Transcripts
DR. TARR:
During the course of HUS there
are some extra intestinal abdominal problems that
can be quite troublesome and some that are also
somewhat over-interpreted.
Pancreatitis is a problem that
occurs in about 10 to 20 percent of children
with oligoanuric HUS, a form of HUS in which
there is no urine output. In these children,
the abdominal pain persists well after their
diarrhea is resolved. They're tender high in
the abdomen.
The smallest oral intake causes
vomiting and abdominal pain and their laboratory
tests demonstrate very high levels of amylase and
lipase.
Once one recognizes
this, treatment for this disorder is total parenteral
nutrition where a child is fed entirely by vein
and also receives nothing by mouth during the
course of the pancreatitis, which usually lasts
for about a week but can go on for longer in
some children.
Now, once we became aware of
pancreatitis, largely through the efforts of
cases reported in Dr. John Brandt's series in
the 1993 outbreak, we began seeing a considerable
amount of so-called chemical pancreatitis.
The child has a modest amount
of abdominal pain and amylase and lipase are
moderately elevated and these abnormalities can
be just caused by the gastroenteritis.
A diagnosis is then made of
acute pancreatitis and then the child is not
allowed to eat anything, even though they're
starving, for a week. So we would be cautious
about overcalling clinically inapparent
pancreatitis and we would generally urge caution
unless these enzyme levels are very, very high
and the examination and history were quite
consistent with pancreatitis.
Now, this is the pancreatitis
that mostly relates to the digestive function of
the pancreas, not the endocrine or the diabetes
function of the pancreas, which will be addressed
by Dr. Mauseth, following me.
