Chronic pancreatitis differential diagnosis: Difference between revisions
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==Differentiating Chronic Pancreatitis from Other Diseases== | ==Differentiating Chronic Pancreatitis from Other Diseases== | ||
=== Differentials based on nausea, vomiting, diarrhea, fatigue and abdominal pain === | |||
Chronic pancreatitis should be differentiated from other diseases presenting with [[nausea]], [[vomiting]], [[diarrhea]], [[fatigue]] and [[abdominal pain]]. The differentials include the following: | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease | |||
| colspan="13" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestations''' | |||
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diagnosis | |||
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | |||
|- | |||
| colspan="9" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Symptoms''' | |||
! colspan="4" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Signs | |||
|- | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Fever | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo- | |||
tension | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Guarding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Chronic pancreatitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Increased [[amylase]] / [[lipase]] | |||
* Increased stool fat content | |||
* Pancreatic function test | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan | |||
* Calcification | |||
* Pseudocyst | |||
* Dilation of main pancreatic duct | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Predisposes to pancreatic cancer | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pancreatic carcinoma]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* ↑ [[Alkaline phosphatase]] | |||
* ↑ [[Bilirubin|serum bilirubin]] | |||
* ↑ [[gamma-glutamyl transpeptidase]] | |||
* ↑ [[CA 19-9]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Computed tomography|MDCT]] with [[Positron emission tomography|PET]]/[[Computed tomography|CT]] | |||
* MRI | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
[[Skin]] manifestations may include: | |||
* [[Bullous pemphigoid]] | |||
* [[Mucous membrane pemphigoid|Cicatricial pemphigoid]] | |||
* [[Thrombophlebitis|Migratory superficial thrombophlebitis]] (classic [[Trousseau's syndrome]]) | |||
* [[Panniculitis|Pancreatic panniculitis]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Dumping syndrome]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Lower and then diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Glucose challenge test | |||
* Hydrogen breath test | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Upper GI series | |||
* Gastric emptying study | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Postgastrectomy | |||
|} | |||
'''Abbreviations:''' | |||
'''[[RUQ]]'''= Right upper quadrant of the abdomen, '''LUQ'''= Left upper quadrant, '''LLQ'''= Left lower quadrant, '''RLQ'''= Right lower quadrant, '''LFT'''= Liver function test, SIRS= [[Systemic inflammatory response syndrome]], '''[[ERCP]]'''= [[Endoscopic retrograde cholangiopancreatography]], '''IV'''= Intravenous, '''N'''= Normal, '''AMA'''= Anti mitochondrial antibodies, '''[[LDH]]'''= [[Lactate dehydrogenase]], '''GI'''= Gastrointestinal, '''CXR'''= Chest X ray, '''IgA'''= [[Immunoglobulin A]], '''IgG'''= [[Immunoglobulin G]], '''IgM'''= [[Immunoglobulin M]], '''CT'''= [[Computed tomography]], '''[[PMN]]'''= Polymorphonuclear cells, '''[[ESR]]'''= [[Erythrocyte sedimentation rate]], '''[[CRP]]'''= [[C-reactive protein]], TS= [[Transferrin saturation]], SF= Serum [[Ferritin]], SMA= [[Superior mesenteric artery]], SMV= [[Superior mesenteric vein]], ECG= [[Electrocardiogram]] | |||
<br><br> | |||
'''The following table outlines the major differential diagnoses of abdominal pain.''' | '''The following table outlines the major differential diagnoses of abdominal pain.''' | ||
Revision as of 15:06, 20 December 2017
Chronic pancreatitis Microchapters |
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Risk calculators and risk factors for Chronic pancreatitis differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]
Overview
Chronic pancreatitis needs to be differentiated from other diseases presenting with similar complaints such as abdominal pain, diarrhea and weight loss.
Differentiating Chronic Pancreatitis from Other Diseases
Differentials based on nausea, vomiting, diarrhea, fatigue and abdominal pain
Chronic pancreatitis should be differentiated from other diseases presenting with nausea, vomiting, diarrhea, fatigue and abdominal pain. The differentials include the following:
Disease | Clinical manifestations | Diagnosis | Comments | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Symptoms | Signs | |||||||||||||||
Abdominal Pain | Fever | Rigors and chills | Nausea or vomiting | Jaundice | Constipation | Diarrhea | Weight loss | GI bleeding | Hypo-
tension |
Guarding | Rebound Tenderness | Bowel sounds | Lab Findings | Imaging | ||
Chronic pancreatitis | Epigastric | − | − | ± | ± | − | + | + | − | − | − | − | N | CT scan
|
| |
Pancreatic carcinoma | Epigastric | − | − | + | + | − | + | + | − | − | − | − | N |
Skin manifestations may include: | ||
Dumping syndrome | Lower and then diffuse | − | − | + | − | − | + | + | − | + | − | − | Hyperactive |
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Abbreviations:
RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram
The following table outlines the major differential diagnoses of abdominal pain.
Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram, US = Ultrasound
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