Acute pancreatitis in children

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

Read also:  Acute pancreatitis in adults

[1], [2], [3], [4], [5], [6], [7], [8]

Causes of the acute pancreatitis

What causes acute pancreatitis in children?

The most common causes of acute pancreatitis in children are:

1. infection (mumps, viral hepatitis, enterovirus, Coxsackie B, chicken pox, herpes, influenza, pseudotuberculosis, dysentery, salmonellosis, sepsis),
2. blunt trauma of the pancreas as a result of a strong blow to the abdomen,
3. diseases with obstruction and increased pressure in the pancreatic ducts (papillitis, choledocholithiasis, cyst or stricture of choledoch, duodenostasis with duodenopancreatic reflux, blockage of duodenal nipple with ascarids, opisthorchiasis, fascioliasis, clonorchiasis),
4. hepatobiliary pathology (cholelithiasis, chronic cholecystitis),
5. hypercalcemia (hyperparathyroidism or hypervitaminosis D),
6. toxic (lead, mercury, arsenic, phosphorus poisoning) and medicamentous lesions (azathioprine, hypothiazide, furosemide, metronidazole, tetracyclines, sulfonamides, high doses of glucocorticoids)

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

Pathogenesis

Pathogenesis of acute pancreatitis

If the tissue of the pancreas is damaged, an inflammatory reaction develops, lysosomal enzymes are released, which perform intrapancreatic activation of enzymes (trypsinogen) damaging the gland. Due to the increase in the blood of biologically active substances, general volemic and microcirculatory disorders develop, a collapse is possible.

Symptoms of the acute pancreatitis

Symptoms of acute pancreatitis in children

In children, predominantly interstitial acute pancreatitis

The main complaint with him - abdominal pain:

• intense, piercing, accompanied by a sense of heaviness, flatulence and eructation,
• localized in epigastrium or navel region;
• they irradiate more often in the left hypochondrium, the left lumbar region.

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

On examination, note:

• pallor or flushing of the face,
• tachycardia, a tendency to arterial hypotension;
• the stomach can be slightly inflated, sometimes reveal the resistance of the muscles in the epigastrium.

Positive symptoms of Mayo-Robson, Frenkel, Bergman and Kalk, is determined by a steady soreness with deep palpation in the zone of Shoffar, at the points of Mayo-Robson and Kach. Typically, the pain increases after palpation of the abdomen.

In the analysis of blood there may be minor leukocytosis, neutrophilia, sometimes a slight increase in ALT, hypoglycemia. Hyperfermentemia (increased levels of amylase, lipase and trypsin) with interstitial pancreatitis is expressed moderately and briefly.

Destructive acute pancreatitis in children is rare.

Characteristic:

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

On examination, note:

• pulse frequent, weak filling, arterial hypotension,
• the abdomen is swollen, tense, deep palpation is hampered by the tension of the anterior abdominal wall.

In the analysis of blood - pronounced neutrophilic leukocytosis, increased ESR, thrombocytopenia. Hyperfermentemia is usually pronounced and persistent.

Pancreatic necrosis can give complications.

• early - shock, hepatic insufficiency, renal failure, ICE, bleeding, diabetes mellitus;
• late - pseudocysts pancreas, abscesses and phlegmon of the pancreas, fistula, peritonitis.

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

Forms

Classification of acute pancreatitis

Distinguish:

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

[9], [10], [11], [12], [13]

Diagnostics of the acute pancreatitis

Diagnosis of acute pancreatitis in children

Diagnosis of acute pancreatitis is based:

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

[14], [15], [16], [17], [18]

Treatment of the acute pancreatitis

Treatment of acute pancreatitis in children

In the first 1-3 days, hunger, drinking alkaline mineral water is necessary. In severe forms of acute pancreatitis, drinking is excluded, and the stomach is continuously sucked through the probe. With the improvement of the patient's condition, the diet is expanded very gradually. On the 7th day, table No. 5 is appointed according to Pevzner.

Drug therapy is aimed at solving the following problems:

Elimination of pain.

To this end, use:

• Analgesics: analgin, baralgin, tramal, promedol;
• antispasmodics: papaverine, no-spa, halidor;
• holinolitiki: platifillin, buscopan, metacin.

[19], [20], [21], [22], [23], [24], [25], [26]

Inhibition of the functional activity of the pancreas.

For this purpose appoint:

• anticholinergics: gastropepine, pyrenesin, telenzepine;
• antacids: almagel, maalox, phosphalugel, protab and others;
• antisecretory agents - H ² -gistaminoblockers (ranitidine or famotidine), inhibitors of H + / K + ATPase (omeprazole), synthetic prostaglandins (misoprostol), somatostatin (sandostatin, okrestoid).

Reduction of enzymatic toxemia

In severe forms of acute pancreatitis apply:

• inhibitors of proteolysis: countercranol, trasanol, gordoks, zymophen;
• glucose-saline solutions, albumin 10%, plasma, vitamins C, B6;
• plasmapheresis or hemosorption.

Against the backdrop of drug-induced pancreatic function suppression, enzymatic preparations (pancreatin, pancitrate, creon) are prescribed for the prevention of purulent complications-broad-spectrum antibiotics (cephalosporins, aminoglycosides).

Dispensary follow-up after acute pancreatitis is carried out for 3 years. Clinical examination, urinalysis for amylase, coprogram, ultrasound is carried out for the first year once a quarter, then 2 times a year,

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