Pancreatitis

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What is pancreatitis?

Pancreatitis is the inflammation and autodigestion of the pancreas. Autodigestion describes a process in which pancreatic enzymes destroy its own tissue leading to inflammation. The inflammation may be sudden (acute) or ongoing (chronic). Acute pancreatitis in kids usually involves a single “attack,” after which the pancreas returns to normal. Severe acute pancreatitis can be life threatening. The scarring experienced by chronic pancreatitis causes permanent damage to the pancreas and its function.

What causes pancreatitis?

The most common causes of pancreatitis in kids include:

• Gall stones
• Abdominal trauma or surgery
• Kidney failure
• Lupus
• Infections, such as mumps, hepatitis A or B, or salmonella
• Cystic fibrosis
• Presence of a tumor
• Excess fat in the blood (dyslipidemia)
• Congenital birth defects in which the pancreas does not form as it should during pregnancy
• A venomous sting from a scorpion.

In some cases, the cause of a child’s pancreatitis is unknown.

What are the symptoms of pancreatitis?

The following are the most common symptoms of pancreatitis. However, each individual may experience symptoms differently. Symptoms may include:

• Abdominal pain that may radiate to the back or chest
• Nausea
• Vomiting
• Rapid heart rate
• Fever
• Swelling in the upper abdomen
• Ascites. Fluid buildup in the abdominal cavity. Learn more about ascites.
• Dropping blood pressure
• Mild jaundice. A yellowing of the skin and eyes. Learn more about jaundice.

Severe abdominal pain in the upper abdomen is usually a symptom of acute pancreatitis. The symptoms of pancreatitis may resemble other medical conditions or problems. Always consult a doctor for a proper diagnosis.

How is pancreatitis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for pancreatitis in kids may include the following:

• Various blood tests. Learn more about blood tests at CHOC.
• Ultrasound (also called sonography). A diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver, spleen, and kidneys, and to assess blood flow through various vessels. Learn more about ultrasounds at CHOC.
• Computed tomography scan (CT or CAT scan). A diagnostic imaging procedure using a combination of X-rays and computer technology to produce horizontal or axial images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. Learn more about CT scans at CHOC.
• Magnetic resonance cholangiopancreatography (MCRP). A test that produces images of body parts by injecting dye into a patient’s veins that helps show the pancreas, gallbladder, and pancreatic and bile ducts. Learn more about MRI at CHOC.
• Endoscopic retrograde cholangiopancreatography (ERCP). A procedure that allows the doctor to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines X-ray and the use of an endoscope, which is a long, flexible, lighted tube. The scope is guided through the patient’s mouth and throat, then through the esophagus, stomach, and duodenum. The doctor can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected which will allow the internal organs to appear on an X-ray.

What is the treatment for pancreatitis?

The pediatric gastroenterologists at CHOC work with patients, their family and referring physicians and other medical specialists to determine the best treatment for each child’s pancreatitis. Treatments are typically based on:

• The child’s age, overall health and medical history
• Extent of the disease
• The child’s tolerance of specific medicines, procedures or therapies
• Expectations for the course of the disease.

The overall goal for treatment of pancreatitis is to rest the pancreas and allow it to recover from the inflammation.

Treatment may include:

• Hospitalization for observation and intravenous (IV) feeding
• No food by mouth for several days
• Bed rest or light activity only
• Pain management
• Antibiotics
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Surgery
• Frequent blood tests (to monitor electrolytes and kidney function).

Children with chronic pancreatitis may also require:

• Medications (for example, H2-blockers) to decrease gastric acid production in the stomach
• Small high-protein meals
• Enzyme supplements to aid in food digestion
• Insulin (if diabetes develops).

Acute pancreatitis is self-limiting, meaning it usually resolves on its own over time. Most people with acute pancreatitis recover without any complications. Chronic pancreatitis may also be self-limiting but may resolve after several attacks and with a greater risk of developing long-term problems, such as diabetes, chronic pain, diarrhea, ascites, biliary cirrhosis, bile duct obstruction or pancreatic cancer.