Pancreatitis

Acute pancreatitis in children demands early aggressive fluid resuscitation—bolus 10–20 mL/kg (up to 3 L in 24 h), then 1.5–2× maintenance—with lactated Ringer's preferred over normal saline for reduced inflammation . Enteral nutrition within 24–72 hours is superior to TPN or NPO, maintaining gut barrier function and lowering SIRS incidence; nasogastric feeds are as effective as nasojejunal . Antibiotics are reserved for infected necrosis; prophylaxis in sterile necrosis is not indicated . Lipase (half-life ~7 days) is more specific than amylase for pancreatic pathology . Ultrasound is first-line imaging to identify gallstones and CBD dilation; CT is reserved for suspected complications (necrosis, collections, vascular thrombosis) . Gallstone pancreatitis should be managed with cholecystectomy during index admission; delaying beyond 6 weeks raises recurrence to 60% . Intraoperative cholangiogram with transcystic exploration clears stones in 86–90% of cases, avoiding ERCP's 10% pancreatitis risk . Chronic pancreatitis in children is often genetic (PRSS1, CFTR, SPINK1); up to 50% eventually require surgery . Conventional drainage (Frey, Puestow) fails in genetic disease because parenchymal inflammation persists . TPIAT is indicated for refractory pain after maximal medical/endoscopic therapy; primary goal is pain relief, secondary is preserving beta-cell mass . Islet yield ≥5000 IEq/kg predicts 50–70% insulin independence; younger age and absence of prior resection improve outcomes . Over 80% achieve opioid independence within months .