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- Thanh Huong L. Nguyen, MD*
- Karla Au Yeung, MD†
- Brian Pugmire, MD‡
- Roberto Gugig, MD†
- *Valley Children’s Pediatric Residency Program,
- †Department of Pediatric Gastroenterology and Nutrition, and
- ‡Department of Radiology, Valley Children’s Hospital, Madera, CA
AUTHOR DISCLOSURE
Drs Nguyen, Au Yeung, Pugmire, and Gugig have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
- AIP:
- autoimmune pancreatitis
- AP:
- acute pancreatitis
- ARP:
- acute recurrent pancreatitis
- CP:
- chronic pancreatitis
- ERCP:
- endoscopic retrograde cholangiopancreatography
- EUS:
- endoscopic ultrasound ultrasonography
- IL:
- interleukin
- LR:
- lactated Ringer solution
- MRCP:
- magnetic resonance cholangiopancreatography
- SIRS:
- systemic inflammatory response syndrome
- TPN:
- total parenteral nutrition
- TUS:
- transabdominal ultrasonography
Education Gaps
Fluid management in acute pancreatitis is evolving to include lactated Ringer solution, although more pediatric research is needed.
Early enteral nutrition within 24 hours is recommended to avoid prolonged nil per os status and associated morbidity.
Prophylactic antibiotics are not recommended.
Objectives
After reading this article, readers should be able to:
Know the classification of pediatric pancreatitis.
Understand the etiology, risk factors, clinical manifestations, approach to diagnosis, and treatment of pancreatitis in children.
Recognize current consensus guidelines on early enteral nutrition and aggressive fluid management.
Know the complications of pancreatitis in children and their appropriate diagnostic and therapeutic strategies.
Introduction
Pancreatitis is an inflammatory process of the pancreas presenting as a spectrum of clinical disease. Acute pancreatitis (AP) is a reversible process, but it may progress to acute recurrent pancreatitis (ARP). This increases the risk of developing chronic pancreatitis (CP), which carries higher morbidity due to irreversible pancreatic duct strictures, exocrine pancreatic insufficiency, insulin-dependent diabetes mellitus, and chronic pain. Pancreatitis is occurring at an increasing rate in children, which is troubling given the paucity of research in pediatric patients. Historically, management recommendations for pediatric pancreatitis have evolved based on consensus conferences and research in the adult population. In 2018, consensus guidelines for the management of AP were published for both pediatrics (1)(2)(3) and adult medicine. (4)
Classification of Pediatric Pancreatitis
Per the INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In search for a cuRE), the 3 categories of pancreatitis are AP, ARP, and CP.
AP in pediatric patients requires at least 2 of the following 3 criteria: 1) abdominal pain suggestive of AP, such as acute onset and …
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