Digestion

Pancreatitis in children: symptoms and treatment

Acute pancreatitis in children is inflammation of the pancreas.

Acute pancreatitis is an inflammatory disease characterized by impaired digestive enzyme outflow from the pancreas into the intestine.

During the course of the disease, the structure of the gland is damaged. Normally, enzymes freely enter the intestine and break down nutrient substrates to easily digestible parts, but if the enzymes remain in the body as a result of inflammation, pancreatic tissues will be digested.

Dangerous disease is not only the destruction of the vital gland, but also the involvement of the adjacent organs and tissues. Enzymes and toxins of the destroyed organ can reach the bloodstream and cause toxic damage to all body systems. When late treatment of acute pancreatitis in children, mortality reaches 50-70%.

Pancreatitis in children - the main reasons

For the child's body is characterized by a more acute reaction to the influence of external factors than in an adult. The flow of almost all allergic and infectious diseases in a child in a certain way affects the functioning of the pancreas and can provoke the development of pancreatitis.

Most often, pancreatitis in children occurs due to:

  • malnutrition,
  • eating foods that have an irritating effect on the child’s body. Such food too stimulates the pancreas, resulting in secreted excessive amounts of digestive enzymes and pancreatic juice, which leads to the development of pancreatitis. Sparkling water, smoked products, canned food, chips, fast food, and so on have such an effect.
  • irregular meals,
  • allergies to food and lactase deficiency in young children (newborns or who have not yet fulfilled one year),
  • food poisoning and the use of some antibiotics - in this case they say about the occurrence of reactive pancreatitis,
  • congenital abnormalities of the structure of the organs of the biliary and digestive systems, lactose resistance, cystic fibrosis,
  • diseases that are accompanied by a violation of the contractile function of the gallbladder and a decrease in the lumen of the duodenum, hypothyroidism, gastritis, gastroduodenitis, metabolic disorders, invasion of worms, systemic lupus erythematosus, infections of bacterial or viral origin (parotitis, salmonellosis, dysentery, influenza, herpes and others) ,
  • neoplasms in the digestive organs of a malignant nature,
  • blunt abdominal trauma.

Signs of illness: when is it time to act?

Signs of pancreatitis in a child depend on his age. The most important harbinger of pancreatitis is pain in the abdomen. Adolescents indicate pain in the epigastrium (upper abdomen) or throughout the abdomen. Small children under 3–5 years of age indicate pain all over the abdomen or around the navel because they cannot say exactly where it hurts. Also, symptoms of pancreatitis can be nausea, vomiting, diarrhea, dry mouth, fever (often observed in children under 3 years), appetite deterioration, heartburn, abdominal distension, irritability, rashes on the skin of an allergic nature.

Pancreatitis is especially dangerous for infants, because the child cannot yet tell what hurts him. One of the main symptoms of pancreatitis in infants are intense pain in between the ribs, restless behavior, poor sleep, weight loss. Also, the baby cries and eats up his legs, refuses to eat (breast milk or other food).

When a child has such symptoms, it is necessary to consult a doctor for a gastroenterologist for subsequent diagnosis and treatment. To confirm the diagnosis, a biochemical blood test (elevated digestive enzymes amylase, elastase-1, lipase indicates pancreatitis) and an ultrasound examination of the abdominal organs (to detect an increase in the size of the pancreas due to edema) are used. In order to diagnose chronic pancreatitis, feces are analyzed (the development of the disease is indicated by an increase in the content of fat, starch, and protein fibers).

Treatment of the disease

After the diagnosis, the doctor prescribes pancreatitis therapy. The treatment is carried out according to a conservative method, which is aimed at functional rest of the pancreas, the elimination of factors that provoke the disease, the elimination of symptoms.

Therapy of the acute form of pancreatitis is carried out permanently with mandatory bed rest. For two days it is recommended not to eat food. Alkaline mineral water is acceptable. Parenterally injected glucose solution and, if necessary, inhibitors of proteolytic enzymes. The next stage of treatment is a diet that does not stimulate the secretion of pancreatic enzymes.

Drug treatment of pancreatitis in children consists of drugs:

  • with analgesic and antispasmodic action,
  • antisecretory action,
  • containing pancreatic enzymes,
  • inhibiting proteases.

Sometimes complex treatment in children can contain antibiotics, corticosteroids and antihistamines.

Dieting

Clinical guidelines for treating pancreatitis in children also include diet. The main feature of this diet is the creation of functional rest conditions for the pancreas. To do this, the food is processed by mechanical and thermal means. Feeding a child should be frequent (about six times a day), but in small portions, and the food is always warm.

Baby food for pancreatitis should not contain fried foods, fatty meat of fish or animals, carbonated drinks, spices, spices, salted and smoked dishes, broths, chocolate, pastry and confectionery, fruit. During this period, you can not introduce new products for the child.

Diet for pancreatitis in children under 3 years should not contain fresh vegetables, citrus fruits and juices. Baby food needs to be crushed, because the baby is not always quite carefully chewing food. This rule is recommended to be observed at the stage of remission.

The volume and the menu for the week are selected individually. Protein food is injected into the baby’s diet because it is useful for improving the state of the pancreas. In the preparation of the menu during the treatment of pancreatitis preference is given to:

  • lean meat (chicken, turkey, rabbit, beef, veal),
  • fish (pikeperch, perch, cod, sometimes pollock),
  • dishes made from eggs (egg whites made from egg whites, boiled eggs or cooked soft-boiled eggs),
  • low-fat cottage cheese (can be used as cottage cheese itself or make pudding, casserole or souffle on its basis),
  • vegetable soups with broccoli, cauliflower, carrots. Vegetables for soups need to take fresh, but if they are not, then you can use frozen. It is allowed to use sour cream or half of yolk for dressing soup,
  • Kasham (buckwheat, oatmeal, rice, semolina). It is allowed to add milk mixed with water or dairy products to such porridges. Do not cook porridge with millet, because it is hard to digest,
  • vegetable stew.

Drinks are allowed compotes or jelly. It is forbidden to use fresh or boxed juices, as they are very strong.

Maintaining a diet is very difficult for both the child and the parents, but if it is not followed, the pancreatitis may become aggravated again. For a stable state, it is necessary to strictly observe the daily regimen and diet for six months - a year.

After treatment of children with pancreatitis put on record with a gastroenterologist or pediatrician. The state of the pancreas is monitored using a coprogram (stool analysis), a biochemical blood test, and an ultrasound diagnosis. Be sure to assign therapy, the purpose of which is to prevent exacerbations. It is performed 3–4 times a year, or 1–2 times if the disease does not worsen during 3 years. The course of treatment lasts about a month. It is possible to treat the disease using herbal preparations and products that contain enzymes.

Rehabilitation of a child in a sanatorium will be useful. Its duration is one month. During this time, the child undergoes a course of physiotherapy and strengthening therapy.

Pancreatitis is a very dangerous and complex disease for the treatment of which it is necessary to apply a lot of strength and patience to the child and parents. If you follow the recommendations of the doctor, strictly follow a diet and lead a correct lifestyle, then there is a high probability of completely curing pancreatitis.

A bit about reactive pancreatitis

This disease is not independent: it arises against the background of another disease. Most often reactive pancreatitis accompanies respiratory diseases, acute viral infections, gastritis, tonsillitis. Another cause of inflammation of the pancreas is the improper nutrition of the child. This is the use of such products as canned food, crackers with flavors, instant noodles, chips, smoked sausages, soda, chocolate bars. These products cause irritation of the gastrointestinal tract. Such food should not be consumed not only by children, but also by their parents.

Every parent should remember that the child’s digestive system is not a chemical factory for processing any raw materials. This is a very fragile, finely built system of internal organs. Physiological changes in the structure of the biliary tract, their narrowing, pancreas bend can lead to reactive pancreatitis. Defects in the structure of an organ are usually diagnosed in the first month of a child’s life. Another reason may be taking antibacterial drugs, antimicrobial agents, taking drugs that do not match the age of the child.

Symptoms of reactive pancreatitis in children:

  1. Cry.
  2. Abdominal pain on the left side.
  3. Repeated vomiting.
  4. Loose stools.
  5. Dehydration.

Even if a child has only some symptoms, it is necessary to consult a doctor. In children, the process of fluid loss is much faster than in adults. In the hospital department, the child will be provided with the necessary assistance and assigned treatment. Treatment of children has the same principles as treatment of pancreatitis in adults. In addition to treatment, most often prescribed a diet.

What can you eat in the acute period of pancreatitis?

The appetite for reactive pancreatitis in children is reduced, as most often the cause of pancreatitis is SARS, at which the temperature rises. Vomiting and diarrhea may also occur. In the acute period of the disease, you can eat soups in vegetable broth, cereal soups on water. Soups are very useful and nutritious, but during the period of reactive pancreatitis they still have to be easily digested and not disturb the pancreas. That is why they should be prepared as follows.

Soup №1 pearl barley. For its preparation you will need 50 g of pearl barley, 500 ml of water, salt 1 teaspoon of butter, boiled meat of 20 g. Krupa should be poured with boiling water and put to boil. Cook until softened, then grind through a sieve. Add butter and twisted boiled meat. Meat should not be fat, it can be chicken, turkey, lean beef without films.

Soup №2 vegetable. For cooking, you need 1 carrot, 2 medium-sized potatoes, a slice of pumpkin 200 g. Vegetables should be peeled and boiled. Then pereteret vegetables and add in broth. The second child can offer a boiled side dish with steam meatballs, meatballs. Garnish can be made from boiled vegetables and cereals. All vegetables better grind. Meatballs, meatballs are made from lean meat, fish.

One of the favorite dishes of children with the disease becomes a steam omelet. In the period of exacerbation, it should be prepared from proteins, during remission - from whole eggs. During reactive pancreatitis, you should stop eating raw vegetables, especially white cabbage, radish, as well as those fruits and vegetables that cause swelling. Sour fruits and juices stimulate the pancreas, so they should not be consumed. From drinks you can drink a weak tea without sugar, savory stewed fruit.

What can you eat during the remission of pancreatitis?

During remission, the diet becomes more developed. Allowed to use hard cheeses, not sharp. Allowed 1 tbsp. l butter a day. You can eat boiled meat. All dishes should be boiled or cooked in the oven. You can give cottage cheese, divorced kefir, or in the form of a casserole. Vegetables are given in the form of mashed potatoes, you can eat non-acidic fresh fruit in a small volume.

Sample menu of the child in remission. Breakfast. Wheat porridge is not thick on water with the addition of 5 g of butter to the finished dish. Slice of bread. Bread is better to use yesterday. Compote from apples. High tea Cottage cheese casserole. Dinner. Vegetable soup, bread. Second lunch Vegetable stew with boiled chicken. Compote. Dinner. Fishcake with a side dish. Fruit jelly.

Allowed to accept butter in an amount of 5 g per day. It should be added to the finished dishes. One of the main rules during the period of illness is feeding a child 6 times a day in small portions. With reactive pancreatitis, a small amount of enzymes is released, so the child is not able to absorb the usual portion. When used in small portions and drug therapy, the patient's condition improves.

Portions should be small, for one meal a child, depending on age, should eat 110-200 g.

Food should be warm, easily crushable. If the child is not chewing thoroughly, it is better to grind the dish additionally. Meals should be balanced and complete, feeding the child only porridge or vegetable soups is unacceptable. Protein food is needed. Dieting is the first step to recovery.

What can not eat?

Forbidden products during reactive pancreatitis include:

  1. Carbonated drinks.
  2. Confectionery.
  3. Pork fat, beef.
  4. Meat broths.
  5. Radish.
  6. Garlic.
  7. Fast food.
  8. Whole milk.
  9. Chocolate.
  10. Tea, cocoa.

What unites all these products? They irritate the gastric mucosa, stimulate the production of pancreatic enzymes. The amount of enzymes in the gland increases, and the process of inflammation only increases.

Several dishes for children with pancreatitis

Steamed vegetable stew. To make a stew, you will need peeled carrots of medium size, peeled potatoes of 2 pieces, 300 g of zucchini, 50 g of rice. Vegetables should be boiled for a couple, boil rice separately. Cut vegetables, mix with rice, you can fill with a small amount of low-fat yogurt. The use of sour dairy products is not recommended.

Fish stew cutlets. For cooking cutlets you need 400 g of fish, 1 chicken egg, a medium-sized onion. You can use sea or river fish. From river fish pike is fine. Clean and gut the fish, remove the ridge and large bones. Grind in a meat grinder, re-grind. In the minced fish add egg and a pinch of salt, mix. Onion peel, wash, chop into mush and add to the minced fish. Form the patties and steam for 20 minutes.

Dried fruits compote.To make compote you will need 100 g of dried apples, 50 g of dried apricots, 50 g of prunes, 50 g of raisins. Dried fruits should be washed and filled with water for 15 minutes. During this time, put on the stove a pot with 2 liters of water, boil. Put apples in boiling water and cook for 10 minutes, then put dried apricots and prunes, cook for 5 minutes, add raisins and cook for another 15 minutes. At the beginning of cooking compote, you can put 70 g of sugar.

Pear Jelly You will need 500 grams of pears, 100 grams of sugar, 1 tbsp. l gelatin. Pour gelatin with a little water. Boil the pears in a small saucepan. To remove pears, peel and peel. Grind pears to the state of baby puree, mix with sugar. Wait until sugar dissolves for 20-30 minutes, add 70 ml of water and put on fire. Bring to a boil, but do not boil. Add gelatin, mix, wait for the change in consistency in a more dense. Pour into molds. Cool for an hour. Remember that a child should eat jelly at room temperature.

What are the types of acute pancreatitis in children?

Pancreatitis with its symptoms can be similar to gastroduodenitis.

Doctors distinguish many forms and classifications of acute pancreatitis, based on the nature and distribution of the pathological process. There are four main forms of the disease:

  • Edematous pancreatitis is a type of acute pancreatitis associated with the accumulation of fluid in the tissues of an organ. The most common form, the highest percentage of recovery among children.
  • Fatty pancreatic necrosis is a dangerous form in which the pancreas undergoes significant destruction, there are areas of hemorrhage.
  • Hemorrhagic pancreatic necrosis is a type of acute pancreatitis with a high mortality rate among patients. Both small and large foci of hemorrhage are characteristic.
  • Infected pancreatic necrosis associated with the development of a bacterial or fungal infection.

Features of acute pancreatitis in children

Acute pancreatitis in children is characterized by a significant number of possible sources, including external and internal factors, as well as lower severity of symptoms. Often parents and even inexperienced doctors confuse the signs of this disease with the manifestation of gastritis or gastroduodenitis.

Acute pancreatitis in young children is often associated with congenital anomalies of the gastrointestinal tract, which increases the need for thorough perinatal diagnosis.

Why does the disease occur?

Improper baby food can lead to the occurrence of this disease.

The etiology of children's acute pancreatitis is complex and not fully understood. The child’s gastrointestinal tract is in its infancy, and any factors can trigger the onset of pathology. The most common causes of acute pancreatitis in children, doctors include:

  1. Diseases of the bile ducts - cholecystitis, stone formation, exposure to hepatitis.
  2. Side effects of valproic acid, asparaginase, prednisone, and certain other medicines.
  3. The presence of idiopathic chronic pancreatitis in history.
  4. Multi-organ diseases - sepsis, shock, hemolytic-uremic syndrome.
  5. Impact injury.
  6. Parasitic diseases of the gastrointestinal tract.
  7. Gastric ulcer, gastroduodenitis and other diseases of the stomach and intestines.
  8. Infectious diseases - hepatitis A and E, rotavirus infection, mycoplasma and adenovirus.
  9. Diabetic ketoacidosis and other metabolic disorders.
  10. Heredity.
  11. Malignant tumor of the pancreas.
  12. Improper baby food, leading to increased secretion of pancreatic enzymes.

Despite a long list of possible causes, in 20% of cases, acute pancreatitis in children occurs under unexplained circumstances.

Symptoms of acute pancreatitis in children

Nausea and vomiting in children is an inherent symptom of acute pancreatitis.

Manifestations of acute pancreatitis in children vary depending on the stage of the disease, the prevalence of the destructive process and the presence of other diseases.

Fortunately, the most dangerous destructive forms of the disease with a wide distribution in the abdominal cavity and retroperitoneal space occur in infancy relatively infrequently.

The more years a child has, the more clearly manifested a number of symptoms characteristic of acute pancreatitis are:

  • Acute epigastric (epigastric) pain with spread to other areas.
  • Often, pain in the back.
  • Nausea and vomiting.

  1. Digestive disorders: diarrhea, bloating, constipation.
  2. Symptoms of peritoneal irritation.
  3. Ascites - the appearance of fluid in the abdominal cavity
  4. Jaundice: the skin and mucous membranes become yellow.
  5. Pleural effusion - fluid in the pleural cavity.
  6. Pallor of the skin.
  7. Lack of appetite.

Of these symptoms, epigastric pain and nausea are almost twice as rare in newborns and infants, but fever is more common in children of this age group.

What are the complications?

When pancreatitis can be observed intestinal upset.

The consequences of acute pancreatitis in children are divided into early and late. The early consequences of doctors include multiple organ dysfunction and shock.

Impaired function is detected in the lungs and kidneys - these are extremely dangerous complications for the life of the child. The lungs are associated with the risk of developing pneumonia or respiratory distress syndrome, and with the kidneys - the appearance of acute renal failure.

Late complications include necrotic changes in the pancreas and the appearance of false cysts in the organ. All of the above complications of the disease in children is much less common than in adults.

Establishing diagnosis

Doctors face a difficult task - to be able to distinguish acute pancreatitis from less dangerous diseases of the gastrointestinal tract and promptly apply instrumental methods to clarify the diagnosis. The list of diagnosis methods includes:

  1. Differential diagnosis: doctors exclude any clinical manifestations characteristic of other diseases.
  2. Ultrasonography (ultrasound) of the abdominal organs.
  3. Computed tomography (CT).
  4. Laboratory diagnostics: in acute pancreatitis, the indicators of enzymes in the blood of a child change.
  5. Laparoscopy - surgical examination of the abdominal cavity.
  6. X-ray diagnostics and magnetic resonance imaging (MRI).
  7. Endoscopy is a non-surgical study of the digestive organs.

How is acute pancreatitis treated?

For the treatment of pancreatitis using various antispasmodics.

Therapy of acute pancreatitis in children is carried out strictly in the hospital under the supervision of doctors. Taking into account the severity of the disease, conservative (drug) or surgical methods are used.

Drug therapy is aimed at cleansing the blood of enzymes and toxins, apply antisecretory drugs, antispasmodics. Antifermentative drugs are rarely prescribed by doctors - according to recent studies, they have not proven their effectiveness.

To prevent the development of bacterial or fungal infections, doctors prescribe antibiotics.
Extensive purulent course of pancreatitis with multiple organ failure is an indication for surgical treatment.

Distinguish resection (with the removal of the pancreas) and organ-sparing operations, children try to carry out the latter - the loss of such an organ necessary for digestion adversely affects the quality of later life. To quickly get rid of toxic tissue breakdown products, surgeons install drainage.

Recommendations to parents

Prevention of acute pancreatitis in children includes timely diagnosis of diseases of the digestive system and developmental abnormalities, proper diet and careful prescription of drugs.

Children with chronic pancreatitis need to be constantly monitored by the attending pediatrician and follow a special diet. Prenatal diagnosis of hereditary diseases also plays a role in prevention.

The nutrition of the child should correspond to his age group. Aggressive gastrointestinal products should be avoided. These include too hot, sharp or difficult digestible dishes.

Fried food provokes excessive secretion of gastric juice - this can also affect the development of acute pancreatitis. Food should be fractional and sufficient, you need to drink more fluid.

Compliance with the daily drinking standard is especially important for children with diseases of the bile ducts, especially with gallstone disease. Acute pancreatitis in childhood is more common lately, but with timely diagnosis and adequate treatment, the prognosis is favorable.

On the treatment of acute pancreatitis tell video:

Watch the video: Pain Management for Pancreatitis. Cincinnati Children's (February 2020).