**3.1 Etiology**

*Pancreatitis*

state of the body.

*2.4.2 Nutritional strategy*

be considered [13].

*2.4.3 Endoscopic and surgical treatment*

hemodynamically stable patients.

rhagic complications [13].

**3. Acute recurrent pancreatitis**

over the next 24–48 h. Monitoring of patients with acute pancreatitis can provide indicators of complications arising, including SIRS and organ dysfunction/failure. Cardiac, respiratory, and renal status should be followed particularly closely within the first 48 h. Opioid analgesics in oral or parenteral forms are required for pain control in acute pancreatitis. Despite previous contentions, there is no evidence about the paradoxical contraction of the sphincter of Oddi induced by morphin and it should be used for acute pancreatitis pain not responding to acetaminophen or NSAIDs (non steroids anti-inflammatory drugs). In pediatric patients with a diagnosis of mild acute pancreatitis oral feedings or enteral nutrition (EN) can be started within 24–48 h. Parenteral nutrition (PN) should be considered in cases where EN is not possible for a prolonged period (longer than 5–7 days) such as in ileus, complex fistulae, abdominal compartment syndrome, to reduce the catabolic

Antibiotics should not be used in the management of AP, except in the presence of documented infected necrosis, or in patients with necrotizing pancreatitis who are not improving clinically without antibiotic use. Antibiotics known to penetrate necrotic tissue (such as carbapenems, quinolones and metronidazole) should be used in management of infected pancreatic necrosis as these may delay surgical intervention and decrease morbidity and mortality. Instead antiprotease or antioxidants are

In severe pancreatitis an earlier oral re-feeding reduces the incidence of infections and contributes to a shorter hospitalization. Serum pancreatic enzymes' level tips the balance in the enteral feeding strategy. If serum amylase and lipase are decreasing liquid intake can be started, according with clinical conditions, while if they are minor than two times the upper normal values, an hypolipidic diet should

Undoubtedly anatomic abnormalities are an indication for surgery while ampulla of Vater anomalies or pancreatic divisum may be eligible for an endoscopic sphincterotomy. In patients with infected necrosis of the pancreatic gland a necrosectomy is mandatory in case of worsening clinical conditions and unresponsiveness to therapeutic measures. However this procedure (percutaneous, endoscopic or laparoscopic necrosectomy) has an high mortality rate and should be performed in

Pancreatic pseudocysts are cysts that develop due to injury of the pancreatic duct and extravasation of fluid. These occur 4 weeks or later after the onset of pancreatitis. Treatment is indicated for pseudocysts if their size does not decrease, if they are accompanied by abdominal pain, or if there are complications of infection or hemorrhage. Whereas endoscopic ultrasound-guided transgastric drainage can safely be considered in case of growing pancreatic pseudocysts or in case of hemor-

Approximately 10–20% of pediatric patients experience recurrent episodes of acute pancreatitis beneath which it is possible to identify an idiopathic or structural

not recommended in the management of acute pancreatitis in children [15].

**74**

Risk factors that predispose to ARP can be categorized according the following frequency in: genetic, obstructive, metabolic and autoimmune [17]. However the etiology of ARP remains unexplained in 30% of cases and can be classified as "idiopathic" is used.
