Pancreatitis and pancreatic disorders — branching viva

Branching viva from the definition and pathophysiology of paediatric pancreatitis through the acute attack, the child on valproate, the child with hereditary pancreatitis, the child with exocrine insufficiency, and the decision about total pancreatectomy with islet autotransplantation, testing the NASPGHAN criteria, early aggressive hydration, early enteral feeding, the genetic workup and the enzyme replacement dose.

branching clinical structured oral4 min readVerification in progress

Prompt

You are the paediatric registrar in the emergency department. The consultant asks you to talk through four children referred with pancreatic disease: an eight-year-old on valproate with acute pancreatitis, a ten-year-old with three episodes of pancreatitis and a family history, a twelve-year-old with chronic pancreatitis and steatorrhoea, and a fourteen-year-old with intractable chronic pancreatitis being considered for total pancreatectomy.

Station opening

Examiner: "Define paediatric pancreatitis and outline your approach to a child presenting with suspected acute disease." [1]

Strong candidate (must-hit)

Defines paediatric pancreatitis by the NASPGHAN two-of-three criteria: at least two of characteristic abdominal pain, a serum lipase or amylase at or above three times the upper limit of normal, and imaging consistent with pancreatitis; frames the approach around recognising the clinical picture, sending the lipase early, confirming with ultrasound, and delivering early aggressive hydration, adequate analgesia and early enteral feeding, while identifying and treating the underlying cause; states that the commonest paediatric causes are medications, trauma and genetic variants rather than gallstones and alcohol. [1]

Weak candidate

"Pancreatitis is inflammation of the pancreas, and I would give fluids, antibiotics and keep the child nil by mouth." [2]

Paediatrics Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References6Show ledger

[1]Abu-El-Haija M; Kumar S; Szabo F; Jażdżewska M; Ranganathan S; Werlin SL Classification of Acute Pancreatitis in the Pediatric Population: Clinical Report From the NASPGHAN Pancreas Committee. J Pediatr Gastroenterol Nutr, 2017.PMID 28333771
[2]Abu-El-Haija M; Kumar S; Quiros JA; Balzer B; Durie PR; Elinoff B Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the NASPGHAN Pancreas Committee. J Pediatr Gastroenterol Nutr, 2018.PMID 29280782
[4]Taylor CJ; Chen K; Horvath K; Hughes J; Rothbaum R; Shun-Shin M ESPGHAN and NASPGHAN Report on the Assessment of Exocrine Pancreatic Function and Pancreatitis in Children. J Pediatr Gastroenterol Nutr, 2015.PMID 25915425
[5]Kumar S; Ooi CY; Werlin S; Abu-El-Haija M; Barth B; Bellin MD Risk Factors Associated With Pediatric Acute Recurrent and Chronic Pancreatitis: Lessons From INSPPIRE. JAMA Pediatr, 2016.PMID 27064572
[9]Husain SZ; Morinville V; Pohl J; Rabinowitz S; Arsenescu R; Barth BA Toxic-metabolic Risk Factors in Pediatric Pancreatitis: Recommendations for Diagnosis, Management, and Future Research. J Pediatr Gastroenterol Nutr, 2016.PMID 26594832
[12]Heinzman C; Hornung L; Lin TK; Stevens J; Spence AB; Bunch K Total pancreatectomy with islet autotransplantation reduces opioid use and improves nutritional support in children with debilitating pancreatitis. PLoS One, 2023.PMID 37540665

Pancreatitis and pancreatic disorders — branching viva

branching clinical structured oral4 min readVerification in progress

Station opening

Examiner: "Define paediatric pancreatitis and outline your approach to a child presenting with suspected acute disease." [1]

Strong candidate (must-hit)

Defines paediatric pancreatitis by the NASPGHAN two-of-three criteria: at least two of characteristic abdominal pain, a serum lipase or amylase at or above three times the upper limit of normal, and imaging consistent with pancreatitis; frames the approach around recognising the clinical picture, sending the lipase early, confirming with ultrasound, and delivering early aggressive hydration, adequate analgesia and early enteral feeding, while identifying and treating the underlying cause; states that the commonest paediatric causes are medications, trauma and genetic variants rather than gallstones and alcohol. [1]

Weak candidate

"Pancreatitis is inflammation of the pancreas, and I would give fluids, antibiotics and keep the child nil by mouth." [2]

Paediatrics Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References6Show ledger

[1]Abu-El-Haija M; Kumar S; Szabo F; Jażdżewska M; Ranganathan S; Werlin SL Classification of Acute Pancreatitis in the Pediatric Population: Clinical Report From the NASPGHAN Pancreas Committee. J Pediatr Gastroenterol Nutr, 2017.PMID 28333771
[2]Abu-El-Haija M; Kumar S; Quiros JA; Balzer B; Durie PR; Elinoff B Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the NASPGHAN Pancreas Committee. J Pediatr Gastroenterol Nutr, 2018.PMID 29280782
[4]Taylor CJ; Chen K; Horvath K; Hughes J; Rothbaum R; Shun-Shin M ESPGHAN and NASPGHAN Report on the Assessment of Exocrine Pancreatic Function and Pancreatitis in Children. J Pediatr Gastroenterol Nutr, 2015.PMID 25915425
[5]Kumar S; Ooi CY; Werlin S; Abu-El-Haija M; Barth B; Bellin MD Risk Factors Associated With Pediatric Acute Recurrent and Chronic Pancreatitis: Lessons From INSPPIRE. JAMA Pediatr, 2016.PMID 27064572
[9]Husain SZ; Morinville V; Pohl J; Rabinowitz S; Arsenescu R; Barth BA Toxic-metabolic Risk Factors in Pediatric Pancreatitis: Recommendations for Diagnosis, Management, and Future Research. J Pediatr Gastroenterol Nutr, 2016.PMID 26594832
[12]Heinzman C; Hornung L; Lin TK; Stevens J; Spence AB; Bunch K Total pancreatectomy with islet autotransplantation reduces opioid use and improves nutritional support in children with debilitating pancreatitis. PLoS One, 2023.PMID 37540665