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HIGH-YIELD FACTS

  • The most common etiologies of pancreatitis are trauma, systemic disease, structural anomalies of the pancreatic–biliary system, drugs, infections, and idiopathic causes.

  • The most common symptoms in children are abdominal pain, nausea, and irritability.

  • Amylase and lipase levels are low at birth and thus not helpful in infants. Elevated amylase and lipase has a sensitivity of 81% in pediatric pancreatitis.

  • The critical goal of treatment is to provide supportive care through aggressive fluid resuscitation, early nutritional support, and pain control.

  • Ranson criteria, Glasgow score, and pediatric acute pancreatitis severity (PAPS) scoring system show limited ability to predict severity in children with acute pancreatitis.

  • Approximately 25% of children with acute pancreatitis develop a complication, but less than 6% of children develop multiorgan dysfunction.

  • The mortality rate reported in children with pancreatitis varies between 4% and 10%.

  • Acute recurrent pancreatitis can be caused by genetic mutations, hypercalcemia, structural abnormalities, or hypertriglyceridemia.

  • Chronic pancreatitis leads to irreversible changes of the pancreatic parenchyma and often presents as acute pancreatitis followed by recurring abdominal pain. Amylase and lipase may not be elevated.

PANCREATITIS

Pancreatitis is inflammation within the parenchyma of the pancreas. This is characterized by the presence of acute inflammatory cells, interstitial edema, and varying degrees of necrosis, apoptosis, and hemorrhage within the pancreas.1

ETIOLOGY

Pancreatitis is a disease process with multiple possible causes (Table 75-1). The most common etiologies are trauma, systemic disease, structural anomalies of the pancreatic–biliary system, drugs, infections, and idiopathic causes.2–4

TABLE 75-1Etiologies of Acute Pancreatitis2–13

TRAUMA

The most common cause of pancreatitis in children is blunt trauma, which accounts for 10% to 40% of cases.2–4 Motor vehicle crashes, sports injuries, accidental falls, and child abuse account for the majority of cases. However, it should be noted that in trauma patients, the amylase levels might be elevated due to intestinal perforation.

SYSTEMIC DISEASES

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