pediatric pancreatitis · 2013. 11. 25. · introduction pancreatitis is nowadays recognized more...
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Pediatric pancreatitis Etiology and imaging approaches
M. Mearadji
International Foundation for Pediatric Imaging Aid
Introduction
Pancreatitis is nowadays recognized more often in pediatric age than previously.
The childhood pancreatitis can result form a wide range of causes.
Early diagnosis and aggressive intervention are needed in children suspected of having pancreatitis.
Pancreatitis should be classified in acute and chronic type because of differences in etiology, prognosis and treatment.
Clinical presentation of pancreatitis
Abdominal pain
Epigastric pain
Radiating pain
Colicky pain
Nausea/vomiting
Greasy stools
Fever
Jaundic
Abdominal distention
Laboratory findings
Leucocytosis.
Increased hematocrit.
Hypocalcemia (15 %).
Hyperglycemia (25 %).
Elevated serum amylase concentration.
Lipase elevated in serum and urinary.
Imaging approaches in diagnosis of pancreatitis
Abdominal plain film, nonspecific.
Sonography (initial imaging procedure).
CT superior to sonography.
MRCP (Magnetic Resonance Cholangio-Pancreatography).
ERCP (Endoscopic Retrograde Cholangio-Pancreatography.
Conditions associated with
childhood pancreatitis
Physical injuries Abdominal trauma, ERCP
Multisystem disease Crohn’s disease, hemolytic uremic syndrome
Metabolic disorders Hyperlipidemia, uremia
Toxics Alcohol, Yellow scorpion bite
Nutricinal problems Malnutricion, rapid refeeding.
Pancreas disorder Cystic fibrosis, pancreas divisum
Biliary tract obstruction Choledochus cyst, gallstones
Vasculitis Henoch-Schönlein, periarteritis
Drugs Asparaginase, Azathioprine
Infections Campylobacter, Salmonella typhi
Viruses Mumps, Coxacie B, Hepatitis B
Miscellaneous Graft versus Host disease, hereditary
Acute pancreatitis
Is an uncommon gastrointestinal emergency with sudden inflammation of pancreas.
The severity of an acute pancreatitis can be described as mild, moderate or severe and as necrotizing pancreatitis.
The proces of acute pancreatitis is mostly self limiting in mild cases.
A severe acute pancreatitis is associated with a high rate of complication.
The course and outcome of acute pancreatitis are somewhat determined by the underlying etiology.
Chronic pancreatitis
Chronic pancreatitis is a destructive inflammatory process of the pancreas.
Ultimately chronic pancreatitis leads to total or partial decline of endo- and exocrine function of the pancreas.
Abdominal pain, digestive functional disturbance, steatorrhea and diabetes mellitus are the clinical features of chronic pancreatitis.
Clinical data of 37 children with an acute (28) and chronic (9) pancreatitis
Age: 1 – 17 years (average 9).
Sex: 24 girls and 13 boys.
Elevated serum or urinary amylase: 29.
Imaging procedures in all 37
cases of pancreatitis
Abdominal plain film 10
Sonography 35 (range 1-7 times per patient)
CT 21 (range 1-3 times per patient)
MRCP 16 (range 1-2 times per patient)
ERCP 13 (mostly as intervention)
Conditions associated with acute
pancreatitis in 28 cases
Abdominal trauma n=10 40%
Iatrogenic post ERCP n=2 7%
Metabolic n=6 21%
Drugs n=3 9%
Gall stones n=3 9%
Choledochal cyst n=1 3%
Pancreatis divisum n=1 3%
Gastroenteritis n=1 3%
Eosinophylic pancreatitis n=1 3%
15 year old girl with acute lymphatic leukemia.
Pancreatitis and diabetes following Asperginase therapy.
5 year old boy treated for
congenital diafragmatic
hernia.
Gall stone complicated with
pancreatitis following
parenteral feeding
Conditions associated with
chronic pancreatitis in 9 cases
Hereditary n=5
Idiopathic n=2
Pancreatis divisum n=1
Metabolic n=1
Pseudocyst in 37 cases of
pancreatitis
Pseudocyst
Acute pancreatitis
(n=28)
n=10 (36%)
Traumatic (n=10)
Untraumatic (n=18)
n=4 (40%)
n=6 ( 33%)
Chronic pancreatitis
(n=9)
n=4 (44%)
14 year old girl with lymphoblastic non-Hodkin lymphoma.
Acute pancreatitis following Asperginase therapy with a
gigantic pancreatic cyst.
Cystic changes and calcification of the pancreas in a15
year old boy with chronic pancreatitis by adipositas.
12 year old girl with chronic pancreatitis with a small
pancreatic cyst caused by a calculus in the pancreatic duct.
A. Carcinoid of
pancreas duct
with obstruction
of the duct.
2 illustrative cases of neoblastic tumor of pancreas which should be
considered in the differential diagnostic of pancreatitis.
B. Solid pseudo
papillary tumor of
the pancreatic tail.
Conclusion
There are around 80 etiological conditions associated with childhood pancreatitis.
Blunt trauma is the most common cause of acute pancreatitis.
In several patients, especially in chronic pancreatitis, the etiological cause remains unknown.
Pseudocyst of pancreas develops most frequently from traumatic pancreatis or following chronic pancreatitis.
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