Acute Pancreatitis and Pancreatic Disease in Children

What this deck covers

Acute Pancreatitis and Pancreatic Disease in Children in twelve illustrated clinical cases with worked explanations – case presentations built around clinical images, radiology, teaching illustrations and real laboratory data, with the reference range beside every value a case quotes. This visual, data-interpretation style of practice suits candidates preparing for MRCPCH AKP in particular, alongside Saudi and Gulf licensing examinations such as the Arab Board, DHA and OMSB. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

The twelve cases, in order

1. Epigastric pain, and a number three times too high
2. Which enzyme, and how high
3. The scan that finds the reason
4. Over the handlebars
5. Three weeks after the new medicine
6. The sample that looked like milk
7. The first six hours
8. Nil by mouth, and for how long
9. Worse on day five
10. A lump six weeks later
11. The fourth attack
12. What is left afterwards

What this deck teaches

• Two of three makes the diagnosis. Characteristic pain, an enzyme above three times normal, or imaging – any two. Imaging is not a prerequisite, and a normal early ultrasound excludes nothing.
• Lipase to diagnose, neither enzyme to monitor. Lipase is more specific and stays up longer, so it still diagnoses a late presentation. Serial enzymes do not track the illness.
• Every child gets an ultrasound – to find the CAUSE. Gallstones are commoner in children than the textbooks suggest, and gallstone pancreatitis recurs until the gallbladder comes out.
• Ask what the child started in the last month. Valproate, L-asparaginase, azathioprine and mercaptopurine are the ones that matter, and the reaction is idiosyncratic rather than dose-related.
• Under-resuscitation in the first day is what makes it severe. Generous isotonic crystalloid, front-loaded and titrated to urine output and perfusion. Restricting fluids is the old teaching and it is backwards.
• Feed the child, not the enzyme. Early oral low-fat feeding within 24 to 48 hours, judged on pain settling and appetite. A lipase that stays high is not a reason to starve anyone.

Exam pearls from this deck

• Two of three makes the diagnosis. Imaging is not a prerequisite.
• Lipase to diagnose. Neither to monitor.

The twelve worked cases in this deck, with the images and the full explanation of every option, are part of Pediatric Case Review membership. See what is included, or start with the free Pediatric Exam Review Sets.

More from this system: all gastroenterology illustrated case decks · gastroenterology board questions for bank-style drilling · the free Pediatric Exam Review Sets · pediatric reference values.