الفهرس 
OVERVIEW OF ACUTE PANCREATITISOnly 14 pages are availabe for public view
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Abstract
Acute pancreatitis is the most common pathological entity affecting the pancreas in children.
Pancreatitis in children has been diagnosed more frequently in the past few decades, possibly due to an increase in health care provider awareness and etiologies of pancreatitis being identified, as well as more thorough evaluations of children.
Although it is a well-known disease concerning its clinical and treatment aspects in the adult population, most of the recommendations in pediatrics related to diagnosis and key points of acute pancreatitis clinical handling, as well as the most appropriate form of introduction of the nutritional therapy, are derived from studies involving only adults.
Significant morbidity and mortality due to numerous local and systemic complications, an intense inflammatory response that may progress to multiorgan failure and/or pancreatic necrosis, can result from a severe episode of AP.
Early severity stratification can result in aggressive treatment and prevent the development of persistent organ damage and multiple organ dysfunction, which are the two primary causes of mortality in patients with acute pancreatitis.
Multiple studies have evaluated the relationship between AP severity and d-dimer, a marker of fibrinolytic activation that reflects plasmin generation. Results indicate that d-dimer is a good initial marker of severity. A major benefit of d-dimer is its high sensitivity, specificity.
The aim of the present study is to find out the value of D-dimer as a prognostic markers as well as time to convalescence in acute and acute recurrent pancreatitis.
This prospective study done on 24 Children and/or adolescents presented to the gastroenterology department Pediatrics Hospitals Ain Shams University diagnosed of acute pancreatitis. All patients underwent serum D-dimer in the 1st, 3rd, 7th, days of admission correlated with the comorbidity of cases.
Patients ages less than 3 years old,patients diagnosed as chronic pancreatitis were excluded.
The study included 8 males 33.3%, 16 females 66.7% which showed female sex predominance.
This study found that there was severe epigastric pain in all patients included in the study, Vomiting in our study presented in 22 patients (91%), Fever presented in 13 patients (54.2%).
This study found that creatinine level ranged from (0.3-5.1) mg/dl, median was 0.5mg/dl, 4 patients (16.6%) had elevated serum creatinine levels.
The study found that aspartate transferase ranged from (13-303), and ALT ranged from 5-500, (median 21), 9 patients 37.5% had high AST levels.
Total bilirubin level ranged from (0-15.6), median was (0.7), 6 patients 24% had bilirubin level >1 mg/dl.
Amylase ranged from 30 to 2887, median was 696, 23 patients (95.8%) had high amylase levels,
Lipase ranged from 8 to 2472, median was 337, 22 patients 91.6% had high lipase levels,
Our study found that only one patient had disturbed lipid profile (high cholesterol, LDL, triglycerides, low HDL), 14 patients show low levels of HDL
Serum calcium level ranged from 6.9-10.8mg/dl,C-reactive protein ranged from 0.2-192, 15 patients showed high CRP level.
In this study all patients underwent abdominal U/S, CT abdomen, 19.7% showed abnormal U/S in the form of pelvic collection, pancreatic pseudocyst, 62.5% showed abnormal CT abdomen in the form of pancreatic edema, necrosis, pseudocyst.
In our study duration of stay in hospital ranged from 1-60 days, median 9 days.
In our study we found that the aetiology is unknown in 11 patients (45.8%), Drug induced in 6 patients (25.0%), trauma in 3 patients (12.5%), other causes (calcular cholecystitis, post ERCP, Auto immune) in 4 patients respectively (16.7%).
In this study 10 patients (41.7%) were readmitted due to recurrent attacks of pancreatitis, 3 patients had organ failure (12.5%) one of them died, 2 patients (8.3%) developed chronic pancreatitis including diabetes mellitus.
Patients divided into two groups according to severity:
group A (Moderately severe to severe AP) 8 patients (33.3%), group B (Mild AP) 16 patients (66.7%).
Patients were classified according to NASPGHAN pancreas committee in 2017.
Our study found that No significant difference in sociodemographic data of the two patient groups.
But there is significant difference between the 2 groups in the duration before diagnosis (P-value 0.014), Median (IQR) 22.50 (6.50 – 30) days in the severe group, Median (IQR) 5.50 (4 – 7) days in mild pancreatitis.
group A showed that there was positive family history of pancreatitis in 2 patients (25%), but no similar familial condition in the group B.
There was a significant difference between the two groups in the chemotherapy history 2 patients (25.0%) received chemotherapy of the severe group, no patients of group B received chemotherapy.
Serum calcium level showed statistical difference (P-value 0.030) between the 2 groups, mean±SD (8.49 ±1.43) in group A, while (9.45 ±0.63) in group B.
Serum amylase, lipase, CRP, CBC, lipid profile showed non statiscal difference between the 2 groups.
Our study found no statistical difference between the 2 groups in the D-dimer levels in 1st, 3rd, 7th samples.
But higher D-dimer levels were related to more severe disease, yet this was not statistically significant and we couldn’t predict a cutoff value to detect severity. Further studies with larger number of participants could be more helpful.
There is statistical difference between the 2 groups in diabetes mellitus which developed after the attack 2 patients (25.0%) of group A, no diabetes mellitus developed in group B.
Also NPO duration Mean ± SD (5.50 ± 2.33) days in group A, (3.75 ± 1.13) days in group B this shows statistical difference (p-value 0.020).