what are the causes of chronic pancreatitis in children and what are the causes of chronic pancreatitis in children
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Etiology of chronic pancreatitis in children
First, the reason
1. Common reasons
There are three common causes of chronic pancreatitis:
(1) Obstructive: Congenital duct abnormality, injury, sclerosing cholangitis and idiopathic fibrous pancreatitis.
(2) Calcification: Hereditary pancreatitis, tropical pancreatitis, gallbladder fibrosis, hypercalcemia and hyperlipidemia.
(3) Mixed: mitochondrial myopathy, inflammatory bowel disease, idiopathic.
2. Chronic calcifying pancreatitis
(1) Hereditary pancreatitis: It is an autosomal recessive hereditary disease. The gene for hereditary pancreatitis is located on the long arm of chromosome 7. Arginine at position 117 of trypsinogen is replaced by histidine, which leads to self-digestion of pancreas and induces pancreatitis.
Pathological findings included pancreatic atrophy fibrosis and calcification almost all acinar cells atrophy duct blockage and extensive fibrosis. Islet cells are intact.
(2) Tropical (nutritional) pancreatitis in adolescents: Tropical (nutritional) pancreatitis is a common cause of chronic pancreatitis in children. It is found in some undernourished people in southern India, Indonesia and tropical regions near the equator in Africa. The reason is malnutrition and eating cassava powder, which contains toxic glycosides. The clinical process is similar to other types of chronic pancreatitis.
3. Chronic obstructive pancreatitis
(1) Pancreatic schizophrenia: The incidence rate of pancreatic schizophrenia in the total population is 5% ~ 15%, which is the most common malformation of pancreas. Because the dorsal and ventral pancreatic primordia cannot be fused, the pancreatic tail, pancreatic body and part of pancreatic head are drained through the relatively narrow accessory pancreatic duct instead of the main pancreatic duct. Many scholars believe that pancreatic schizophrenia is related to recurrent pancreatitis. ERCP can diagnose pancreatic schizophrenia. Sphincterotomy of nipple sphincter helps.
(2) Abdominal trauma: After abdominal trauma, recessive injury of pancreatic duct can lead to stenosis, pseudocyst formation and chronic obstruction.
4. Idiopathic fibrotic pancreatitis
Idiopathic fibrotic pancreatitis is rare and can have abdominal pain or obstructive aundice. Diffuse fibrous tissue hyperplasia can be seen in glands.
Pancreatitis can occur in patients with hyperlipidemia type ⅰ, ⅳ and ⅴ. Transient hyperlipidemia can occur in pancreatitis, so the elevated blood lipid in acute pancreatitis must be retested after improvement. Other causes include gallbladder fibrosis, sclerosing cholangitis, inflammatory bowel disease and so on.
Second, the pathogenesis
Chronic pancreatitis has two main pathological types: calcification and obstruction. Both types are rare in children. In children, chronic calcifying pancreatitis is seen in hereditary pancreatitis and idiopathic pancreatitis. The pancreas is hard and calcite can be touched during operation. Occlusion occurs when a viscous plug containing a variety of proteins such as digestive enzymes mucopolysaccharides and glycoproteins fuses into the catheterized cavity. Calcium carbonate precipitates to form stones in the tube. It is also speculated that toxic metabolites aggravate pancreatic damage.
Pancreatic stone protein is a glycoprotein, which can prevent calcium salt precipitation in normal pancreatic juice. Chronic ethanol intake and protein deficiency will reduce pancreatic lithin synthesis. The decrease of pancreatic lithin level and the formation of secondary calcium stones may be the common pathway of calcified pancreatitis for many reasons.
Obstructive pancreatitis occurs when congenital malformations or acquired diseases, such as tumors, fibrosis or traumatic stenosis, block the main pancreatic duct. Pancreatic epithelium is inflamed and replaced by fibrous tissue. Free radicals and antioxidant deficiency play an important role in the formation and development of chronic pancreatitis.
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