Pancreatitis

The pancreas is a large organ or gland that sits behind the stomach. It is responsible for producing and secreting digestive enzymes that help break down food. These enzymes are secreted into the duodenum, which is the upper section of the small intestine. This is where the breakdown of food takes place. The pancreas is also responsible for producing two hormones named insulin and glucagon. These hormones are responsible for regulating blood sugar levels. With pancreatitis, the gland becomes inflamed. This inflammation takes place when the digestive enzymes are activated in the pancreas instead of the small intestine.

Causes

There are many causes for pancreatitis. The two main causes, which account for up to 90% of cases, are gallstones and alcohol abuse. Of course this wouldn’t be a problem with small children; however, in today’s society, teenage alcohol abuse is on the rise. With gallstones, there is a stone blocking the pancreatic duct. This disables the pancreas from excreting the digestive enzymes into the small intestine. Consequently, these digestive juices will begin causing damage to the pancreas itself.

Some other causes of pancreatitis includes: some medications, family history, infection bacteria, viruses, fungi, and some parasites, injury resulting from abdominal trauma, exposure to certain chemicals, high fat levels in the blood, high calcium levels in the blood, mumps, and hypothermia autoimmune disease.

Signs/Symptoms

The most prominent symptom associated with this disease is severe pain in the left upper quadrant of the abdomen that can radiate to the back. The pain can become so intense, that it will sometimes make it difficult for your child to sit upright or stand. The abdomen may be tender to touch. Other symptoms that accompany this disease are nausea with intractable vomiting, anorexia, jaundice (yellowing of the skin or the white portion of the eyeball), fever, and dehydration. Blood pressure could be elevated due to pain OR decreased due to dehydration.

Diagnosis

There are several findings that will lead to a definitive diagnosis of pancreatitis. However, be aware of other disease processes that can mimic pancreatitis such as an inflamed gall bladder, a perforated peptic ulcer (hole in the stomach), an infarcted bowel (dead intestinal tissue due to loss of blood supply and oxygen) and diabetic ketoacidosis. First of all, the signs and symptoms listed previously are significant for pancreatitis. Secondly, lab work, specifically serum amylase and lipase levels, which can be elevated as high as 4-6 times above normal. Thirdly, an abdominal ultrasound is recommended, which will not only show an inflamed pancreas, but also can be beneficial in detecting the cause of pancreatitis. Gallstones and an alcoholic fatty liver may be detected via ultrasound. CT scan can be utilized to make a definitive diagnosis.

Treatment

The treatment for pancreatitis is supportive in nature and includes medications, diet, and possibly surgery. Your doctor will order strong pain medications to alleviate the discomfort associated with this disease. Medication to relieve the nausea is also commonly ordered. Pancreatic enzyme capsules, if ordered, are usually given once your child is allowed to eat and are taken prior to eating. In regards to diet, patients will most likely be placed on NPO status (no food or drink) initially. If the vomiting is intractable (continuous in nature), a nasogastric (NG) tube may be inserted through the nose and down to the stomach and placed to suction. This will keep the stomach empty, thus eliminating the vomiting. Anticipate your child receiving nutrition via the veins at this point. Once your child can begin eating again, a clear, liquid diet will be introduced first and progress to a low fat diet. Pancreatitis can also lead to respiratory problems, so supplemental oxygen might become necessary. If the pancreatitis is caused by gallstones blocking the bile duct or pancreatic duct, surgery might become necessary to remove those stones. Surgery to remove the damaged pancreatic tissue may also occur, but this is done very rarely and is usually reserved as a last resort.