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Acute Recurrent Pancreatitis
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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
In chronic or acute recurrent pancreatitis patients with ductal changes, the pancreatic duct is often dilated and abnormal at baseline, so secretin may not be needed to visualize the duct. — Andrew Trout, Function Tests & Pain Management: Pancreatic Disease · 9:41
Function Tests & Pain Management: Pancreatic Disease
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Dr. Maisam Abu-El-Haija discusses pancreatic function testing, exocrine pancreatic function testing, and the double lumen tube test. Dr. Joe Palermo discusses chronic pancreatitis management as well as pain management. Dr. Kenneth R. Godsch
video26:27 · Jan 2019
Opioids used in the right patient and setting in acute pancreatitis can allow earlier feeding, improve outcomes, and enable earlier discharge; providers should not be shy about using them. — Maisam Abu-El-Haija, Acute Pancreatitis · 6:27
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
Dexamethasone infusion is used for the first 2 days postoperatively to decrease the instant blood mediated inflammatory response which has a potentially detrimental effect on islets. — Jamie, Total Pancreatectomy with Islet Autotransplantation: Pancreatic Disease · 33:17
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
Total Pancreatectomy with Islet Autotransplantation: Pancreatic Disease
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Dr. Jaimie Nathan introduces the session, covering indications for total pancreatectomy with islet auto-transplantation(TPIAT), pre-TPIAT evaluation, pre- and post-operative management, and long-term follow-up.Dr. Joe Palermopresents a chro
video47:20 · Jan 2019
Total pancreatectomy with islet autotransplantation (TPIAT) - Cincinnati Children's Pancreas Care Center
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In this video, we take you through a Total Pancreatectomy with Islet Autotransplantation (TPIAT)—one of the most complex abdominal surgeries performed in children. Learn about who qualifies for TPIAT, the surgical process, and the critical
video10:19 · Dec 2024
Surgical management of the pancreas is not offered unless medical and endoscopic management have been maximized. — Juan Gurria, Update Course Rewind: Management of Recurrent Pancreatitis · 4:16
Update Course Rewind: Management of Recurrent Pancreatitis
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We're back with another Update Course Rewind from the 11th annual update Course held in Cleveland on August 2023
This time we have "Management of Recurrent Pancreatitis"
with Dr. Juan Gurria, the surgical director of the Pancreas Care cen
video6:37 · May 2024
Chronic pancreatitis requires imaging findings plus one of three: abdominal pain consistent with pancreatic origin, evidence of exocrine insufficiency, or endocrine insufficiency. — Maisam Abu El Haija, Pancreas Care Updates 2020 - FULL SHOW · 6:00
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
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
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Dr. Jaimie Nathan introduces the nextsession on chronic pancreatitis and exocrine pancreatitis insufficiency.Dr. Joe Palermo discusses chronic pancreatitis disease management, pediatric genetic implications, and pancreatic function testing.
video51:02 · Jan 2019
Pancreas Care Updates 2020 - FULL SHOW
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During our event, course directors Dr. Maisam Abu-El-Haija, MD, MS; Jaimie Nathan, MD, lead a panel of celebrated faculty in providing an overview of updates in pancreas care.CME credit was only available for the live event.
video2:04:44 · Dec 2020
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Expert statements from the recordings in this collection.
Acute Pancreatitis
Lipase half-life is about 7 days and is more specific for pancreatic/intestinal pathology than amylase, which can be elevated in appendicitis, gynecologic conditions, or salivary issues.
clinicalMaisam Abu-El-Haija3:02 ↗
Amylase rises and normalizes much quicker than lipase; in a patient presenting 2 days after symptom onset, amylase may not be the best indicator.
clinicalMaisam Abu-El-Haija2:40 ↗
Ultrasound is the initial imaging modality for suspected uncomplicated acute pancreatitis; it is radiation-free and gives a reasonably good look at the pancreas, but is limited for evaluating complications.
clinicalAndrew Trout2:09 ↗
The most helpful use of ultrasound in acute pancreatitis is looking for a biliary component (CBD dilation suggesting early ERCP need, or gallstones changing management), not documenting pancreatitis or looking for complications.
clinicalMaisam Abu-El-Haija4:03 ↗
There is no data on optimal pain medication in acute pancreatitis; even adult studies have not identified a superior medication.
clinicalMaisam Abu-El-Haija6:21 ↗
Opioids used in the right patient and setting in acute pancreatitis can allow earlier feeding, improve outcomes, and enable earlier discharge; providers should not be shy about using them.
opinionMaisam Abu-El-Haija6:27 ↗
Early enteral nutrition (within 24–72 hours) in acute pancreatitis is associated with more favorable outcomes: maintains gut barrier function, inhibits bacterial translocation, lowers incidence of systemic inflammatory response, and avoids severe complications.
clinicalMaisam Abu-El-Haija9:03 ↗
A 2012 meta-analysis comparing TPN vs. enteral nutrition in predicted severe acute pancreatitis showed enteral nutrition was associated with decreased organ failure, surgical intervention rate, mortality, and infections.
Host summaryMaisam Abu-El-Haija summarizing the discussion — not the host's own clinical position9:32 ↗
The 2007 Ekerwal study randomized 60 adult patients to eat on admission vs. NPO; early feeding did not increase abdominal pain and decreased length of stay by 2 days.
Host summaryMaisam Abu-El-Haija summarizing the discussion — not the host's own clinical position13:19 ↗
Cincinnati Children's replicated the early feeding approach in 38 pediatric admissions with mild pancreatitis (published late 2015); early nutrition was safe, feasible, and not associated with worse pain outcomes.
clinicalMaisam Abu-El-Haija14:29 ↗
Pilot analysis showed patients who ate the most fat had the lowest pain scores; fat intake did not increase length of stay. Patients likely self-regulate and eat more when ready.
clinicalMaisam Abu-El-Haija15:28 ↗
NG feeds vs. NJ feeds in acute pancreatitis show no difference in outcomes; duration of hospital stay and mortality are similar even in severe acute pancreatitis.
Host summaryMaisam Abu-El-Haija summarizing the discussion — not the host's own clinical position12:41 ↗
Aggressive IV fluid resuscitation in acute pancreatitis is associated with improved outcomes; early aggressive resuscitation (>1/3 of 72-hour fluid volume in first 24 hours) reduces mortality and incidence of SIRS and organ failure at 72 hours.
Host summaryMaisam Abu-El-Haija summarizing the discussion — not the host's own clinical position18:58 ↗
In the late resuscitation group, patients received more total fluid than the early resuscitation group, but outcomes were worse, indicating a critical 24-hour window for intervention.
clinicalMaisam Abu-El-Haija19:45 ↗
A small 2011 study (40 patients) and a 2023 abstract (40 patients, Spain) showed early resuscitation with lactated Ringer's (LR) vs. normal saline reduced inflammation (CRP markers) when using goal-directed management targeting urine output 3 mL/kg/hr.
Host summaryMaisam Abu-El-Haija summarizing the discussion — not the host's own clinical position20:05 ↗
Cincinnati Children's study of 201 patients showed 35% of NPO + low IV fluids group developed severe pancreatitis vs. 4.2% in early PO + aggressive resuscitation group.
clinicalMaisam Abu-El-Haija24:10 ↗
CT is the imaging test of choice when complicated pancreatitis is suspected; it best visualizes necrosis, fluid collections, hemorrhage, and masses.
clinicalMaisam Abu-El-Haija5:00 ↗
MRCP is useful for workup of biliary and pancreatic ductal issues but is not the first imaging modality in acute pancreatitis; edema during acute attack obscures ductal anatomy.
clinicalMaisam Abu-El-Haija5:28 ↗
For pediatric pancreatitis CT, a portal venous phase is sufficient (no multi-phase needed); oral contrast helps separate fluid-filled bowel from pancreatic fluid collections but is not a deal-breaker if patient cannot tolerate it.
clinicalAndrew Trout28:19 ↗
Absent enhancement on contrast-enhanced CT is highly concerning for pancreatic necrosis.
clinicalAndrew Trout29:51 ↗
Ranson's criteria applied to pediatric pancreatitis (studied since 2002, including Midwest/University of Cincinnati studies) initially showed promise but did not prove sufficiently sensitive and specific upon validation.
clinicalMaisam Abu-El-Haija30:31 ↗
Cincinnati Children's study proposes using white blood cell count, albumin, and lipase on admission to predict severity in ~70% of pediatric pancreatitis patients; this tool still needs optimization.
clinicalMaisam Abu-El-Haija31:20 ↗
Antibiotics should not be used in mild pancreatitis or in severe pancreatitis unless infected necrosis is suspected (e.g., fever present).
clinicalMaisam Abu-El-Haija32:32 ↗
When antibiotics are indicated in pancreatitis, imipenem or 3rd-generation cephalosporins are good initial choices based on available evidence.
clinicalMaisam Abu-El-Haija33:08 ↗
Acute recurrent pancreatitis (ARP) is defined by the INSPPIRE group as ≥2 distinct episodes with complete pain resolution and a 1-month pain-free interval, or enzyme normalization with complete pain resolution in <1 month.
Host summaryMaisam Abu-El-Haija summarizing the discussion — not the host's own clinical position34:47 ↗
ARP workup includes inflammatory causes (IBD, celiac), systemic/mitochondrial diseases, cystic fibrosis, metabolic conditions (triglycerides, calcium, kidney disease), anatomic evaluation (MRCP, possibly ERCP), and genetic testing (PRSS1, SPINK1, CFTR, CTRC).
clinicalMaisam Abu-El-Haija35:37 ↗
Aspiration of pancreatic necrosis to rule out infection carries risk of introducing infection into a sterile collection; empiric antibiotics may be started if fever is present, but aspiration is rarely performed (Cincinnati has needed one necrosectomy in 10 years).
clinicalJaimie Nathan38:49 ↗
Adult evidence supports endoscopic necrosectomy via EUS-guided transmural approach with good outcomes; pediatric experience is extremely limited and Cincinnati has not performed this procedure.
clinicalTom Lynn41:12 ↗
Secretin-enhanced MRCP has unclear added value in pediatric pancreatitis; adult literature data is 'iffy.' In acute recurrent or chronic pancreatitis patients, ducts are often dilated enough to visualize without secretin.
opinionAndrew Trout42:34 ↗
Cincinnati Children's prospective acute pancreatitis registry (3 years, 85 patients) found increased weight percentile for age (not BMI) during first attack predicts recurrence; abstract submitted to World Congress.
clinicalMaisam Abu-El-Haija43:25 ↗
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