Could Your Child’s Tummy Pain Be Pancreatitis?

How to know when a stomachache is something more serious
Could Your Child’s Tummy Pain Be Pancreatitis?

Contributor: Kadakkal Radhakrishnan, MD

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When your child is feverish and nauseous with a stomachache, it’s often just a 24-hour bug. However, pancreatitis – an inflammation of the pancreas –  also has symptoms that are quite similar to a stomach virus. Although we typically only hear about pancreatitis being a problem for adults, children also can be affected.

In adults, gallstones and alcohol are the two leading causes of pancreatitis and can cause major illnesses, with prolonged hospitalization. In children, the causes often are different, and illness is less frequent.

To lessen the risk of complications, it’s important for parents to recognize the symptoms of pancreatitis early.

Factors and causes of pancreatitis in children

The pancreas is a digestive gland in the back of the abdominal cavity. The pancreas makes digestive juices that drain into the upper part of the small intestine, and it’s important in the digestion of carbohydrates, fats and proteins.

It’s an amazing phenomenon that the pancreas, despite making the digestive juices, never digests itself due to the natural checks and balances in the gland. When these checks and balances are interrupted, pancreatitis can occur.

These checks and balances include producing digestive secondary to certain hormonal signals when food reaches the beginning of the small intestine, free flow of digestive juices into the small intestine through tubes called ducts and prevention of activation of the digestive enzymes.

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There are two main types of pancreatitis: acute and chronic. When pancreatitis occurs one time, it’s known as acute pancreatitis, and when it occurs repeatedly, it’s called chronic pancreatitis. When pancreatitis does not heal or improve, more long-term problems can occur. For example, the pancreas can become scarred and develop calcium deposits in the gland, as well as sludge and stone in the pancreatic duct.

In children, the exact cause of pancreatitis is unknown half the time. Acute pancreatitis may be caused by medications, a viral infection or trauma. On the contrary, recurrent pancreatitis may be due to genetic defects or due to congenital abnormalities in the pancreatic duct.

Although rare, two genetic defects associated with repeated pancreatitis include cystic fibrosis gene changes and mutations causing activation of a digestive enzyme called trypsin in the pancreas.

Symptoms of pancreatitis

Pancreatitis can be extremely painful for children. If your child complains of persistent upper abdominal pain — often to the middle and left and sometimes with radiation of pain to the back — that could be a sign than it’s more than just the flu or a tummy ache.

The pain is often intense and associated with nausea or vomiting. Pain can be unrelenting and almost always is not associated with diarrhea. Occasionally, children can develop dehydration, breathing difficulty and even shock due to fluid loss into the tissues.

Diagnoses and treatment of pancreatitis

Pancreatitis can be difficult to diagnose, and it takes a high degree of suspicion to start testing for it. The best screening test for acute pancreatitis is a simple blood test that looks for elevation of two enzymes: amylase and lipase.

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An ultrasound also may be a helpful tool in evaluating the pancreas, and a CT scan may be required if the symptoms are severe and if there’s concern for significant inflammation. An MRI may be required if the pancreatitis becomes recurrent or if there are concerns for obstruction by a gall stone causing pancreatitis. Once pancreatitis becomes recurrent, the help of a genetics doctor may be enlisted to look for genetic mutations that may be associated with pancreatitis.

When treating pancreatitis, the help of a pediatric gastroenterologist should be sought. Although specific therapies are limited, many management tools can help control symptoms. Overall treatment includes adequate pain management and avoiding an oral diet to rest the pancreas and correcting fluid losses.

When pain and nausea improves, oral nutrition or feeding by a nasogastric tube can be started. Medical evidence shows that starting nutrition orally early or through a feeding tube speeds recovery and shortens the hospital stay.

When pancreatitis becomes recurrent, a low-fat diet may help reduce the frequency of attacks. Sometimes, digestive enzyme supplementation is required if the patient develops digestive enzyme deficiency.

When attacks of pancreatitis become more frequent, the pain can become debilitating. For this, more intense treatment options are available, such as removal of the pancreas andinjection of the patient’s own insulin-making cells from the pancreas to the liver. These have both been shown to improve quality of life and decrease the risk of diabetes.

This post is based on one of a series of articles produced by U.S. News & World Report in association with the medical experts at Cleveland Clinic. 

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