acute and chronic pancreatitis

WHAT IS THE PANCREAS AND WHAT DOES IT DO?

The pancreas is an organ that is present in the back of the abdomen (the belly) and is an important part of the digestive system responsible for releasing substances in the body. The pancreas makes digestive enzymes that are released into the small intestine to help break down the foods. It also makes two hormones – insulin and glucagon – that help controls blood sugar levels.

WHAT IS PANCREATITIS?

Pancreatitis is an inflammation of the pancreas. Normal pancreas secretes digestive enzymes that remain inactive until they reach the small intestine and when the pancreas become inflamed, these digestive enzymes being attacking the pancreas itself.

Pancreatitis can be acute or chronic and both forms can lead to complications.

ACUTE PANCREATITIS occurs suddenly and will result in severe abdominal pain accompanied with nausea and vomiting. Most cases of acute pancreatitis resolve within a week and long-term complications are rare. This is more common among kids and most kids experience only one episode.

CHRONIC PANCREATITIS last for a long time and can be a result of recurring attacks of acute pancreatitis. The inflammation of the pancreas, since it remains so for a longtime, can permanently damage the pancreas.

WHAT ARE THE SIGNS & SYMPTOMS OF PANCREATITIS?

The signs & symptoms of pancreatitis are often vague and can be confused with signs & symptoms of other diseases, such as viral gastroenteritis.

SIGNS & SYMPTOMS OF ACUTE PANCREATITIS:

Children suffering from acute pancreatitis need immediate medical attention and usually require hospitalization for close monitoring.

The common signs & symptoms of acute pancreatitis may include:

• abdominal pain
• nausea & vomiting
• fever
• difficulty in breathing

SIGNS & SYMPTOMS OF CHRONIC PANCREATITIS:

The most common symptom of chronic pancreatitis among children is consistent or intermittent pain and discomfort in the upper abdomen that may last for hours or even days. This pain, in some cases extends to the back of the abdomen and may increase after eating or drinking.

The other symptoms of chronic pancreatitis include the following digestive issues:

• chronic weight loss even if the eating habits and amount is normal
• nausea and vomiting that might be accompanied with diarrhea
• greasy or oily stool that is difficult to flush

WHAT HAPPENS WHEN A CHILD GETS PANCREATITIS?

When the pancreas gets scarred for some reason, the organ is no longer able to make the right amount of enzymes needed to digest the food and because of that the child’s body is not able digest the fat and the key elements of food. Further, damage to the pancreas or part of the pancreas that are responsible for making insulin may lead to diabetes.

PROBLEMS ASSOCIATED WITH ACUTE & CHRONIC PANCREATITIS:

For children suffering with chronic pancreatitis, chronic pain is the main problem and both acute & chronic pancreatitis can lead to some serious complications, such as:

• dehydration or low blood pressure
• bleeding, tissue damage and infection
• fluid-filled cavities called pseudocysts in the pancreas that cause vomiting and fever
• injury to the heart, lungs, and kidneys or other organs when the digestive enzymes & toxins enter the bloodstream
• diabetes mellitus as a result of the loss of pancreatic tissue & cells that are responsible for producing insulin
• diarrhea, bellyache, bloating and distension (a protruding belly)

WHAT CAUSES PANCREATITIS?

CAUSES OF ACUTE PANCREATITIS: The causes of acute pancreatitis are many but in approximately 30% of cases, doctors cannot pinpoint the exact cause. It could be a result of an injury to the abdomen from a playground accident or a sports injury or it could be because of some common medications and conditions, such as:

• anti-seizure medications
• gallstones or infections
• certain antibiotics
• problems with the body’s immune system
• blockages in the various ducts that drain the enzymes from the pancreas
• high level of fats (triglycerides) in the blood
• an overactive parathyroid gland that are responsible to maintain the right balance of calcium in the blood and in tissues that depend on calcium for proper functioning

CAUSES OF CHRONIC PANCREATITIS:

Recurring episodes of acute pancreatitis can lead to chronic pancreatitis. While in some cases, genetics may be a factor that causes pancreatitis, but in some cases the doctors do not know the right cause of the condition.

Certain medical conditions or illnesses are also responsible for pancreatitis, such as cystic fibrosis or celiac disease.

HOW IS ACUTE PANCREATITIS DIAGNOSED IN CHILDREN?

While there is no single test that detects acute pancreatitis, the first step in the process of diagnosis, a pediatric gastroenterologist does a blood test to reveal whether there exist abnormally high levels of enzymes in the blood. These enzymes, known as amylase and lipase, are key digestive enzymes that helps the body break down starches and helps the body digest fats respectively. If the levels of these hormones are high, the pediatric gastroenterologist will get an abdominal ultrasound done to check the liver and the pancreas and also look for gallstones. Further, some other tests, such as a CAT Scan, or an MRI can be done to check for inflammation or damage to the pancreas.

The blood test and various radiology scans do not always provide a clear-cut diagnosis of acute pancreatitis, and the pediatric gastroenterologist will make a clinical judgment based on the child’s medical history and the severity of the symptoms.

HOW IS CHRONIC PANCREATITIS DIAGNOSED IN CHILDREN?

While a blood test will probably identify the possibility of acute pancreatitis, it does not help in identifying chronic pancreatitis, and the pediatric gastroenterologist will need to get several tests done to determine if a child has chronic pancreatitis.

To identify chronic pancreatitis, various imaging tests are done, they include:

• Abdominal Ultrasound that will confirm the inflammation of the pancreas
• An MRI Scan that will help rule out other causes of abdominal pain.
• A CT Scan that will also help rule out other causes of abdominal pain.
• An ERCP (Endoscopic Retrograde Cholangiopancreatography) Test. This test combines an x-ray technique known as fluoroscopy with flexible endoscopy and it involves a scope with a tiny HD camera on the end to see the insides of the body. It helps identify problems of the pancreas, the pancreatic duct, the liver, the gallbladder and bile ducts.

WHAT ARE THE VARIOUS TREATMENT OPTONS FOR PANCREATITIS IN CHILDREN?

In most of the cases, pancreatitis gets better on its own in about a week and the treatment is concerned with medication to control pain and address the nausea and vomiting.

TREATMENT FOR ACUTE PANCREATITIS:

For acute pancreatitis, there is no specific medication or treatment that helps the pancreas to recover and the child needs supportive care that will help the body perform its normal functions. The supportive care that a child would need includes the following:

• medicines to help treat the pain
• anti-nausea medication to take care of persistent vomiting
• administration of intravenous fluids to ensure that the child is well hydrated

In cases of severe pancreatitis where the child is not able to eat for many days, your child’s pediatric gastroenterologist may recommend giving essential liquid nutrition through a feeding tube, or he might recommend intravenous nutrition.

The pediatric gastroenterologist addresses the pain, vomiting and discomfort associated with the condition, and once these have been resolved, the child’s appetite will slowly return. The child needs to be encouraged to eat and the diet will range from clear liquids to regular food.

TREATMENT FOR CHRONIC PANCREATITIS:

For chronic pancreatitis too, there is no specific medication or cure and the child is given supportive care where the pediatric gastroenterologist treats the symptoms and ensure body’s normal functioning. The supportive care may include the following:

• medication to ease the pain
• pancreatic enzyme treatment to help with the digestion
• and in severe cases, the child may be given insulin to control the blood sugar levels

In some cases of chronic pancreatitis and pain, your child’s pediatric gastroenterologist might recommend a surgical procedure known as Lateral Pancreatojejunostomy, or Peustow. In this procedure, the child’s abdomen is opened with an incision from the lower breastbone to the belly button. In the exposed pancreas, the main pancreatic duct is then opened from the head to the tail of the pancreas and the opened pancreatic duct is connected to a loop of the small intestine. This is done so that the pancreas drains directly into the intestines. This procedure has a high success rate and low operative complications.

WHAT YOU, AS A MOTHER, SHOULD KNOW ABOUT PANCREATITIS?

When treating pancreatitis in children, the help of a pediatric gastroenterologist should always be sought because if not treated properly, it can lead to complications that could be life threatening.

The overall treatment modality for pancreatitis includes adequate pain management and avoiding an oral diet so that the pancreas can rest for short durations and correct fluid losses.

Most of the children with acute pancreatitis recover without any problem whereas children with chronic pancreatitis have trouble digesting food and might need pancreatic enzyme supplements. Chronic pancreatitis might cause diabetes, but it usually takes many years.