Pancreatitis in children: from symptoms to treatment

Children's pancreatitis is a fairly common diagnosis, especially among children who have some kind of digestive problems. The disease can be extremely dangerous if the child does not start receiving the correct treatment in a timely manner, and therefore the task of not only doctors, but also parents, is the early detection of pathology.

About the disease

We often begin to guess about the presence of a pancreas in our body only when it suddenly “breaks down”. Children's pancreatitis is no exception, which often begins without symptoms or is skillfully "disguised" under a variety of diseases of the digestive tract.

Pancreatitis is an inflammatory process in the tissues of the pancreas. It is located next to the stomach. The stomach accepts food, in it it undergoes primary splitting, after which the food mass enters the small intestine, and here digestive enzymes are needed, which, in addition to insulin, are produced by the pancreas. She releases the product of her secretion into the duodenum. But that's how a healthy gland works.

In the inflamed pancreas, enzymes are produced normally, but they are activated before they get where they need to for proper digestion. This only intensifies the inflammatory process, since the gland, in fact, begins to digest itself. Gradually, the tissues of the gland are damaged, they cope worse with their enzyme-production task, and enzyme deficiency develops. In a severe case, necrotic changes in the gland begin - pancreatonecrosis, in which the prognosis is very disappointing. In many cases, it is fatal.

In children, pancreatitis occurs in about 15-25% of cases, if we take as a basis a group susceptible to diseases of the gastrointestinal tract.

Very often the beginning pancreatitis goes unnoticed. Parents treat completely different diseases that resemble inflammation of the pancreas in symptoms, for example, dysbiosis or gastritis.

Classification and types

Doctors use different classification systems to determine the type of pancreatitis. The very first appeared in the middle of the last century, but she attributed the inflammation of the pancreas only to alcoholics. When it became clear that both children and adults who do not drink alcohol were suffering from the disease, a universal classification was created, which was supplemented by German scientists in 2007.

Thus, today all cases of inflammation of the pancreas are divided into:

acute pancreatitis;
recurrent acute;
chronic;
chronic in the acute stage.

In order to better understand the essence of such a division, one should know that an acute process is called a process that has just arisen with all the characteristic symptoms. If the disease recurs even before six months have passed since the moment of acute pancreatitis, they speak of a recurrent acute disease. If more than half a year has passed, doctors diagnose "chronic pancreatitis in the acute stage."

Depending on how much the pancreas is affected, if destructive processes have begun in its tissues, determine:

edematous pancreatitis (the gland is edematous, but only individual cells are damaged, there are no large necrotic areas);
destructive (there are necrotic foci).

Specifying the condition, doctors indicate that small, medium or large foci of necrosis are present. It is noteworthy that doctors usually do not use the term "pancreatic necrosis". They are mainly operated on by pathologists to describe the causes of death.

Several phases are distinguished in the course of the disease:

enzymatic stage - lasts up to 4-5 days;
jet period - starts on the 5-6th day and ends on the 14th day;
sequestration - starts from 15 days from the onset of the disease;
stage of outcome - lasts about six months after the onset of the disease.

Children's pancreatitis, if acute, is usually accompanied by inflammation and swelling of the gland. In the most severe cases, there are hemorrhagic symptoms - hemorrhage. But in childhood, acute pancreatitis in its pure form is very rare. In 90% of cases, children have a chronic disease, and often it is latent.

The peculiarity of childhood leaves an imprint on the diagnosis: if a baby is diagnosed with reactive pancreatitis, then doctors regard it as a pancreatic response to a variety of pathological processes in the gastrointestinal tract, and such a disease is reversible with proper and timely treatment.

If untreated, reactive children's pancreatitis can turn into true pancreatitis, in which the destruction of the gland tissues will begin.

Causes

The child's pancreas can react with inflammation and edema to many unfavorable factors, but then its own enzymes, which begin to activate ahead of time right in the gland, become the cause of the intensification of the inflammatory process. At the same time, not only the tissues of the gland suffer, but the entire body, because the products of decay of tissue cells begin to enter the blood, and this is precisely what causes intoxication in the acute form of the disease. This can be pancreatitis with salmonellosis and or acute herpesvirus infection, with enterovirus (intestinal infection).

Parents do not always attach importance to the symptoms of acute pancreatitis, and then the disease can become chronic. Exacerbations will occur when the child's body is exposed to a variety of situations and factors:

food poisoning;
any viral disease;
fungal infections;
food allergy;
overeating or malnutrition;
stress, worries.

It is believed that the main cause of the inflammatory process in the gland is a violation of the outflow of the secretion that it produces. The excretory ducts may begin to cope worse with their functions after a blunt abdominal injury, against the background of parasitic diseases in children (especially with opisthorchiasis and the presence of ascaris), in the presence of various diseases of the digestive system (gastritis, gastroduodenitis, hepatitis, gallbladder disease).

The gland can begin to produce an excess amount of enzymes that simply cannot be completely excreted into the duodenum, in such cases:

the child does not eat properly - there is a lot of fatty, spicy, chips, fast food, drinks a lot of soda, eats irregularly, overeats;
the child has suffered severe poisoning;
the baby is allergic to foods or medicines (corticosteroid hormones, antibiotics-sulfonamides, cytostatic drugs, some nonsteroidal anti-inflammatory drugs are especially dangerous for the children's pancreas);
the child is diagnosed with obesity;
there is a confirmed excess thyroid function.

Often, pancreatitis develops in children who have had mumps (mumps), dysentery.

Signs

An acute attack of pancreatitis can be recognized by severe pain in the stomach. It develops suddenly and causes quite pronounced inconveniences. Children at a conscious age (5-6 years old, 7-8 years old and older) may well describe their feelings and indicate exactly where they are hurt. In a baby, an attack of pain manifests itself a strong cry and pressing the legs to the stomach, in connection with which mothers often confuse inflammation of the pancreas with intestinal colic.

The child's pain is concentrated mainly in the upper abdomen, many complain that slightly "gives" to the right side of the body. Acute attack characteristic vomiting in it, parents can easily distinguish bile impurities. After an attack of such vomiting, there is no relief, and the child starts to feel sick again. The temperature often rises.

It is important to pay attention to the color of urine and feces. If the head of the pancreas becomes inflamed and increases in size, then the child may develop mechanical jaundice - the outflow of bile is disrupted, and therefore its coloring pigments enter the blood. The skin becomes yellowish, the whites of the eyes, the urine is colored dark, and the feces, on the contrary, become light, almost white.

When the described signs of acute pancreatitis appear, it is important to call an ambulance. But in most cases, children's pancreatitis occurs in milder forms, and age also plays a role: the younger the child, the less noticeable the signs of pancreatic disease may be.

You should pay attention to symptoms such as flatulence, bloating, repeated nausea and vomiting, loose stools, loss of appetite. The temperature is usually within 37.0 degrees and a little higher, baby looks pale, dry mouth.

Chronic pancreatic disease is sharply accompanied severe pain attacks. Usually, from time to time, the child complains of aching pain in the stomach, which may worsen if the day before the baby ate something fatty or drank soda, as well as during periods of emotional and psychological stress, strong physical exertion. Such aching attacks are both short - from an hour, and long - up to several days.

Children with a chronic pathological process in the pancreas are prone to heartburn, have decreased appetite, often experience bouts of nausea, especially after eating, often suffer from unstable bowel movements - constipation is replaced by diarrhea and vice versa.

Symptoms of complications may gradually develop - the child begins to lose weight, he develops pleurisy or diabetes mellitus.

How is the diagnosis made?

Self-diagnosis is not worth doing. When the signs described above appear, it is worth visiting a doctor for a detailed examination. The doctor will be able to suspect signs of pancreatitis in a child by feeling the epigastric region, especially if the pancreas is swollen and enlarged. But the diagnosis is made not only by a combination of symptoms and manual research. Laboratory diagnostics play an important role.

If a child has acute pancreatitis, then a large number of leukocytes and high ESR values are determined in the blood. More accurate information is provided by a biochemical blood test - it can determine the increased activity of pancreatic enzymes, as well as a high content of glucose in the blood serum. The presence of some enzymes of the pancreas is also determined in the feces.

The child is doing an ultrasound scan of the pancreas, stomach, gallbladder. Ultrasound makes it possible to see whether the gland is enlarged, whether there is edema, a change in its shape, whether areas of necrotic lesion have appeared. If necessary, the child may be recommended computed tomography of the abdominal organs or MRI.

After contacting a doctor with characteristic complaints, it is very important that he can get as much laboratory and instrumental information as possible to distinguish pancreatitis from stomach ulcers, acute cholecystitis, renal colic, intestinal obstruction, appendicitis.

How to treat?

How to treat acute or chronic pancreatitis depends on how large the lesions of the gland are, whether there are complications. In any case, in both acute illness and exacerbation of a chronic one, it is important to create such conditions for the gland to be in functional rest, that is, therapeutic fasting is prescribed for several days until the attack subsides.

Acute pancreatitis requires the child to be in the hospital (up to 3-4 years old - with a parent). The baby is recommended bed rest and lack of food, you can not feed anything. You can drink mineral water, the composition of which is alkaline. The child is injected with a glucose solution, hemodez, enzyme preparations. After 2-3 days, a therapeutic diet is prescribed, in which the pancreas will not produce enzymes too actively.

Such nutrition implies a complete ban on fatty and fried foods, concentrated meat broths, pork, lard, offal, all smoked, sausages and sausages, fatty fish, canned food, pickled, sauces, eggs, seasonings, raw onions, garlic, legumes, spinach, bananas , pomegranate, grapes, sweets, cocoa and carbonated drinks, baked goods. The child's menu resembles a menu for gastritis, it includes vegetable stews, mashed potatoes, cereals, vegetable soups, boiled and baked meat, poultry, fish. Among the mineral waters, the preference is given to "Essentuki" (No. 4.17), "Narzan".

If a child has chronic pancreatitis, then pain relief is considered the main treatment tactic. Further, it is important to plan the child's nutrition so that repeated exacerbations are excluded.

During rehabilitation after an attack, the doctor may prescribe drugs pancreatic enzymes ("Pancreatin", "Creon") - these drugs will contribute to the digestive processes, while slightly loading the pancreas itself. It is important to follow the daily routine, nutrition. Treatment is possible at home.

The exact list of drugs that a doctor can prescribe to a small patient will only be reported by the doctor himself after the examination, because other medications are also given to eliminate the accompanying symptoms and pathologies: antibiotics, hormonal agents, and antispasmodics are also used. The reception scheme is also individual.

In severe cases, when conservative treatment does not help, and destructive changes in the gland progress, according to clinical guidelines, surgical treatment can be performed - resection of the gland, necrectomy, removal and drainage of the gland abscess.

Forecasts

Many scientists have devoted their monographs to pancreatitis, but even in them you will not find an abundance of information on forecasting - this is a very individual disease. In general, it can be noted that mild forms of acute reactive pancreatitis in children have quite favorable prognosis, if, of course, parents and doctors immediately provided the child with the necessary assistance and treatment. The forecasts for hemorrhagic and purulent forms of the disease are somewhat worse. With pancreatic necrosis, there is a high probability of death.

In the chronic form of childhood pancreatic disease, predictions are difficult - it all depends on how often and how much the disease worsens.

If a child eats properly, leads a healthy lifestyle, regularly undergoes preventive treatment to prevent relapses, receives the spa treatment he needs, then the prognosis is also assessed as quite favorable.

The opinion of Dr. Komarovsky

The famous pediatrician Yevgeny Komarovsky claims that pancreatitis is a disease of an incorrect lifestyle, and it is always easier to prevent than to cure it later (if we are not talking about a hereditary form of the disease). To prevent this disease, the doctor suggests a number of measures.

Do not overfeed the child, do not force him to eat every crumb - this is where the wrong eating habits begin to form.
Make sure that the food on the child's table is fairly well thermally processed so that they have a valid shelf life.
From an early age, teach your child to be mobile and active. A sedentary lifestyle, laziness and constant watching cartoons in combination with chips or hamburgers can lead to obesity of internal organs, including the pancreas.
Encourage your child to eat healthy foods if they don't like them (which is not uncommon), change the presentation, design and serve dishes differently to make them more attractive. A hungry child will eat what is offered - this is the golden rule.
Temper and improve your baby's health, walk more in the air, use rubdowns and cool baths.

You should not give your child pills for any reason (from the head, from the priests, from the rash, and so on). Uncontrolled and excessive medication is one of the main causes of childhood pancreatitis.

Reviews

According to parents, in the treatment of pancreatitis in a child, the most difficult thing is to maintain the diet recommended by doctors. During a food break, if food is not recommended at all, after an attack, the child begins to ask for food the next morning, and then an iron will is required from the parents. In some cases, if children are more than 3 years old, doctors are allowed to drink a small amount of water with honey.

When treating chronic pancreatitis, mothers often admit that it is not possible to maintain the recommended diet for a long time. All the same, there are breakdowns (on holidays, for example). Most argue that it is such breakdowns that lead to an attack of pain and discomfort, to diarrhea, but after the resumption of proper nutrition, everything goes away. As a rule, as experienced parents say, after a few years of the correct diet, foods previously prohibited can be gradually added to the child's diet in small portions. With intelligent administration, the child's condition is not affected.