Pancreatitis is inflammation of the pancreas. The pancreas is an organ that lies behind the stomach and next to part of the small intestine. The pancreas aids in digestion of proteins, fats and carbohydrates by secreting digestive enzymes into the first part of the small intestine called the duodenum. When the pancreas becomes inflamed, these digestive enzymes are activated before they leave the pancreas and cause damage to the pancreatic tissue. Acute pancreatitis occurs when the pancreas becomes rapidly inflamed while chronic pancreatitis occurs when there is longstanding inflammation in the pancreas.

Causes

Acute pancreatitis can be caused by:

• abdominal trauma
• bacterial or viral infection
• medications or toxins
• obstruction to pancreatic fluid flow, including gallstones
• systemic disease (i.e. diabetes, Crohn's disease)

Chronic pancreatitis can be caused by:

• hereditary pancreatitis
• congenital structural abnormality
• high lipid and/or calcium levels
• autoimmune disorders
• cystic fibrosis

In almost half of pediatric pancreatitis cases, no cause is identified.

Symptoms

• Abdominal Pain – belly pain is usually severe, occurs rapidly and is located above the belly button and on the left side of the abdomen. Sometimes the pain is felt in the middle of the back. Often the child will not want to move and lies on the side with the knees pulled to the chest.
• Abdominal tenderness (tender belly)
• Abdominal distension (swollen belly)
• Nausea
• Vomiting
• Decreased appetite
• Low-grade fever
• Ill-appearing child

Exams and Tests

Blood Tests

If your child's pediatric GI specialist suspects pancreatitis he or she will order a blood test to measure the level of amylase and lipase, two pancreatic enzymes. If the enzyme levels are elevated, the doctor will diagnose pancreatitis.

Imaging

If a blood test reveals pancreatitis, your child's pediatric gastroenterologist will want to follow up with ultrasound or CT scan to make sure there are no anatomical defects or complications such as gallstones. A special MRI test called MRCP (magnetic resonance cholangiopancreatography) may be used to examine the bile duct, gallbladder and pancreatic duct.

ERCP

In complex or repeated cases of pancreatitis, a scope test called ERCP (endoscopic retrograde cholangiopancreatography) is sometimes done to look for problems in the bile and pancreatic ducts. A flexible tube with a camera and light is passed through the mouth to the small intestine.

Mild pancreatitis is treated by giving the pancreas time to rest. Your child will not be allowed to eat or drink for a few days and will be given intravenous fluids for nutrition and to relieve pain. Once pain subsides and blood enzymes improve, eating and drinking may resume. If recovery takes longer, tube or IV feedings may be necessary. Most children recover completely without any complications. Symptoms usually last for days, but severe cases can last for weeks.

Chronic pancreatitis is sometimes treated with pancreatic enzymes in an effort to prevent future flare-ups. In rare cases pancreatic insufficiency (low digestive enzyme production) may develop.

Points to Remember

• Pancreatitis is inflammation of the pancreas. In most children, symptoms only last a few days and there are no long-term complications.
• There are many causes of pancreatitis, and often the cause is undetermined.
• Genetic, anatomic abnormalities or certain disorders such as cystic fibrosis can cause chronic pancreatitis.

For More Information

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition - NASPGHAN.org

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health - digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis/