617500/all/Pancreatitis.
Pancreatitis. In: Cabana MDM, ed. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617500/all/Pancreatitis. Accessed December 7, 2024.
Pancreatitis. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult (8th ed.). Wolters Kluwer. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617500/all/Pancreatitis
Pancreatitis [Internet]. In: Cabana MDM, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2024 December 07]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617500/all/Pancreatitis.
* Article titles in AMA citation format should be in sentence-case
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