Pancreatitis Clinical Pathway, Emergency Department and Inpatient – History and Physical

Pancreatitis Clinical Pathway — Emergency Department and Inpatient

History and Physical Exam

Most children with pancreatitis have epigastric or RUQ pain that may or may not radiate to the back. Pain is rarely in other locations or absent, though young children and infants may not be able to express, describe, or localize pain. Children with moderate/severe disease may have symptoms/signs of organ dysfunction.

History

Common Pancreatitis Symptoms
  • Pain
    • Onset, duration
    • Epigastric location, radiation
    • Severity (appropriate pain scale)
    • Triggers
    • Treatments attempted
  • Anorexia/nausea/hydration
    • Appetite and last good meal
    • Fluid intake, urine output
    • Weight loss/growth failure
    • Symptoms of malabsorption (diarrhea, flatulence)
  • Vomiting
    • Number of episodes, last episode
    • Presence of bile/blood
  • Fever
  • Jaundice/icterus
Medical
  • Pancreatitis
  • Other GI disorders
    • Gallstones, IBD, celiac disease
  • Underlying conditions
    • CF, autoimmune disease, seizures, hypertriglyceridemia, hypercalcemia
  • Abdominal trauma
Social
  • Alcohol, tobacco, opioids, amphetamines
  • Organophosphates, scorpion/snake envenomation
Family
  • Acute or chronic pancreatitis
  • Gallstones
  • Hyperlipidemia, hypercalcemia
  • CF, autoimmune diseases, IBD, celiac disease
High-Risk Medication Use
  • Valproic acid
  • Tetracyclines, metronidazole
  • NSAIDs
  • Steroids
  • 6-mercaptopurine, methotrexate, L-asparaginase
  • Furosemide
  • Doxycycline

Physical Exam

General Appearance Mental status
Respiratory, CV HR, RR, WOB, hyper/hypothermia
Abdomen
  • Location of tenderness, presence of guarding/rebound
  • Hepatosplenomegaly
  • Grey Turner sign (flank ecchymosis)
  • Cullen sign (periumbilical ecchymosis)
Skin Color, perfusion