Clinical manifestations and diagnosis of chronic pancreatitis in children
- Mohamad Miqdady, MD
Mohamad Miqdady, MD
- Adjunct Faculty
- Cleveland Clinic Foundation
- Seiji Kitagawa, MD
Seiji Kitagawa, MD
- Associate Professor of Pediatric Gastroenterology
- Baylor College of Medicine
- Section Editors
- William J Klish, MD
William J Klish, MD
- Section Editor — Pediatric Gastroenterology
- Emeritus Professor of Pediatrics
- Baylor College of Medicine
- 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 characterized by irreversible structural changes that result in irreversible exocrine and/or endocrine pancreatic insufficiency [1-3]. 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.
This topic review will provide an overview of the clinical manifestations, diagnosis, and prognosis in children with chronic pancreatitis. Discussions of specific etiologies of chronic pancreatitis in children are presented separately. (See "Causes and contributing risk factors for chronic pancreatitis in children and adolescents".)
The clinical manifestations of chronic pancreatitis are similar regardless of the etiology. The age of onset, rate of disease progression, and prognosis depend upon the specific etiology and severity of the underlying condition or process. (See "Causes and contributing risk factors for chronic pancreatitis in children and adolescents".)
Some patients present with recurrent episodes of acute pancreatitis. Others may present with abdominal pain of insidious onset. Another group of patients may present with malabsorption or obstructive jaundice caused by obstruction of the common bile duct . Less commonly, patients may be asymptomatic or present only after signs of pancreatic failure (eg, malabsorption, diabetes), which occurs late in the course [1,3,5,6]. These presentations are discussed in greater detail below.
Chronic pancreatitis should be considered in the differential diagnosis of children with growth failure, particularly those with a weight deficit and malnutrition. The examination is often normal, but may include epigastric or upper abdominal tenderness . An epigastric mass may be palpated if the patient has developed a pseudocyst. (See "Overview of the complications of chronic pancreatitis".)
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- CLINICAL MANIFESTATIONS
- Abdominal pain
- Diabetes mellitus
- Other manifestations
- DIAGNOSTIC APPROACH
- LABORATORY EVALUATION
- Routine tests
- Serum pancreatic enzymes
- Pancreatic function
- Stool fat
- Genetic testing
- IMAGING STUDIES
- Plain films
- Ultrasonography (US)
- - Endoscopic US
- Abdominal CT
- - ERCP
- - MRCP
- SUMMARY AND RECOMMENDATIONS
- Laboratory evaluation
- Genetic tests