“From mild disease to multiorgan failure and sepsis, acute pancreatitis is a disorder that has numerous causes, an obscure pathogenesis, and an often unpredictable outcome.”
Where is the Pancreas?
The pancreas is a long gland behind the stomach in the upper area of the abdomen. The pancreas has 2 main functions:
1. Produces enzymes that help you digest food.
2. Releases hormones such as insulin and glucagon that helps your body process sugar.
What Causes Acute Pancreatitis in Children?
- Drug
- Idiopathic/Genetic
- Biliary
- Trauma
- Congenital
- Systemic/ autoimmune
Complicated Pancreatitis
Complicated Pancreatitis is a maturing collection of pancreatic juice encased by reactive granulation tissue which has developed as a consequence of acute or chronic pancreatitis.
Symptoms: Abdominal pain, Nausea & food intolerance and Fever
Therapy: Surgery, Percutaneous drainage and Endoscopic drainage techniques
Acute Recurrent Pancreatitis
2 or more episodes of pancreatitis within one year, and generally progresses to chronic pancreatitis.
There are many causes of Acute Recurrent Pancreatitis:
Mechanical: Stones/sludge/microlithiasi, Pancreatic strictures, Pancreatic stones, Sphincter stenosis / dyskinesia (SOD)
Toxic: ETOH
Genetic: Autoimmune, SPINK I, Cystic Fibrosis, Hereditary
Metabolic: Hypertriglyceridemia, Hypercalcemia
Congenital: Annular pancreas, Choledochocele, Pancreatic Divisum
Drugs: Multiple
The goal of therapy is to prevent further attacks of acute pancreatitis.
Chronic Pancreatitis
Chronic Pancreatitis is a Scarring of the pancreas as a result of repeated injuries.
Mechanisms of pain: Pancreatic duct hypertension, Pancreatic outflow obstruction, Papillary stenosis, PD stone, stricture, Pseudocyst, Perineural inflammation, Occult pancreatic carcinoma
Management of Pain: Octreotide, Antioxidants, Low-fat diet, Analgesics, Pancreatic enzymes, Experimental, Endoscopic Tx, Surgical Tx
Endoscopic Retrograde
Cholangio-Pancreatography
Scope that allows access to the biliary and pancreatic ductal systems and deliver therapies.
Endoscopic
UltraSound
Scope that allows the best visualization of the pancreas, liver, gallbladder and ductal systems.
Pancreatic biopsies and injections can be performed.
Obstructive Chronic Pancreatitis
Therapeutic Approach
Endoscopic Therapies:
Sphincterotomy, Stone removal, PD stenting, Celiac neurolysis
Surgical Therapies:
Sphincteroplasty, Peustow, Whipple, Pancreatectomy c Islet cell Transplant (TPAIT)
*Careful selection process, mandatory
