Pancreatitis is inflammation of the pancreas that typically causes very sudden and severe abdominal pain. When there are multiple episodes of pancreatitis, two or more, this is called acute recurrent pancreatitis (ARP). The condition can progress to chronic pancreatitis (CP) if there are signs of permanent damage to the pancreas.
Common causes of acute recurrent pancreatitis and chronic pancreatitis include genetic mutation, systemic illnesses, gallstones, trauma, autoimmune diseases, anatomical abnormalities, and certain medications. Early diagnosis is crucial for managing symptoms and preventing complications, like diabetes or malnutrition. Our expert Pancreas Program team offers a comprehensive approach to care, from diagnosis to advanced treatments tailored to your child’s needs to ensure the best possible outcomes.
Types of Pancreatitis
Acute Recurrent Pancreatitis (ARP)
The pancreas is an organ in the upper abdomen, located behind the stomach. It has two main functions:
- Producing enzymes, which help the body digest proteins, fats, and carbohydrates.
- Producing hormones, which help control the body’s blood sugar levels. There are clusters of cells called islets, and within them are beta-cells responsible for making insulin. Insulin controls how the body uses and stores sugar (glucose), which is the body’s main source of energy.
Pancreatitis involves inflammation of the pancreas, causing severe abdominal pain and temporary loss of pancreatic function. Most of the time, a child with acute pancreatitis will recover within seven days without any serious complications. Among those, up to one third may experience another episode. When a child experiences two or more episodes, this is called acute recurrent pancreatitis (ARP). These repeated episodes can progress to chronic pancreatitis (CP) and cause more serious complications over time.
Chronic Pancreatitis
Chronic pancreatitis is a progressive inflammation of the pancreas that causes permanent damage and scarring to the pancreas tissue and loss of pancreatic function. This severe pancreatitis can lead to trouble digesting food, weight loss, and can even cause diabetes.
Similar to acute recurrent pancreatitis, the majority of children with CP have at least one genetic mutation, other causes can include systemic illnesses, gallstones, and congenital structural abnormalities. Proper diagnosis and treatment is important to prevent further complications and improve your child’s quality of life.
Causes and Risk Factors
Acute pancreatitis (AP) can be caused by a variety of factors, however, in up to one third of cases the cause is unknown.
Common causes of acute pancreatitis in children include:
- Systemic (affecting the entire body) illnesses associated with pancreatitis
- Gallstones or bile duct obstruction disease
- Trauma (motor vehicle accidents, bike handlebar injuries)
- Medications (anti-seizure drugs, chemotherapy agents, certain antibiotics, steroids, diuretics)
- Pancreas structure anomalies
- Infections
- Genetic mutations
- Metabolic disease
- Toxins
Congenital structural abnormalities can also be a cause of acute recurrent or chronic pancreatitis.
Signs and Symptoms
Acute pancreatitis symptoms can easily be confused with signs of another disease. They also vary depending on your child’s age and developmental level. It’s important to note, not every child with pancreatitis will have all these symptoms.
Common symptoms include:
- Abdominal pain
- Irritability (infants)
- Nausea
- Vomiting
- Loss of appetite
- Back pain
- Fever
- Jaundice (yellowing of the skin)
- Fast breathing
- Fast heartbeat
Symptoms with chronic pancreatitis can be more persistent and may include:
- Repeated attacks of abdominal pain
- Irritability (infants)
- Nausea
- Vomiting
- Diarrhea and oily bowel movements
- Trouble digesting food
- Weight loss or poor growth
- Diabetes generally takes many years to appear, but some patients with chronic pancreatitis will develop diabetes in adolescence.
Complications
In most cases, acute pancreatitis in children resolves in about a week, however, about 13%-20% of children experience symptoms for a longer period with complications, such as:
- Acute fluid collection around the pancreas
- Pseudocyst: fluid collection around the pancreas with a thin surrounding wall
- Damage of pancreas tissue
- Infection of the fluid collection
- Multi-organ failure
Diagnoses and Tests for Pediatric Pancreatitis
Diagnosing pancreatitis can be challenging and can often be misdiagnosed as a less severe condition. A diagnosis requires several steps, as there is no single test for this condition. A diagnosis of pancreatitis depends on the presence of symptoms, abnormal blood test results, and radiographic images showing inflammation in the pancreas.
Here are common tests your child’s doctor may recommend:
- Blood Tests: Both amylase and lipase are enzymes made by the pancreas to aid digestion of foods. When the pancreas is injured or inflamed, the blood levels of both amylase and lipase can rise above normal. Other conditions can also raise these enzyme levels, therefore, additional testing might be needed for a proper diagnosis.
- Ultrasound: Used to check if the pancreas is inflamed.
- CT Scan: Used to look for pancreatic damage and can help rule out other potential causes of abdominal pain.
- MRI Scan: Used to look for abnormalities and can also help rule out other potential causes for abdominal pain.
- Endoscopic Ultrasound (EUS): This test involves performing endoscopy under sedation or anesthesia with a special flexible endoscope with an ultrasound probe. Endoscopic ultrasound helps provide a detailed examination of the pancreas tissue and the pancreatic ducts to identify the stage of pancreatitis. It also has the capability to obtain pancreatic tissue in certain cases to be further examined by a pathologist to identify causes of pancreatitis.
- Endoscopic retrograde cholangiopancreatography (ERCP): Used to look inside the bile and pancreatic ducts. This procedure is done under sedation or general anesthesia and combines the use of an endoscope, a flexible tube with light, and x-ray. The tube is inserted through the mouth down to the beginning of the small intestine. Once there, contrast material is injected into the ducts and an x-ray machine is used to take images. With this study, we are able to examine the pancreatic duct, evaluate for strictures, and treat them with dilation or stent placement.
The pancreas can sometimes appear normal on these scans during an episode of pancreatitis. So, it is important to get comprehensive testing and diagnosis at a children’s hospital, like Children’s Hospital Los Angeles, with pediatric expertise.
Treatment for Pediatric Pancreatitis
With acute pancreatitis, children usually recover within seven days and because there is not one specific medication used to treat it, it often requires supportive care. Treatment might involve:
- Pain medication to ease abdominal pain
- Anti-nausea medication to reduce nausea and vomiting
- IV fluids to keep your child hydrated
- A feeding tube, in rare cases
Chronic pancreatitis can be severe and cause serious complications. It often requires ongoing care, including pain management, intervention procedures like ERCP, nutrition and diabetes monitoring. And in selective severe cases, surgery. Treatments options include:
- Pain management medications
- Pancreatic digestive enzyme supplements
- Steroid medications if there is an autoimmune factors
- ERCP and EUS
- Total pancreatectomy with islet autotransplantation (TPIAT) surgery
- Whipple procedure if there is a mass in the head of the pancreas
Learn more about pediatric pancreatitis treatment options at CHLA.
Pancreatitis Care at Children’s Hospital Los Angeles
Pancreatitis symptoms can range in severity and in some cases be debilitating and have a negative impact on a child’s life. At CHLA, we provide specialized care that is customized to each child’s unique condition and needs. Your child will be cared for by leading experts using the latest treatments, all done with compassion. Learn more about what CHLA’s Pancreas Program has to offer.
FAQs
Complications of acute pancreatitis depend on the severity of the condition. The most common is the collection of fluid around the pancreas. These collections can be small or large enough to cause a swollen abdomen. Generally, the fluid will go away with time, but if the pockets of fluid cause symptoms, the fluid may need to be drained. Symptoms include vomiting from blockage of the stomach or part of the small intestine and fever due to infection. Rarely, the fluid collections will cause bleeding in the abdomen or intestines.
Complications of chronic pancreatitis can include chronic pain, nutrient malabsorption, micronutrients deficiency, and the development of diabetes. Though rare, there is an increased risk of pancreatic cancer.
On average, symptoms of acute pancreatitis will last about 3-7 days, and will improve over time. Children with chronic pancreatitis may develop long-term issues.
Death from acute pancreatitis is quite rare (2%-10%) in children but it can happen. Most deaths associated with pancreatitis occur in children who have a significant illness that damages multiple organs.
Yes, about 10%-30% of children will experience another bout of acute pancreatitis. Even fewer will have multiple episodes. If your child has another episode, their doctor will do additional testing to search for known causes of acute recurrent pancreatitis.
There are some treatable causes of acute pancreatitis. These include gallstone disease, high blood calcium, high blood triglycerides, and abnormalities of the bile ducts that come from the liver or the ducts within the pancreas. Treating these disorders can help prevent future episodes. Unfortunately, for most patients, there is no effective way to prevent pancreatitis.
There is no clear evidence that a special diet is required for chronic pancreatitis. Still, many physicians will prescribe a short period of low-fat diet during an acute attack, and advise their patients to eat more frequent, smaller meals. Patients who have lost the ability to digest food will be prescribed pills containing pancreatic enzymes to help with digestion. They may also be prescribed fat-soluble vitamins A, D, E and K, since the difficulty absorbing fat also interferes with patients’ ability to absorb these vitamins, which are crucial for maintaining good health.
With chronic pancreatitis, there is an increased risk of developing pancreatic cancer compared to the general population. The degree of risk depends on the underlying cause of pancreatitis and should be discussed with your doctor.