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Acute Pancreatitis
Compiled from across the library · built automatically
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Welcome and Introductions: Pancreatic Disease
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Dr. Todd Ponsky introduces the event onacute pancreatitis, recurrent and chronic pancreatitis, exocrine insufficiency, interventional procedures as well as surgical indications for the diseased pancreas in children, culminating with a state
video6:04 · Jan 2019
The INSPPIRE consortium defines acute recurrent pancreatitis in children as at least two distinct episodes with complete resolution of pain and a one-month pain-free interval, or normalization of enzymes with complete pain resolution in less than one month. — Maisam Abu-El-Haija, Acute Pancreatitis · 34:34
Acute Pancreatitis
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In this podcast, extracted from GlobalCast presentation, Dr. Maisam A. Abu-El-Haija discussesacute pancreatitis, along with participation fromDrs Andrew Taut, Jaimie Nathan, Tom Lin and the audience. Dr. Abu-El-Haija is the medical director
podcast45:24 · Jan 2019
Misconceptions of Acute Pancreatitis: Pancreatic Disease
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Dr. Maisam Abu-El-Haija discusses common misconceptions in the management of acute pancreatitis.
video2:28 · Jan 2019
Acute Pancreatitis
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In this podcast, extracted from GlobalCast presentation, Dr. Maisam A. Abu-El-Haija discusses acute pancreatitis, along with participation from Drs Andrew Taut, Jaimie Nathan, Tom Lin and the audience. Dr. Abu-El-Haija is the medical direct
podcast45:24 · Dec 2020
Diagnosis of acute pancreatitis requires serum lipase at least 3 times the upper limit of normal, plus imaging findings (ultrasound, MRI/MRCP, or CT). — Juan Gurria, Overview of the Surgical Management of Acute and Chronic Pancreatitis in Children with Dr. Juan Gurria · 5:44
Overview of the Surgical Management of Acute and Chronic Pancreatitis in Children with Dr. Juan Gurria
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Join us for a virtual webinar on Surgical Management of Acute and Chronic Pancreatitis in Children with Dr. Juan Gurria.This session will provide a practical overview of surgical approaches, decision-making, and management strategies for pe
video1:06:03 · Apr 2026
There is no reason to give antibiotics for pancreatitis, even in the face of necrosis or necrotizing pancreatitis, unless there are signs of sepsis or infected pancreatitis — Juan Gurria, Update Course Rewind: Management of Acute Pancreatitis 2023 · 2:29
ERCP: Pancreatic Disease
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Dr.Tom K. Lin, MD, a pediatric gastroenterologist at Cincinnati Children’s Hospital Medical Center, discusses endoscopic retrograde cholangiopancreatography (ERCP) management in acute and acute recurring pediatric pancreatitis. Dr. Lin pres
video9:11 · Jan 2019
Endoscopic & Surgical Interventions: Pancreatic Disease
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Dr. Tom Lin, Dr. Jaimie Nathan, Dr. Andrew Trout, and Dr. Milton Smith present on endoscopic, radiologic, and surgical interventions for pancreatic disease.
video55:54 · Jan 2019
Update Course Rewind: Management of Acute Pancreatitis 2023
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We are back with another Update Course Rewind video from the Update course in Pediatric Surgery 2023.
This time we are presenting you “Management of Acute Pancreatitis" with Dr. Juan Gurría.
Host: Cecilia Gigena
Brought to you by C
video6:46 · Apr 2024
Genetic testing is key in pediatric pancreatitis and should be obtained for all patients with chronic or recurrent pancreatitis, and even considered after a first severe attack. — Juan Gurria, Update Course 2023 - Updates in Pancreatitis · 14:59
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
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Dr. Abu-El-Haija gives a presentation on acute and acute recurrent pancreatitis. Her discussion includes diagnosis, imaging, and management. Dr.Tom K. Lin discusses endoscopic retrograde cholangiopancreatography (ERCP) management in acute a
video56:45 · Jan 2019
Update Course 2023 - Updates in Pancreatitis
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This session is on Updates in Pancreatitis with Dr. Juan Gurria.
The 11th Annual Pediatric Surgery Update Course was held on August 29, 2023 in Cleveland, Ohio and was livestreamed to a global audience. The full day symposium is desig
video32:50 · Oct 2023
Expert statements from the recordings in this collection.
Acute Pancreatitis
Lipase half-life is about 7 days and is more specific for pancreatic pathology than amylase, which can be elevated in appendicitis, gynecologic conditions, or salivary disease.
Maisam Abu-El-Haija3:00
Amylase rises and normalizes much quicker than lipase, so in a patient presenting 2 days after symptom onset, amylase may not be the best indicator of pancreatitis.
Maisam Abu-El-Haija2:40
Ultrasound is the initial imaging modality for suspected uncomplicated acute pancreatitis in children because it is radiation-free and gives a reasonably good look at the pancreas.
Andrew Trout2:09
Ultrasound is limited in the setting of suspected complications of pancreatitis; CT is the image of choice for complicated cases to better visualize necrosis, fluid collections, hemorrhage, or masses.
Maisam Abu-El-Haija2:23
The most helpful use of ultrasound in acute pancreatitis is looking for a biliary component—CBD dilation suggesting need for early ERCP, or gallstones that change management—not documenting pancreatitis or looking for complications.
Maisam Abu-El-Haija4:03
There is no data identifying a superior pain medication for acute pancreatitis; even adult studies have not identified optimal management.
Maisam Abu-El-Haija6:21
Opioids should not be avoided in acute pancreatitis; when used appropriately, they can help advance feeds, improve outcomes, and facilitate earlier discharge.
Maisam Abu-El-Haija6:35
Early nutrition (within 24 to 72 hours) in acute pancreatitis is associated with more favorable outcomes: it maintains gut barrier function, inhibits bacterial translocation, and lowers the incidence of systemic inflammatory response.
Maisam Abu-El-Haija9:03
A 2012 meta-analysis comparing TPN versus enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, reduced surgical intervention rate, lower mortality, and fewer infections.
Maisam Abu-El-Haija9:32
The Ekerwal 2007 study randomized 60 adult patients to eat on admission versus NPO and found that early feeding did not increase abdominal pain and decreased length of stay by 2 days.
Maisam Abu-El-Haija13:19
In a Cincinnati Children's study of 38 admissions for mild pancreatitis, early nutrition was safe and feasible, and patients who received feeds had similar pain scores to those kept NPO.
Maisam Abu-El-Haija14:29
Pilot analysis showed patients with the lowest pain scores were those who ate the most fat; fat intake did not increase length of stay.
Maisam Abu-El-Haija15:28
Studies comparing NG feeds versus NJ feeds in acute pancreatitis show no difference in outcomes; duration of hospital stay and mortality were very similar, even in severe acute pancreatitis.
Maisam Abu-El-Haija12:41
Aggressive IV fluid resuscitation (more than one-third of 72-hour fluid volume given in the first day) is associated with reduced mortality and reduced incidence of SIRS and organ failure at 72 hours.
Maisam Abu-El-Haija19:02
In studies of aggressive resuscitation, the late resuscitation group received more total fluid than the early resuscitation group, suggesting a critical 24-hour window for intervention.
Maisam Abu-El-Haija19:45
A 2011 study of 40 patients using goal-directed management (resuscitating to urine output of 3 mL/kg/hour) showed early resuscitation with lactated Ringer's reduced inflammation markers (CRP) compared to normal saline.
Maisam Abu-El-Haija20:18
In a Cincinnati Children's study of 201 patients, those kept NPO with low IV fluids had 35% rate of developing severe pancreatitis, versus 4.2% in those who ate early and received aggressive resuscitation.
Maisam Abu-El-Haija23:48
For CT imaging of acute pancreatitis, a single portal venous phase is sufficient; multi-phase imaging is not needed in pediatric patients as the goal is to identify complications (venous thrombosis, necrosis, fluid collections), not masses.
Andrew Trout28:19
Oral contrast is helpful in CT of pancreatitis to separate fluid-filled bowel loops from pancreatic fluid collections, but a sick patient who cannot tolerate oral contrast can still have an informative CT without it.
Andrew Trout28:41
On contrast-enhanced CT, absent enhancement in pancreatic tissue is highly concerning for necrosis.
Andrew Trout29:51
Ranson's criteria have not proven sensitive and specific for predicting severity in pediatric pancreatitis when validated in further studies, despite initial promise in a 2002 Midwest study.
Maisam Abu-El-Haija30:31
A Cincinnati Children's prognostic tool using white blood cell count, albumin value, and lipase on admission can predict severity in almost 70% of pediatric pancreatitis patients.
Maisam Abu-El-Haija31:20
Antibiotics should not be used routinely in mild acute pancreatitis or in severe pancreatitis unless there is infected necrosis.
Maisam Abu-El-Haija32:32
When antibiotics are indicated for infected pancreatic necrosis, imipenem or 3rd generation cephalosporins are good initial choices.
Maisam Abu-El-Haija33:08
MRCP is not the most helpful imaging modality during an acute pancreatitis attack because edema obscures ductal anatomy; it is better reserved for workup of biliary and pancreatic ductal issues after resolution.
Maisam Abu-El-Haija5:15
The INSPPIRE consortium defines acute recurrent pancreatitis in children as at least two distinct episodes with complete resolution of pain and a one-month pain-free interval, or normalization of enzymes with complete pain resolution in less than one month.
Workup for acute recurrent pancreatitis includes inflammatory causes (IBD, celiac), systemic illnesses, mitochondrial diseases, cystic fibrosis, metabolic conditions (triglycerides, calcium, kidney disease), anatomic evaluation (MRCP, possibly ERCP), and genetic testing for PRSS1, SPINK1, CFTR, and CTRC.
Maisam Abu-El-Haija35:31
In adult literature, there is growing evidence for endoscopic necrosectomy via EUS (transmural approach through stomach into necrotic cavity) showing good outcomes, but pediatric experience is extremely limited.
Tom Lynn41:01
Sticking needles or drains into the pancreas risks introducing infection into sterile necrosis; intervention should be avoided unless there is true significant clinical deterioration.
The pancreas can be difficult to visualize on ultrasound in larger patients, in patients who are not NPO (stomach full of gas), or when there is ileus from inflammation; bowel gas affects ultrasound wave penetration.
Andrew Trout25:33