Case Chronicles: What Would You Do - Pancreatitis
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The patient had been seen 21 times at other facilities over three years prior to this presentation.
Every time the patient was seen by a doctor previously, it was after her attack had resolved.
Lipase was checked a year earlier by the pediatrician after pain had resolved.
The lipase returned more than 3 times the upper limit of normal for her age.
Ultrasound not picking up pancreatic abnormalities in pancreatitis is not all that uncommon.
CT scan showed the pancreas is inflamed with fluid tracking around it.
The pancreas makes juice or enzymes that break food down when a person eats.
The body keeps pancreatic enzymes switched off until they are down in the intestines where the food is.
In this patient's pancreatitis, enzymes are switching on while still in the pancreas, causing inflammation.
The traditional approach of nothing by mouth to rest the pancreas is not what is done anymore.
The pancreas doesn't rest; starving a child with pancreatitis doesn't quiet it down.
Kids with pancreatitis who get fed early actually do better and it's safe.
Doctor Abu Al Haija wrote the international guideline for feeding children with pancreatitis.
Pancreatitis is inflammation, not infection, so antibiotics are not indicated.
In an adult, pancreatitis is almost always caused by gallstones or alcohol.
In a child, the list of pancreatitis causes is different from adults.
In kids like this patient, the cause of pancreatitis is usually something the child was born with.
Sweat test and genetic panel are sent to evaluate for congenital causes of pediatric pancreatitis.
At Cincinnati Children's, sweat test and genetic panel results come back much sooner than normal, usually less than a month.
For most kids with pancreatitis, the first attack is the only attack.
The diagnosis required one blood test (lipase) drawn while the pain was happening.