Clinical manifestations and diagnosis of chronic and acute recurrent pancreatitis in children
- Sarah Jane Schwarzenberg, MD
Sarah Jane Schwarzenberg, MD
- Associate Professor of Pediatrics
- Director, Pediatric Gastroenterology, Hepatology and Nutrition
- University of Minnesota Masonic Children's Hospital
- Section Editors
- Melvin B Heyman, MD, MPH
Melvin B Heyman, MD, MPH
- Section Editor — Pediatric Gastroenterology
- Professor of Pediatrics
- University of California, San Francisco
- David C Whitcomb, MD, PhD
David C Whitcomb, MD, PhD
- Section Editor — Pancreatic Diseases
- Professor of Medicine
- University of Pittsburgh School of Medicine
Chronic pancreatitis is a progressive inflammatory disease of the pancreas. It is defined mechanistically as "a pathologic fibroinflammatory syndrome of the pancreas in individuals with genetic, environmental, or other risk factors who develop persistent pathologic responses to parenchymal injury or stress" . The severity of clinical signs and symptoms vary between patients and more advanced disease is characterized by pancreatic atrophy, fibrosis, pain syndromes, duct distortion and strictures, calcifications, pancreatic exocrine dysfunction, pancreatic endocrine dysfunction, and dysplasia. In advanced disease, the structural changes, pain syndromes, and exocrine and/or endocrine pancreatic insufficiency appear to be irreversible [2-4]. The structural changes include irregular sclerotic and diffuse or focal destruction, acinar cell loss, islet cell loss, inflammatory cell infiltrate, and pancreatic duct abnormalities. Intraductal obstruction may be caused by protein plugs and/or calculi. Chronic and acute recurrent pancreatitis are distinguished by frequency of symptoms and presence or absence of irreversible changes in the pancreas or pancreatic function (table 1) .
This topic review will provide an overview of the clinical manifestations, diagnosis, and prognosis in children with chronic and acute recurrent pancreatitis. Related information is available in the following topic reviews:
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- CLINICAL MANIFESTATIONS
- Abdominal pain
- Pancreatic diabetes
- INITIAL EVALUATION FOR SUSPECTED CHRONIC OR ACUTE RECURRENT PANCREATITIS
- Physical examination
- Laboratory testing
- Initial imaging
- Other tests
- FURTHER EVALUATION FOR THE CAUSE
- Genetic testing
- Toxic-metabolic risk factors
- Autoimmune pancreatitis
- OVERVIEW OF MANAGEMENT
- Therapeutic ERCP
- Pain management
- SUMMARY AND RECOMMENDATIONS