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ECR 2019 / C-1542
Acute pancreatitis in pediatric age
Congress: ECR 2019
Poster No.: C-1542
Type: Educational Exhibit
Keywords: Pancreas, Paediatric, Emergency, Ultrasound, CT, Complications, Diagnostic procedure, Pathology, Acute
Authors: G. Piqué Rey, G. Muniz Da Silva, M. Herrero Redondo, A. Oliva Martí, A. M. VIVEROS CASTAÑO, E. García Rodríguez, M. Cugat Gimeno; Tortosa/ES
DOI:10.26044/ecr2019/C-1542

Background

DEFINITION:

 

Acute pancreatitis is a sudden inflammation of the pancreas that leads to an enzyme activation within the pancreas and produces an auto-digestion of the gland and local inflammation. 

 

 

EPIDEMIOLOGY:

 

The rise in incidence of pancreatitis in pediatric population is believed to be multifactorial. Some studies have linked it to the rising incidence of obesity among children others to an increase in emergency department visits and testing of serum amylase and lipase.

 

 

ETIOLOGY:

 

Elucidation of the etiology of acute pancreatitis should be continued after a diagnosis of acute pancreatitis. Blunt abdominal trauma (included abdominal trauma caused by child abuse), viral infection and drug toxicity are common causes of acute pancreatitis in children.

While alcohol and gallstones are the most common causes of acute pancreatitis in many adults ( up to 60%), drugs, viral infections, blunt abdominal trauma (included abdominal trauma caused by child abuse),  and anatomic anomalies such as choledochal cysts and in second place abnormal union of the pancreatobiliary junction are frequent causes of acute pancreatitis in children.

 

  • Congenital anomalies: periampullary obstruction choledochal cyst, abnormal union of the pancreaticobiliary junction, gallstone, cholecystitis, pancreatic divisum, tumor, ascaris aberrant
  • Infectious: mumps, measles, coxsackie, echo, lota, influenza, epstein-barr virus, Mycoplasma, salmonella, gram-negative bacteria
  • Drugs: L-asparaginase, steroid, valproic acid, azathioprine, Mercaptopurine, mesalazine, Cytarabine, Salicylic acid, indomethacin, tetracycline, chlorothiazide, isoniazid, anticoagulant drug, borate, alcohol
  • Trauma: blunt injury, child abuse, ERCR, After surgery
  • Systemic disease: Reye syndrom, systemic lupus erythematosus, polyarteritis nodosa, Juvenile rheumatoid arthritis, sepsis, multiple organ failure, Organ transplantation, hemolytic-uremic syndrome, henoch-schoenlein purpura, kawasaki disease, inflammatory bowel disease, chronic intestinal pseudo-obstruction, gastric ulcer, anorexia nervosa, food allergy, cystic fibrosis
  • Metabolic: hyperlipoproteinemia (I, IV, V), hypercalcemia, diabetes, α1 antitrypsin deficiency
  • Nutrition: malnutrition, high-calorie infusion, vitamin A and D deficiency
  • Familial, idiopathic.

 

 

CLINICAL MANIFESTATIONS

 

Acute pancreatitis is a disease with a wide range of clinical features, from mild and self-limiting disease up to severe symptoms that can evolve up to multisystem organ failure and death. It is important to stablish a prompt diagnosis in order to start an  appropriate early treatment.  Pancreatitis is less common in children than in adults and it is more likely that it is acute instead of chronic. 2 out of 3 of these criteria must be present for its diagnosis:

  1. Acute onset of abdominal pain and tenderness mainly in the upper abdomen.
  2. Elevated levels of pancreatic enzymes in blood or urine 3 times upper limits of normal (blood lipase is recommended).  
  3. Diagnostic finding imaging associated with pancreatitis.

Abdominal pain can be radiated to epigastrium and to the back or to the upper right-left quadrant. It can also come along with nauseas and vomits. The presence of jaundice or an increase in aminotransferases suggests a bile ducts compromise.

 

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