Acute pancreatitis in children

Acute pancreatitis is an acute inflammatory-destructive lesion of the pancreas associated with the activation of pancreatic enzymes within the gland itself and enzymatic toxemia. Acute pancreatitis occurs much less frequently in children than in adults.

Read also: Acute pancreatitis in adults

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Causes of acute pancreatitis in children

The most common causes of acute pancreatitis in children are:

1. infections (epidemic mumps, viral hepatitis, enterovirus, Coxsackie B, chickenpox, herpes, influenza, pseudotuberculosis, dysentery, salmonellosis, sepsis),
2. blunt trauma to the pancreas resulting from a strong blow to the abdomen,
3. diseases with obstruction and increased pressure in the pancreatic ducts (papillitis, choledocholithiasis, cyst or stricture of the common bile duct, duodenostasis with duodenopancreatic reflux, blockage of the duodenal papilla by roundworms, opisthorchiasis, fascioliasis, clonorchiasis),
4. hepatobiliary pathology (cholelithiasis, chronic cholecystitis),
5. hypercalcemia (hyperparathyroidism or hypervitaminosis D),
6. toxic (lead, mercury, arsenic, phosphorus poisoning) and drug-induced injuries (azathioprine, hypothiazide, furosemide, metronidazole, tetracyclines, sulfonamides, high doses of glucocorticoids)

Excessive consumption of fatty, fried foods can only be an additional factor provoking the manifestation of the disease against the background of other above-mentioned reasons. In 25% of children with acute pancreatitis, the etiology cannot be established.

Pathogenesis

When pancreatic tissue is damaged, an inflammatory reaction develops, lysosomal enzymes are released, which carry out intrapancreatic activation of enzymes (trypsinogen) that damage the gland. Due to an increase in biologically active substances in the blood, general volemic and microcirculatory disorders develop, and collapse is possible.

Symptoms of acute pancreatitis in children

In children, interstitial acute pancreatitis is predominantly found.

The main complaint is abdominal pain:

• intense, piercing, accompanied by a feeling of heaviness, flatulence and belching,
• localized in the epigastrium or umbilical region;
• radiate more often to the left hypochondrium, left lumbar region.

Vomiting is possible, sometimes repeated. Body temperature is normal or subfebrile.

During examination, the following is noted:

• pallor or flushing of the face,
• tachycardia, tendency to arterial hypotension;
• the abdomen may be slightly distended, sometimes muscle resistance is detected in the epigastrium.

The Mayo-Robson, Frankel, Bergman and Calk symptoms are positive, persistent pain is determined with deep palpation in the Chauffard zone, at the Mayo-Robson and Kacha points. Typically, pain increases after abdominal palpation.

Blood analysis may show slight leukocytosis, neutrophilia, sometimes a slight increase in ALT, hypoglycemia. Hyperfermentemia (increased levels of amylase, lipase and trypsin) in interstitial pancreatitis is moderate and short-lived.

Destructive acute pancreatitis in children is rare.

Characteristics:

• very intense persistent pain in the left side of a constant nature;
• uncontrollable vomiting;
• hemodynamic disorders: shock, collapse;
• Fat necrosis of the subcutaneous fat tissue on the abdomen is possible, less often on the face and extremities. There may be ecchymosis, hemorrhagic rash, jaundice;
• body temperature is subfebrile or febrile.

During examination, the following is noted:

• pulse is frequent, weak, arterial hypotension,
• the abdomen is swollen, tense, deep palpation is difficult due to tension of the anterior abdominal wall.

Blood analysis shows pronounced neutrophilic leukocytosis, increased ESR, thrombocytopenia. Hyperfermentemia is usually pronounced and persistent.

Pancreatic necrosis can cause complications.

• early - shock, liver failure, kidney failure, DIC, bleeding, diabetes mellitus;
• late - pseudocysts of the pancreas, abscesses and phlegmon of the pancreas, fistulas, peritonitis.

The main causes of death in severe forms of acute pancreatitis are shock, bleeding, and purulent peritonitis.

Forms

A distinction is made between:

• interstitial (edematous-serous) acute pancreatitis;
• destructive (pancreatic necrosis) acute pancreatitis

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Diagnostics of acute pancreatitis in children

Diagnosis of acute pancreatitis is based on:

• based on clinical and anamnestic data;
• on an increase in the level of pancreatic enzymes (amylase, lipase and trypsin) in the blood and urine;
• based on the results of ultrasound (in acute pancreatitis, a diffuse increase in the size of the pancreas, a decrease in tissue echogenicity, and unclear visualization of contours are noted), and computed tomography.

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Treatment of acute pancreatitis in children

During the first 1-3 days, fasting and drinking alkaline mineral waters are necessary. In severe forms of acute pancreatitis, drinking is also excluded, and the gastric contents are constantly sucked out through a tube. As the patient's condition improves, the diet is expanded very gradually. From the 7th day, table No. 5 according to Pevzner is prescribed.

Drug therapy is aimed at solving the following problems:

Elimination of pain.

For this purpose, the following are used:

• analgesics: analgin, baralgin, tramadol, promedol;
• antispasmodics: papaverine, no-spa, halidor;
• anticholinergics: platyphylline, buscopan, metacin.

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Suppression of the functional activity of the pancreas.

For this purpose the following is prescribed:

• anticholinergics: gastrocepin, pirenzepine, telenzepine;
• antacids: almagel, maalox, phosphalugel, protab, etc.;
• antisecretory agents - H2 ^- histamine blockers (ranitidine or famotidine), H+/K+ATPase inhibitors (omeprazole), synthetic prostaglandins (misoprostol), somatostatin (sandostatin, octreotide).

Reduction of enzymatic toxemia

In severe forms of acute pancreatitis the following is used:

• proteolysis inhibitors: contrical, trasylol, gordox, zymophen;
• glucose-salt solutions, 10% albumin, plasma, vitamins C, B6;
• plasmapheresis or hemosorption.

Against the background of drug suppression of pancreatic function, enzyme preparations (pancreatin, pancitrate, creon) are prescribed for replacement purposes, and broad-spectrum antibiotics (cephalosporins, aminoglycosides) are prescribed for the prevention of purulent complications.

Outpatient observation after acute pancreatitis is carried out for 3 years. Clinical examination, urine test for amylase, coprogram, ultrasound are carried out once a quarter during the first year, then twice a year,

Acute pancreatitis in children must be differentiated from diseases accompanied by intense abdominal pain: acute appendicitis, acute cholecystitis, ulcer perforation, acute intestinal obstruction, biliary colic.