Pancreatitis is inflammation of the pancreas.  This inflammation may be caused by toxins, medicines, infections, obstruction of the bile ducts, systemic diseases or trauma.  The pancreas serves 2 major functions: 1. To produce hormones that regulate blood glucose level (example – insulin and glucagon).  2. To produce enzymes that help with digestion of foods.  Pancreatitis is usually discovered after severe, rapid onset abdominal pain and vomiting.

What causes pancreatitis?

• Drugs & Toxins – Alcohol, medicines, estrogen (as in birth control pills or hormone replacement therapy)
• Infections – especially viruses
• Obstruction of the pancreatic duct (by a gallstone for example)
• Systemic diseases – autoimmune disease, cystic fibrosis, diabetes, high blood lipid levels
• Trauma
• Unknown causes

What are the symptoms of pancreatitis?

• Abdominal pain (usually in the mid upper abdomen, just below the sternum)
• Vomiting
• Fever
• Malaise (not feeling well)
• Jaundice (if there is blockage by a gallstone)

Red Flags (seek medical care immediately)

• Severe or persistent vomiting
• Ill-appearing child
• Rash
• High fever
• Not drinking fluids or not keeping them down
• Decreased urine output
• Excessive sleepiness, confusion or unusual behavior

How is pancreatitis infection diagnosed? 

Blood tests for the enzymes produced by the pancreas (amylase and lipase) are available.  Occasionally imaging studies are done to look for pancreatitis or for associated complications such as a pseudocyst.  Computed tomography (a CT scan) is usually the most helpful study. If a gallstone is blocking the bile and pancreatic ducts, then endoscopic retrograde cholangiopancreatography (ERCP) study may be necessary to release the blockage. 

What is a pseudocyst? 

A pseudocyst is a collection of fluid in the pancreas that may occur as a result of pancreatitis.  The inflammation causes damage that reduces the ability of the pancreas to drain digestive fluids.  Surgery is sometimes needed to drain a pseudocyst. 

How is pancreatitis treated in children? 

Replacing lost water and electrolytes with intravenous (IV) fluids is the first step.  This is especially important if the child has been vomiting.  Pain medicines are given.  The child is kept in the hospital without taking anything by mouth (no food or water) until the symptoms and blood tests improve.  Once eating is allowed, the child is given liquids first and then a bland low-fat diet.  As long as the symptoms do not recur, the diet will be advanced and the patient can be sent home (usually within a few days).  Antibiotics are usually not helpful. 

Medicines are occasionally used to treat vomiting and nausea in older children.  Some examples of anti-nausea medicines are Zofran® and Phenergan®.

 

Can pancreatitis be prevented?

• Medicines known to cause symptoms should be stopped. 
• If gallstones are present, a cholecystectomy (removal of the gallbladder) may be necessary.