Acute Pancreatitis in Children

Management of Acute Pancreatitis in the Pediatric Population

“…The diagnosis of pediatric AP should follow the published INSPPIRE definitions (by meeting at least two out of three criteria: (1) abdominal pain compatible with AP, (2) serum amylase and/or lipase values ≥3 times upper limits of normal, (3) imaging findings consistent with AP). Adequate fluid resuscitation with crystalloid appears key especially within the first 24h.…”

“…The INSPPIRE ( IN ternational S tudy Group of P ediatric P ancreatitis: I n Search for a Cu RE ) definition of pediatric AP is an expert definition modeled after the Atlanta criteria in adults (8). As per INSPPIRE criteria, a diagnosis of AP requires at least 2 of the following: (1) abdominal pain compatible with AP, (2) serum amylase and/or lipase values ≥3 times upper limits of normal, (3) imaging findings consistent with AP (9, 10). INSPPIRE or other criteria do not address phases (early or late) of AP in children or types (interstitial edematous pancreatitis, necrotizing pancreatitis, infected pancreatic necrosis) or severity of AP (mild, moderate or severe AP with multisystem organ failure).…”

“…The review by Lowe et al summarized the top 6 overall etiological categories in published reviews as being idiopathic/other in 24%, trauma in 17%, systemic illness in 15%, structural abnormalities in 14%, drugs in 10%, and infections in 8%. (3) Considering more common etiologies as well as those for which directed therapies exist, a 2012 manuscript by Morinville et al presented a survey of pediatric gastroenterologists providing pancreatology care and proposed the following workup in first cases of pancreatitis: serum liver enzymes, triglyceride and calcium levels, and abdominal ultrasound. They suggested reserving testing for genetic causes/predispositions (which at the time consisted of CFTR(cystic fibrosis transmembrane conductance regulator), SPINK1 (serine protease inhibitor Kazal type 1) and PRSS1 (cationic trypsinogen)), sweat chloride, and more detailed imaging for cases of ARP, CP, or first instances of AP with increased concern for underlying risk for recurrence based on presentation, past medical history, or family history(9).…”

“…Diagnosis of AP in pediatric patients requires at least 2 of the following: (1) abdominal pain compatible with AP, (2) serum amylase and/or lipase values ≥3 times upper limits of normal, (3) imaging findings consistent with AP.…”

“…As mentioned previously, anatomic, obstructive (including biliary), infectious, trauma, toxic, metabolic, systemic illness, inborn errors of metabolism, genetic predispositions, and idiopathic have all been described as potential etiologies in pediatric AP, acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) (3,4,53). The review by Lowe and Morinville (3) summarized the top 6 overall etiological categories in published reviews as being idiopathic/other in 24%, trauma in 17%, systemic illness in 15%, structural abnormalities in 14%, drugs in 10%, and infections in 8%.…”