Pancreatic cancer differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Pancreatic cancer}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Pancreatic_cancer]]
{{CMG}}; {{AE}} {{Cherry}}
{{CMG}}; {{AE}} {{Cherry}}


==Overview==
==Overview==
[[Pancreatic cancer]] must be differentiated from other [[Pancreas|pancreatic]] pathologies such as [[chronic pancreatitis]], [[autoimmune pancreatitis]], [[pancreatic pseudocyst]], and neuroendocrine tumors of the pancreas. Pathologies of the [[bile duct]] and [[duodenum]] such as [[Choledocholithiasis]], [[Gallstone disease|gallstones]] ([[Gallstone disease|Cholelithiasis]]), [[Bile duct cyst|Choledochal Cysts]], [[Cholangiocarcinoma]], [[Bile duct]] [[Stenosis|strictures]] and [[Ampulla of Vater|ampullary]] cancer should be differentiated from [[pancreatic cancer]] based on [[imaging]] and [[biopsy]] findings. [[Metastasis]] from different sites and [[vascular]] causes such as [[Abdominal aortic aneurysm|abdominal aortic aneurysms]] may also mimic [[pancreatic cancer]].
[[Pancreatic cancer]] must be distinguished from other pancreatobiliary pathologies that cause [[abdominal pain]] and [[jaundice]] such as acute [[Pus|suppurative]] [[cholangitis]], [[Cholecystitis|acute cholecystitis]], [[Gallstone disease|cholelithiasis]], [[chronic pancreatitis]], [[primary biliary cirrhosis]] and [[primary sclerosing cholangitis]]. [[Pancreatic cancer]] must also be differentiated from other [[Pancreas|pancreatic]] [[Pathological|pathologies]] such as  [[autoimmune pancreatitis]], [[pancreatic pseudocyst]], and [[neuroendocrine tumors]] of the pancreas. [[Pathological|Pathologies]] of the [[bile duct]] and [[duodenum]] such as [[Choledocholithiasis]], [[Gallstone disease|gallstones]] ([[Gallstone disease|cholelithiasis]]), [[Bile duct cyst|choledochal cysts]], [[Cholangiocarcinoma]], [[Bile duct]] [[Stenosis|strictures]] and [[Ampulla of Vater|ampullary]] cancer should be differentiated from [[pancreatic cancer]] based on [[imaging]] and [[biopsy]] findings. [[Metastasis]] from different sites and [[vascular]] causes such as [[Abdominal aortic aneurysm|abdominal aortic aneurysms]] may also mimic [[pancreatic cancer]].
==Differentiating Pancreatic Cancer from other Diseases==
==Differentiating Pancreatic Cancer from other Diseases==


The differentials for [[pancreatic cancer]] mainly involve pathologies of the [[pancreas]], [[bile duct]], [[duodenum]], lymphovascular tissue or [[metastasis]] from other sites. It is difficult to differentiate pancreatic cancer from other neoplasms as they all present with non specific constitutional symptoms. Hence, differentiation is primarily based on investigations:<ref name="pmid29029521">{{cite journal |vauthors=He XK, Ding Y, Sun LM |title=Contrast-enhanced endoscopic ultrasound for differential diagnosis of pancreatic cancer: an updated meta-analysis |journal=Oncotarget |volume=8 |issue=39 |pages=66392–66401 |year=2017 |pmid=29029521 |pmc=5630421 |doi=10.18632/oncotarget.18915 |url=}}</ref><ref name="pmid29022085">{{cite journal |vauthors=Steinman J, Zaheer A, Kluger MD, Remotti H, Hecht EM |title=Rare pancreatic tumors |journal=Abdom Radiol (NY) |volume= |issue= |pages= |year=2017 |pmid=29022085 |doi=10.1007/s00261-017-1342-x |url=}}</ref><ref name="pmid28700485">{{cite journal |vauthors=Ran L, Zhao W, Zhao Y, Bu H |title=Value of contrast-enhanced ultrasound in differential diagnosis of solid lesions of pancreas (SLP): A systematic review and a meta-analysis |journal=Medicine (Baltimore) |volume=96 |issue=28 |pages=e7463 |year=2017 |pmid=28700485 |pmc=5515757 |doi=10.1097/MD.0000000000007463 |url=}}</ref><ref name="pmid28216481">{{cite journal |vauthors=Kołodziejczyk E, Wejnarska K, Oracz G |title=Autoimmune pancreatitis in the paediatric population - review of the literature and own experience |journal=Dev Period Med |volume=20 |issue=4 |pages=279–286 |year=2016 |pmid=28216481 |doi= |url=}}</ref><ref name="pmid28197876">{{cite journal |vauthors=Zhu L, Xue HD, Liu W, Wang X, Sui X, Wang Q, Zhang D, Li P, Jin ZY |title=Enhancing pancreatic mass with normal serum CA19-9: key MDCT features to characterize pancreatic neuroendocrine tumours from its mimics |journal=Radiol Med |volume=122 |issue=5 |pages=337–344 |year=2017 |pmid=28197876 |doi=10.1007/s11547-017-0734-x |url=}}</ref><ref name="pmid28154274">{{cite journal |vauthors=Sano I, Katanuma A, Yane K, Kin T, Nagai K, Yamazaki H, Koga H, Kitagawa K, Yokoyama K, Ikarashi S, Takahashi K, Maguchi H, Omori Y, Shinohara T |title=Pancreatic Metastasis from Rectal Cancer that was Diagnosed by Endoscopic Ultrasonography-guided Fine Needle Aspiration (EUS-FNA) |journal=Intern. Med. |volume=56 |issue=3 |pages=301–305 |year=2017 |pmid=28154274 |pmc=5348454 |doi=10.2169/internalmedicine.56.7213 |url=}}</ref><ref name="pmid27926362">{{cite journal |vauthors=Salaria SN, Shi C |title=Pancreatic Neuroendocrine Tumors |journal=Surg Pathol Clin |volume=9 |issue=4 |pages=595–617 |year=2016 |pmid=27926362 |doi=10.1016/j.path.2016.05.006 |url=}}</ref><ref name="pmid27803081">{{cite journal |vauthors=Kawasaki K, Kawaguchi Y, Suzuki Y, Tanaka N |title=Renal neuroendocrine tumour and synchronous pancreas metastasis: histopathological diagnosis using prostatic acid phosphatase |journal=BMJ Case Rep |volume=2016 |issue= |pages= |year=2016 |pmid=27803081 |doi=10.1136/bcr-2016-214759 |url=}}</ref><ref name="pmid27673319">{{cite journal |vauthors=Nassour I, Choti MA |title=Diagnosis and Treatment of Pancreatic Cystic Neoplasms |journal=JAMA |volume=316 |issue=12 |pages=1326 |year=2016 |pmid=27673319 |doi=10.1001/jama.2016.9130 |url=}}</ref><ref name="pmid28418702">{{cite journal |vauthors=Javadi S, Menias CO, Korivi BR, Shaaban AM, Patnana M, Alhalabi K, Elsayes KM |title=Pancreatic Calcifications and Calcified Pancreatic Masses: Pattern Recognition Approach on CT |journal=AJR Am J Roentgenol |volume=209 |issue=1 |pages=77–87 |year=2017 |pmid=28418702 |doi=10.2214/AJR.17.17862 |url=}}</ref><ref name="pmid27807633">{{cite journal |vauthors=Bergmann F |title=[Pancreatic acinar neoplasms : Comparative molecular characterization] |language=German |journal=Pathologe |volume=37 |issue=Suppl 2 |pages=191–195 |year=2016 |pmid=27807633 |doi=10.1007/s00292-016-0235-z |url=}}</ref><ref name="pmid27232353">{{cite journal |vauthors=Cheng SK, Chuah KL |title=Metastatic Renal Cell Carcinoma to the Pancreas: A Review |journal=Arch. Pathol. Lab. Med. |volume=140 |issue=6 |pages=598–602 |year=2016 |pmid=27232353 |doi=10.5858/arpa.2015-0135-RS |url=}}</ref><ref name="pmid27000276">{{cite journal |vauthors=Haage P, Schwartz CA, Scharwächter C |title=[Ductal adenocarcinoma and unusual differential diagnosis] |language=German |journal=Radiologe |volume=56 |issue=4 |pages=325–37 |year=2016 |pmid=27000276 |doi=10.1007/s00117-016-0090-1 |url=}}</ref><ref name="pmid26777740">{{cite journal |vauthors=Scialpi M, Reginelli A, D'Andrea A, Gravante S, Falcone G, Baccari P, Manganaro L, Palumbo B, Cappabianca S |title=Pancreatic tumors imaging: An update |journal=Int J Surg |volume=28 Suppl 1 |issue= |pages=S142–55 |year=2016 |pmid=26777740 |doi=10.1016/j.ijsu.2015.12.053 |url=}}</ref><ref name="pmid25799073">{{cite journal |vauthors=Senosiain Lalastra C, Foruny Olcina JR |title=[Autoimmune pancreatitis] |language=Spanish; Castilian |journal=Gastroenterol Hepatol |volume=38 |issue=9 |pages=549–55 |year=2015 |pmid=25799073 |doi=10.1016/j.gastrohep.2015.01.006 |url=}}</ref><ref name="pmid25638877">{{cite journal |vauthors=Barbier L, Delpero JR |title=[Pancreatic tumours] |language=French |journal=Rev Prat |volume=64 |issue=9 |pages=1307–12 |year=2014 |pmid=25638877 |doi= |url=}}</ref><ref name="pmid25288201">{{cite journal |vauthors=Díte P, Uvírová M, Bojková M, Novotný I, Dvorácková J, Kianicka B, Nechutová H, Dovrtelová L, Floreánová K, Martínek A |title=Differentiating autoimmune pancreatitis from pancreatic cancer |journal=Minerva Gastroenterol Dietol |volume=60 |issue=4 |pages=247–53 |year=2014 |pmid=25288201 |doi= |url=}}</ref><ref name="pmid25063236">{{cite journal |vauthors=Lalwani N, Mannelli L, Ganeshan DM, Shanbhogue AK, Dighe MK, Tiwari HA, Maximin S, Monti S, Ragucci M, Prasad SR |title=Uncommon pancreatic tumors and pseudotumors |journal=Abdom Imaging |volume=40 |issue=1 |pages=167–80 |year=2015 |pmid=25063236 |doi=10.1007/s00261-014-0189-7 |url=}}</ref><ref name="pmid24572485">{{cite journal |vauthors=Dite P, Nechutova H, Uvirova M, Dvorackova J, Kianicka B, Martinek A |title=Autoimmune pancreatitis |journal=Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub |volume=158 |issue=1 |pages=17–22 |year=2014 |pmid=24572485 |doi=10.5507/bp.2013.094 |url=}}</ref><ref name="pmid24242859">{{cite journal |vauthors=Mastoraki A, Tzortzopoulou A, Tsela S, Danias N, Sakorafas G, Smyrniotis V, Arkadopoulos N |title=Hereditary pancreatitis: dilemmas in differential diagnosis and therapeutic approach |journal=J Gastrointest Cancer |volume=45 |issue=1 |pages=22–6 |year=2014 |pmid=24242859 |doi=10.1007/s12029-013-9559-6 |url=}}</ref><ref name="pmid24193862">{{cite journal |vauthors=Beyer G, Menzel J, Krüger PC, Ribback S, Lerch MM, Mayerle J |title=[Autoimmune pancreatitis] |language=German |journal=Dtsch. Med. Wochenschr. |volume=138 |issue=46 |pages=2359–70; quiz 2371–4 |year=2013 |pmid=24193862 |doi=10.1055/s-0033-1349475 |url=}}</ref><ref name="pmid24060833">{{cite journal |vauthors=Al-Hawary MM, Kaza RK, Azar SF, Ruma JA, Francis IR |title=Mimics of pancreatic ductal adenocarcinoma |journal=Cancer Imaging |volume=13 |issue=3 |pages=342–9 |year=2013 |pmid=24060833 |pmc=3800430 |doi=10.1102/1470-7330.2013.9012 |url=}}</ref><ref name="pmid23918083">{{cite journal |vauthors=Bednar F, Scheiman JM, McKenna BJ, Simeone DM |title=Breast cancer metastases to the pancreas |journal=J. Gastrointest. Surg. |volume=17 |issue=10 |pages=1826–31 |year=2013 |pmid=23918083 |doi=10.1007/s11605-013-2291-5 |url=}}</ref><ref name="pmid23852141">{{cite journal |vauthors=DiMagno MJ, DiMagno EP |title=Chronic pancreatitis |journal=Curr. Opin. Gastroenterol. |volume=29 |issue=5 |pages=531–6 |year=2013 |pmid=23852141 |pmc=4387887 |doi=10.1097/MOG.0b013e3283639370 |url=}}</ref><ref name="pmid28831506">{{cite journal |vauthors=Berger AW, Seufferlein T, Kleger A |title=[Cystic pancreatic tumors: diagnostics and new biomarkers] |language=German |journal=Chirurg |volume=88 |issue=11 |pages=905–912 |year=2017 |pmid=28831506 |doi=10.1007/s00104-017-0493-1 |url=}}</ref><ref name="pmid27840080">{{cite journal |vauthors=Nougaret S, Mannelli L, Pierredon MA, Schembri V, Guiu B |title=Cystic pancreatic lesions: From increased diagnosis rate to new dilemmas |journal=Diagn Interv Imaging |volume=97 |issue=12 |pages=1275–1285 |year=2016 |pmid=27840080 |doi=10.1016/j.diii.2016.08.017 |url=}}</ref><ref name="pmid28858107">{{cite journal |vauthors=Xu MM, Yin S, Siddiqui AA, Salem RR, Schrope B, Sethi A, Poneros JM, Gress FG, Genkinger JM, Do C, Brooks CA, Chabot JA, Kluger MD, Kowalski T, Loren DE, Aslanian H, Farrell JJ, Gonda TA |title=Comparison of the diagnostic accuracy of three current guidelines for the evaluation of asymptomatic pancreatic cystic neoplasms |journal=Medicine (Baltimore) |volume=96 |issue=35 |pages=e7900 |year=2017 |pmid=28858107 |pmc=5585501 |doi=10.1097/MD.0000000000007900 |url=}}</ref><ref name="pmid26818541">{{cite journal |vauthors=Dong J, Cong L, Zhang TP, Zhao YP |title=Pancreatic metastasis of renal cell carcinoma |journal=HBPD INT |volume=15 |issue=1 |pages=30–8 |year=2016 |pmid=26818541 |doi= |url=}}</ref>
{| class="wikitable"
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Origin
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Differentiation based on Investigations
|-
| style="background:#DCDCDC; + " | '''Pancreas'''
|
* [[Chronic pancreatitis]]
* [[Autoimmune pancreatitis]]
* [[Pancreatic pseudocyst|Pseudocyst]] of [[pancreas]]
* [[Pancreatic cyst]]
* [[Neuroendocrine tumors|Neuroendocrine tumors of pancreas]]
** [[Gastrinoma (patient information)|Gastrinoma]]
** [[VIPoma]]
** [[Neuroendocrine tumors|Somatostatinoma]]
** [[Insulinoma]]
|
* [[Imaging]]: Non-contrast helical [[Computed tomography|CT]]
* [[Biopsy]] findings
* Serum [[IgG4-related systemic disease|IgG4]] levels for autoimmune pancreatitis
* For pancreatic [[Neuroendocrine tumors|NETs]]:
** [[Gastrin]] levels
** [[Somatostatin]] levels
** [[Insulin]] levels
** Serum electrolytes
|-
| style="background:#DCDCDC; + " | '''Bile duct'''
|
* [[Choledocholithiasis]]
* [[Gallstone disease|Gallstones]] ([[Gallstone disease|Cholelithiasis]])
* [[Bile duct cyst|Choledochal Cysts]]
* [[Cholangiocarcinoma]]
* [[Bile duct]] [[Stenosis|strictures]]
* [[Cholangitis]]
* [[Cholecystitis]]
|
* [[Imaging]]:
** [[Magnetic resonance imaging|MRI]]
** [[Magnetic resonance cholangiopancreatography|MRCP]]
** [[Ultrasound|USG bile duct]]
** [[Endoscopic retrograde cholangiopancreatography|ERCP]]
* [[Biopsy]] findings
|-
| style="background:#DCDCDC; + " | '''Duodenum'''
|
* Ampullary cancer
* [[Duodenum|Duodenal]] cancer
|
* [[Imaging]]:
** [[Magnetic resonance imaging|MRI]]
** [[Endoscopic retrograde cholangiopancreatography|ERCP]]
** Upper [[Gastrointestinal tract|GI]] [[Endoscopy]]
* [[Biopsy]] findings
|-
| style="background:#DCDCDC; + " | '''Lymphovascular'''
'''tissue'''
|
* [[Abdominal aortic aneurysm]]
* [[Mesenteric ischemia|Intestinal ischemia]]
* [[Lymphoma|Lymphomas]]
** [[Stomach|Gastric]]
** [[Pancreas|Pancreatic]]
|
* Imaging:
** [[Magnetic resonance imaging|MRI]]
** MR [[Angiogram|Angiography]]
** CT [[Angiogram|Angiography]]
* [[Biopsy]] for [[lymphoma]]
|-
| style="background:#DCDCDC; + " | '''Metastasis'''
|
* [[Skin]]([[Melanoma]])
* [[Kidney]]
* [[Breast]]
* [[Colon (anatomy)|Colon]]
* [[Liver]]([[Hepatocellular carcinoma]])
* [[Stomach]]
|
* [[Imaging]]:
** [[Magnetic resonance imaging|MRI]]
** [[Positron emission tomography|PET scan]]
** [[Computed tomography|CT]]
* [[Biopsy]]
* Specific markers for different [[Cancer|cancers]]:
** [[Hepatocellular carcinoma|HCC]]: [[Alpha-fetoprotein|AFP]]
** [[Breast]]: ''BRCA 1 and 2''
** [[Colorectal cancer|Colon cancer]]: [[CEA]]
** [[Melanoma]]: [[S100B|S100]]
|}


[[Pancreatic cancer]] may also be distinguished from other causes of [[abdominal pain]] and [[jaundice]] as depicted in the table below:
[[Pancreatic cancer]] may also be distinguished from other causes of [[abdominal pain]] and [[jaundice]] as depicted in the table below:
Line 103: Line 13:
|
|
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! colspan="3" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of acute abdomen based on etiology
! colspan="3" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Classification of pain in the abdomen based on etiology
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical manifestations
! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" |Clinical manifestations
! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diagnosis
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Comments
|-
|-
! colspan="4" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Symptoms
! colspan="4" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Symptoms
! colspan="4" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Signs
! colspan="4" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Signs
|-
|-
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Fever
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and chills
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills
! align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal Pain
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain
! align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice
! align="center" style="background:#4479BA; color: #FFFFFF;" |Hypo-
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo-
tension
tension
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Guarding
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Guarding
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rebound Tenderness
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel sounds
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Lab Findings
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Lab Findings
! align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
|-
|-
! rowspan="39" align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal causes
! rowspan="18" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal causes
! colspan="1" rowspan="27" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Inflammatory causes
! colspan="1" rowspan="17" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Inflammatory causes
! rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pancreato-biliary disorders
! rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pancreato-biliary disorders
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Acute suppurative cholangitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Acute suppurative cholangitis
Line 139: Line 49:
* Abnormal [[LFT]]
* Abnormal [[LFT]]
* WBC >10,000
* WBC >10,000
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[biliary]] dilatation/stents/tumor
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]] shows [[biliary]] dilatation/stents/[[tumor]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Septic shock occurs with features of [[SIRS]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Septic shock]] occurs with features of [[SIRS]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Cholangitis|Acute cholangitis]]  
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Cholangitis|Acute cholangitis]]  
Line 152: Line 62:
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Abnormal [[LFT]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Abnormal [[LFT]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[biliary]] dilatation/stents/tumor
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]] shows [[biliary]] dilatation/stents/tumor
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Biliary drainage ([[Endoscopic retrograde cholangiopancreatography|ERCP]]) + IV antibiotics
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Biliary drainage ([[Endoscopic retrograde cholangiopancreatography|ERCP]]) + [[Intravenous|IV]] [[antibiotics]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute cholecystitis|Acute cholecystitis]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute cholecystitis|Acute cholecystitis]]
Line 167: Line 77:
* [[Hyperbilirubinemia]]
* [[Hyperbilirubinemia]]
* [[Leukocytosis]]
* [[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows gallstone and evidence of inflammation
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]] shows [[gallstone]] and evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]]
|-
|-
Line 180: Line 90:
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[amylase]] / [[lipase]]  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[amylase]] / [[lipase]]  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]] shows evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Pain radiation to back
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Pain radiation to back
|-
|-
Line 226: Line 136:
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N to hyperactive for dislodged stone
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N to hyperactive for dislodged stone
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[gallstone]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]] shows [[gallstone]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]]
|-
|-
Line 251: Line 161:
* Involvement of the regional [[Lymph node|lymph nodes]] and adjacent [[Circulatory system|vasculature]]
* Involvement of the regional [[Lymph node|lymph nodes]] and adjacent [[Circulatory system|vasculature]]
* [[Pancreatic duct|Pancreatic ductal]] [[Dilation|dilatation]]
* [[Pancreatic duct|Pancreatic ductal]] [[Dilation|dilatation]]
* [[Pancreas|Pancreatic]] atrophy
* [[Pancreas|Pancreatic]] [[atrophy]]
* [[Obstruction]] of the [[Common bile duct|common bile duct (CBD)]]
* [[Obstruction]] of the [[Common bile duct|common bile duct (CBD)]]


* [[Ultrasound|USG]] shows:
* [[Ultrasound|USG]] shows:
 ill defined hypoechoic mass is seen infiltrating into a bright ''pancreatic parenchyma''
 ill defined hypoechoic mass is seen infiltrating into a bright ''[[pancreatic]] parenchyma''
* [[Endoscopic ultrasound|EUS]]-guided [[Fine needle aspiration|fine needle aspiration biopsy (FNA)]] is the best modality for obtaining a tissue diagnosis.
* [[Endoscopic ultrasound|EUS]]-guided [[Fine needle aspiration|fine needle aspiration biopsy (FNA)]] is the best modality for obtaining a tissue [[diagnosis]].
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Signs of [[Metastasis|metastatic disease]] include: 
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Signs of [[Metastasis|metastatic disease]] include: 
* Left [[Supraclavicular lymph nodes|supraclavicular]] [[lymphadenopathy]] ([[Virchow's node]])
* Left [[Supraclavicular lymph nodes|supraclavicular]] [[lymphadenopathy]] ([[Virchow's node]])
Line 263: Line 173:
* Involvement of other [[Lymph node|nodes]] in the [[cervical]] area
* Involvement of other [[Lymph node|nodes]] in the [[cervical]] area
|-
|-
! colspan="1" rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Gastric causes
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastric]] causes
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Peptic Ulcer Disease|Peptic ulcer disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in perforated
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ascitic fluid
** [[LDH]] > serum [[LDH]]
** Glucose < 50mg/dl
** Total protein > 1g/dl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Air under [[diaphragm]] in upright [[CXR]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Upper GI [[endoscopy]] for diagnosis
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastritis|Gastritis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| 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="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastroesophageal reflux disease|Gastroesophageal reflux disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| 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="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastric outlet obstruction|Gastric outlet obstruction]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| 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="left" |Hyperactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastrointestinal perforation]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastrointestinal perforation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 333: Line 187:
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
! rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intestinal causes
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Intestinal]] causes
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute appendicitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +in pyogenic appendicitis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Starts in [[epigastrium]], migrates to RLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in perforated appendicitis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], [[decreased appetite]]
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diverticulitis|Acute diverticulitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |LLQ
| 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" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound shows evidence of inflammation
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Inflammatory bowel disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |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" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Irritable bowel syndrome]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |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" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Tests done to exclude other diseases as it diagnosis of exclusion
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Tests done to exclude other diseases as it diagnosis of exclusion
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Symptomatic treatment
* High [[dietary fiber]]
 
* [[Osmotic]] [[laxatives]]
* [[Antispasmodic]] drugs
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Whipple's disease]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Whipple's disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
Line 417: Line 215:
* [[Arthritis]]
* [[Arthritis]]
* [[Ascites]]
* [[Ascites]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Toxic megacolon]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |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" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tropical sprue]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |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" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Celiac disease]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Celiac disease]]
Line 452: Line 224:
| 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 (increased sounds)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Hyperactive]] (increased sounds)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[IgA]] endomysial antibody
* [[IgA]] endomysial [[antibody]]
* [[IgA]] [[tissue transglutaminase]] antibody
* [[IgA]] [[tissue transglutaminase]] antibody
* [[Anti-gliadin antibodies|Anti-gliadin antibody]]
* [[Anti-gliadin antibodies|Anti-gliadin antibody]]
Line 460: Line 232:
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatic causes
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatic]] causes
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis|Viral hepatitis]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis|Viral hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 479: Line 251:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in sepsis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in [[sepsis]]
| 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" |
Line 504: Line 276:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Dull / aching
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in cirrhotic patients
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in cirrhotic patients
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |may be in cardicmyopathy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |may be in cardicmyopathy
| 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" |>60% TS<br> >240 μg/L SF <br>Raised LFT <br>Hyperglycemia
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |>60% TS<br> >240 μg/L SF <br>Raised LFT <br>[[Hyperglycemia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Ultrasound shows evidence of cirrhosis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Ultrasound]] shows evidence of [[cirrhosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Extra intestinal findings:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Extra intestinal findings:
* hyperpigmentation
* [[hyperpigmentation]]
* Diabetes mellitus
* [[Diabetes mellitus]]
* Arthralgia
* [[Arthralgia]]
* Impotence in males
* [[Impotence]] in males
* Cardiomyopathy
* [[Cardiomyopathy]]
* Atherosclerosis
* [[Atherosclerosis]]
* Hypopituitarism
* [[Hypopituitarism]]
* Hypothyroidism
* [[Hypothyroidism]]
* Extrahepatic cancer
* [[Extrahepatic cholangiocarcinoma|Extrahepatic]] cancer
* Prone to specific infections
* Prone to specific [[infections]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cirrhosis|Cirrhosis]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cirrhosis|Cirrhosis]]
Line 536: Line 308:
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" | Peritoneal causes
! style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Peritoneal]] causes
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Spontaneous bacterial peritonitis]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Spontaneous bacterial peritonitis]]
| 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" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in cirrhotic patients
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in [[Cirrhosis|cirrhotic]] patients
| 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" |−
Line 547: Line 319:
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ascitic fluid [[PMN]]>250 cells/mm<small>³</small>
* [[Ascitic]] [[fluid]] [[PMN]]>250 cells/mm<small>³</small>


* Culture: Positive for single organism  
* Culture: Positive for single organism  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound for evaluation of liver cirrhosis
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]] for evaluation of liver cirrhosis
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
! colspan="2" rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Hollow Viscous Obstruction  
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hollow Viscous Obstruction
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Small intestine obstruction
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |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" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Abdominal X-ray|Abdominal X ray]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Volvulus]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |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="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and [[Abdominal x-ray|abdominal X ray]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Biliary colic]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Biliary colic]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
Line 590: Line 336:
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[bilirubin]] and [[alkaline phosphatase]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[bilirubin]] and [[alkaline phosphatase]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Renal colic]]
|}
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
|}
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
 
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Flank pain]]
=== Differentials based on weight loss, nausea, vomiting, diarrhea, fatigue and abdominal pain ===
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
Pancreatic carcinoma should be differentiated from other diseases presenting with [[weight loss]], [[nausea]], [[vomiting]], [[diarrhea]], [[fatigue]] and [[abdominal pain]]. The differentials include the following:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
 
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| colspan="13" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestations'''
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Hematuria]]
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diagnosis
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Comments
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Colicky [[abdominal pain]] associated with [[Nausea and vomiting|nausea & vomiting]]
|-
|-
! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Vascular Disorders
| colspan="9" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Symptoms'''
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ischemic causes
! colspan="4" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Signs
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Periumbilical
| 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" |[[Leukocytosis]] and [[lactic acidosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], normal physical examination
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ischemic colitis|Acute ischemic colitis]]
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Fever
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo-
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
tension
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
! 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
|-
|-
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hemorrhagic causes
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Chronic pancreatitis]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ruptured abdominal aortic aneurysm]]
| 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" |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" |−
| 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="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan  
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Unstable hemodynamics
| 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" |Intra-abdominal or [[retroperitoneal hemorrhage]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pancreatic carcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| 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" |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" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Anemia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of [[trauma]]
|-
! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gynaecological Causes
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Tubal causes
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Torsion of the cyst
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RLQ / LLQ
| 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" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Salpingitis|Acute salpingitis]]
| 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" |RLQ / LLQ
| 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" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
* ↑ [[Alkaline phosphatase]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
* ↑ [[Bilirubin|serum bilirubin]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
* ↑ [[gamma-glutamyl transpeptidase]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Pelvic ultrasound]]
* ↑ [[CA 19-9]] 
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Vaginal discharge]]
| 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" |Cyst rupture
| 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" |RLQ / LLQ
| 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="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]]
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pregnancy
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ruptured [[ectopic pregnancy]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RLQ / LLQ
| 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" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Positive [[pregnancy test]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of missed period and [[vaginal bleeding]]
|-
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Extra-abdominal causes
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pulmonary disorders
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pleural empyema]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]/[[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="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Glucose challenge test
* [[Hydrogen Breath Test|Hydrogen breath test]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Upper [[Gastrointestinal tract|GI]] series
* Gastric emptying study
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| 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>
'''To review a comprehensive differential diagnosis of diseases presenting with abdominal pain, [[Abdominal pain differential diagnosis#Differential diagnosis of abdominal pain|click here]].'''
===Differentiating Pancreatic Carcinoma on the basis of involved Organ===
The differentials for [[pancreatic cancer]] mainly involve pathologies of the [[pancreas]], [[bile duct]], [[duodenum]], lymphovascular tissue or [[metastasis]] from other sites. It is difficult to differentiate pancreatic cancer from other [[neoplasms]] as they all present with non specific constitutional [[symptoms]]. Hence, differentiation is primarily based on anatomic location:<ref name="pmid29029521">{{cite journal |vauthors=He XK, Ding Y, Sun LM |title=Contrast-enhanced endoscopic ultrasound for differential diagnosis of pancreatic cancer: an updated meta-analysis |journal=Oncotarget |volume=8 |issue=39 |pages=66392–66401 |year=2017 |pmid=29029521 |pmc=5630421 |doi=10.18632/oncotarget.18915 |url=}}</ref><ref name="pmid29022085">{{cite journal |vauthors=Steinman J, Zaheer A, Kluger MD, Remotti H, Hecht EM |title=Rare pancreatic tumors |journal=Abdom Radiol (NY) |volume= |issue= |pages= |year=2017 |pmid=29022085 |doi=10.1007/s00261-017-1342-x |url=}}</ref><ref name="pmid28700485">{{cite journal |vauthors=Ran L, Zhao W, Zhao Y, Bu H |title=Value of contrast-enhanced ultrasound in differential diagnosis of solid lesions of pancreas (SLP): A systematic review and a meta-analysis |journal=Medicine (Baltimore) |volume=96 |issue=28 |pages=e7463 |year=2017 |pmid=28700485 |pmc=5515757 |doi=10.1097/MD.0000000000007463 |url=}}</ref><ref name="pmid28216481">{{cite journal |vauthors=Kołodziejczyk E, Wejnarska K, Oracz G |title=Autoimmune pancreatitis in the paediatric population - review of the literature and own experience |journal=Dev Period Med |volume=20 |issue=4 |pages=279–286 |year=2016 |pmid=28216481 |doi= |url=}}</ref><ref name="pmid28197876">{{cite journal |vauthors=Zhu L, Xue HD, Liu W, Wang X, Sui X, Wang Q, Zhang D, Li P, Jin ZY |title=Enhancing pancreatic mass with normal serum CA19-9: key MDCT features to characterize pancreatic neuroendocrine tumours from its mimics |journal=Radiol Med |volume=122 |issue=5 |pages=337–344 |year=2017 |pmid=28197876 |doi=10.1007/s11547-017-0734-x |url=}}</ref><ref name="pmid28154274">{{cite journal |vauthors=Sano I, Katanuma A, Yane K, Kin T, Nagai K, Yamazaki H, Koga H, Kitagawa K, Yokoyama K, Ikarashi S, Takahashi K, Maguchi H, Omori Y, Shinohara T |title=Pancreatic Metastasis from Rectal Cancer that was Diagnosed by Endoscopic Ultrasonography-guided Fine Needle Aspiration (EUS-FNA) |journal=Intern. Med. |volume=56 |issue=3 |pages=301–305 |year=2017 |pmid=28154274 |pmc=5348454 |doi=10.2169/internalmedicine.56.7213 |url=}}</ref><ref name="pmid27926362">{{cite journal |vauthors=Salaria SN, Shi C |title=Pancreatic Neuroendocrine Tumors |journal=Surg Pathol Clin |volume=9 |issue=4 |pages=595–617 |year=2016 |pmid=27926362 |doi=10.1016/j.path.2016.05.006 |url=}}</ref><ref name="pmid27803081">{{cite journal |vauthors=Kawasaki K, Kawaguchi Y, Suzuki Y, Tanaka N |title=Renal neuroendocrine tumour and synchronous pancreas metastasis: histopathological diagnosis using prostatic acid phosphatase |journal=BMJ Case Rep |volume=2016 |issue= |pages= |year=2016 |pmid=27803081 |doi=10.1136/bcr-2016-214759 |url=}}</ref><ref name="pmid27673319">{{cite journal |vauthors=Nassour I, Choti MA |title=Diagnosis and Treatment of Pancreatic Cystic Neoplasms |journal=JAMA |volume=316 |issue=12 |pages=1326 |year=2016 |pmid=27673319 |doi=10.1001/jama.2016.9130 |url=}}</ref><ref name="pmid28418702">{{cite journal |vauthors=Javadi S, Menias CO, Korivi BR, Shaaban AM, Patnana M, Alhalabi K, Elsayes KM |title=Pancreatic Calcifications and Calcified Pancreatic Masses: Pattern Recognition Approach on CT |journal=AJR Am J Roentgenol |volume=209 |issue=1 |pages=77–87 |year=2017 |pmid=28418702 |doi=10.2214/AJR.17.17862 |url=}}</ref><ref name="pmid27807633">{{cite journal |vauthors=Bergmann F |title=[Pancreatic acinar neoplasms : Comparative molecular characterization] |language=German |journal=Pathologe |volume=37 |issue=Suppl 2 |pages=191–195 |year=2016 |pmid=27807633 |doi=10.1007/s00292-016-0235-z |url=}}</ref><ref name="pmid27232353">{{cite journal |vauthors=Cheng SK, Chuah KL |title=Metastatic Renal Cell Carcinoma to the Pancreas: A Review |journal=Arch. Pathol. Lab. Med. |volume=140 |issue=6 |pages=598–602 |year=2016 |pmid=27232353 |doi=10.5858/arpa.2015-0135-RS |url=}}</ref><ref name="pmid27000276">{{cite journal |vauthors=Haage P, Schwartz CA, Scharwächter C |title=[Ductal adenocarcinoma and unusual differential diagnosis] |language=German |journal=Radiologe |volume=56 |issue=4 |pages=325–37 |year=2016 |pmid=27000276 |doi=10.1007/s00117-016-0090-1 |url=}}</ref><ref name="pmid26777740">{{cite journal |vauthors=Scialpi M, Reginelli A, D'Andrea A, Gravante S, Falcone G, Baccari P, Manganaro L, Palumbo B, Cappabianca S |title=Pancreatic tumors imaging: An update |journal=Int J Surg |volume=28 Suppl 1 |issue= |pages=S142–55 |year=2016 |pmid=26777740 |doi=10.1016/j.ijsu.2015.12.053 |url=}}</ref><ref name="pmid25799073">{{cite journal |vauthors=Senosiain Lalastra C, Foruny Olcina JR |title=[Autoimmune pancreatitis] |language=Spanish; Castilian |journal=Gastroenterol Hepatol |volume=38 |issue=9 |pages=549–55 |year=2015 |pmid=25799073 |doi=10.1016/j.gastrohep.2015.01.006 |url=}}</ref><ref name="pmid25638877">{{cite journal |vauthors=Barbier L, Delpero JR |title=[Pancreatic tumours] |language=French |journal=Rev Prat |volume=64 |issue=9 |pages=1307–12 |year=2014 |pmid=25638877 |doi= |url=}}</ref><ref name="pmid25288201">{{cite journal |vauthors=Díte P, Uvírová M, Bojková M, Novotný I, Dvorácková J, Kianicka B, Nechutová H, Dovrtelová L, Floreánová K, Martínek A |title=Differentiating autoimmune pancreatitis from pancreatic cancer |journal=Minerva Gastroenterol Dietol |volume=60 |issue=4 |pages=247–53 |year=2014 |pmid=25288201 |doi= |url=}}</ref><ref name="pmid25063236">{{cite journal |vauthors=Lalwani N, Mannelli L, Ganeshan DM, Shanbhogue AK, Dighe MK, Tiwari HA, Maximin S, Monti S, Ragucci M, Prasad SR |title=Uncommon pancreatic tumors and pseudotumors |journal=Abdom Imaging |volume=40 |issue=1 |pages=167–80 |year=2015 |pmid=25063236 |doi=10.1007/s00261-014-0189-7 |url=}}</ref><ref name="pmid24572485">{{cite journal |vauthors=Dite P, Nechutova H, Uvirova M, Dvorackova J, Kianicka B, Martinek A |title=Autoimmune pancreatitis |journal=Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub |volume=158 |issue=1 |pages=17–22 |year=2014 |pmid=24572485 |doi=10.5507/bp.2013.094 |url=}}</ref><ref name="pmid24242859">{{cite journal |vauthors=Mastoraki A, Tzortzopoulou A, Tsela S, Danias N, Sakorafas G, Smyrniotis V, Arkadopoulos N |title=Hereditary pancreatitis: dilemmas in differential diagnosis and therapeutic approach |journal=J Gastrointest Cancer |volume=45 |issue=1 |pages=22–6 |year=2014 |pmid=24242859 |doi=10.1007/s12029-013-9559-6 |url=}}</ref><ref name="pmid24193862">{{cite journal |vauthors=Beyer G, Menzel J, Krüger PC, Ribback S, Lerch MM, Mayerle J |title=[Autoimmune pancreatitis] |language=German |journal=Dtsch. Med. Wochenschr. |volume=138 |issue=46 |pages=2359–70; quiz 2371–4 |year=2013 |pmid=24193862 |doi=10.1055/s-0033-1349475 |url=}}</ref><ref name="pmid24060833">{{cite journal |vauthors=Al-Hawary MM, Kaza RK, Azar SF, Ruma JA, Francis IR |title=Mimics of pancreatic ductal adenocarcinoma |journal=Cancer Imaging |volume=13 |issue=3 |pages=342–9 |year=2013 |pmid=24060833 |pmc=3800430 |doi=10.1102/1470-7330.2013.9012 |url=}}</ref><ref name="pmid23918083">{{cite journal |vauthors=Bednar F, Scheiman JM, McKenna BJ, Simeone DM |title=Breast cancer metastases to the pancreas |journal=J. Gastrointest. Surg. |volume=17 |issue=10 |pages=1826–31 |year=2013 |pmid=23918083 |doi=10.1007/s11605-013-2291-5 |url=}}</ref><ref name="pmid23852141">{{cite journal |vauthors=DiMagno MJ, DiMagno EP |title=Chronic pancreatitis |journal=Curr. Opin. Gastroenterol. |volume=29 |issue=5 |pages=531–6 |year=2013 |pmid=23852141 |pmc=4387887 |doi=10.1097/MOG.0b013e3283639370 |url=}}</ref><ref name="pmid28831506">{{cite journal |vauthors=Berger AW, Seufferlein T, Kleger A |title=[Cystic pancreatic tumors: diagnostics and new biomarkers] |language=German |journal=Chirurg |volume=88 |issue=11 |pages=905–912 |year=2017 |pmid=28831506 |doi=10.1007/s00104-017-0493-1 |url=}}</ref><ref name="pmid27840080">{{cite journal |vauthors=Nougaret S, Mannelli L, Pierredon MA, Schembri V, Guiu B |title=Cystic pancreatic lesions: From increased diagnosis rate to new dilemmas |journal=Diagn Interv Imaging |volume=97 |issue=12 |pages=1275–1285 |year=2016 |pmid=27840080 |doi=10.1016/j.diii.2016.08.017 |url=}}</ref><ref name="pmid28858107">{{cite journal |vauthors=Xu MM, Yin S, Siddiqui AA, Salem RR, Schrope B, Sethi A, Poneros JM, Gress FG, Genkinger JM, Do C, Brooks CA, Chabot JA, Kluger MD, Kowalski T, Loren DE, Aslanian H, Farrell JJ, Gonda TA |title=Comparison of the diagnostic accuracy of three current guidelines for the evaluation of asymptomatic pancreatic cystic neoplasms |journal=Medicine (Baltimore) |volume=96 |issue=35 |pages=e7900 |year=2017 |pmid=28858107 |pmc=5585501 |doi=10.1097/MD.0000000000007900 |url=}}</ref><ref name="pmid26818541">{{cite journal |vauthors=Dong J, Cong L, Zhang TP, Zhao YP |title=Pancreatic metastasis of renal cell carcinoma |journal=HBPD INT |volume=15 |issue=1 |pages=30–8 |year=2016 |pmid=26818541 |doi= |url=}}</ref>
{| class="wikitable"
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Origin
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnostic study of choice
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cardiovascular disorders
| style="background:#DCDCDC; + " | '''[[Pancreas]]'''
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Myocardial Infarction]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
* [[Chronic pancreatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
* [[Autoimmune pancreatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]]
* [[Pancreatic pseudocyst|Pseudocyst]] of [[pancreas]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
* [[Pancreatic cyst]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in cardiogenic shock
* [[Neuroendocrine tumors|Neuroendocrine tumors of pancreas]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
** [[Gastrinoma (patient information)|Gastrinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
** [[VIPoma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
** [[Neuroendocrine tumors|Somatostatinoma]]
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
** [[Insulinoma]]
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Imaging]]: Non-contrast helical [[Computed tomography|CT]]
* [[Biopsy]] findings
* Serum [[IgG4-related systemic disease|IgG4]] levels for [[autoimmune]] [[pancreatitis]]
* For [[pancreatic]] [[Neuroendocrine tumors|NETs]]:
** [[Gastrin]] levels
** [[Somatostatin]] levels
** [[Insulin]] levels
** Serum [[Electrolyte|electrolytes]]
|-
|-
|}
| style="background:#DCDCDC; + " | '''Bile duct'''
|}
|
 
* [[Choledocholithiasis]]
{|
* [[Gallstone disease|Gallstones]] ([[Gallstone disease|Cholelithiasis]])
* [[Bile duct cyst|Choledochal Cysts]]
* [[Cholangiocarcinoma]]
* [[Bile duct]] [[Stenosis|strictures]]
* [[Cholangitis]]
* [[Cholecystitis]]
|
* [[Imaging]]:
** [[Magnetic resonance imaging|MRI]]
** [[Magnetic resonance cholangiopancreatography|MRCP]]
** [[Ultrasound|USG bile duct]]
** [[Endoscopic retrograde cholangiopancreatography|ERCP]]
* [[Biopsy]] findings
|-
|-
| <figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Right_upper_quadrant.PNG|link=Right upper quadrant abdominal pain resident survival guide|339x339px]]</figure-inline></figure-inline></figure-inline>||<figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Epigastric_quadrant_pain.PNG|link=Epigastric pain resident survival guide|179x179px]]</figure-inline></figure-inline></figure-inline>||<figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Left_upper_quadrant.PNG|link=Left upper quadrant abdominal pain resident survival guide|329x329px]]</figure-inline></figure-inline></figure-inline>
| style="background:#DCDCDC; + " | '''[[Duodenum]]'''
|
* [[Ampulla|Ampullary cancer]]
* [[Duodenum|Duodenal]] cancer
|
* [[Imaging]]:  
** [[Magnetic resonance imaging|MRI]]
** [[Endoscopic retrograde cholangiopancreatography|ERCP]]
** Upper [[Gastrointestinal tract|GI]] [[Endoscopy]]
* [[Biopsy]] findings
|-
|-
| <figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Right_flank_quadrant.PNG|link=Right flank pain resident survival guide|338x338px]]</figure-inline></figure-inline></figure-inline>||<figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Umbilical_pain.PNG|link=Umbilical region pain resident survival guide|165x165px]]</figure-inline></figure-inline></figure-inline>||<figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Left_flank_quadrant.PNG|link=Left flank quadrant abdominal pain resident survival guide|335x335px]]</figure-inline></figure-inline></figure-inline>
| style="background:#DCDCDC; + " | '''Lymphovascular'''
'''tissue'''
|
* [[Abdominal aortic aneurysm]]
* [[Mesenteric ischemia|Intestinal ischemia]]
* [[Lymphoma|Lymphomas]]
** [[Stomach|Gastric]]
** [[Pancreas|Pancreatic]]
|
* Imaging:
** [[Magnetic resonance imaging|MRI]]
** MR [[Angiogram|Angiography]]
** CT [[Angiogram|Angiography]]
* [[Biopsy]] for [[lymphoma]]
|-
|-
| <figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Right_lower_quadrant.PNG|link=Right lower quadrant abdominal pain resident survival guide|338x338px]]</figure-inline></figure-inline></figure-inline>||<figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Hypogastric.PNG|link=Hypogastric pain resident survival guide|199x199px]]</figure-inline></figure-inline></figure-inline>||<figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Left_lower_quadrant.PNG|link=Left lower quadrant abdominal pain resident survival guide|335x335px]]</figure-inline></figure-inline></figure-inline>
| style="background:#DCDCDC; + " | '''[[Metastasis]]'''
|
* [[Skin]]([[Melanoma]])
* [[Kidney]]
* [[Breast]]
* [[Colon (anatomy)|Colon]]
* [[Liver]]([[Hepatocellular carcinoma]])
* [[Stomach]]
|
* [[Imaging]]:
** [[Magnetic resonance imaging|MRI]]
** [[Positron emission tomography|PET scan]]
** [[Computed tomography|CT]]
* [[Biopsy]]
* Specific markers for different [[Cancer|cancers]]:
** [[Hepatocellular carcinoma|HCC]]: [[Alpha-fetoprotein|AFP]]
** [[Breast]]: ''BRCA 1 and 2''
** [[Colorectal cancer|Colon cancer]]: [[CEA]]
** [[Melanoma]]: [[S100B|S100]]
|}
|}


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{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Surgery]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]

Latest revision as of 20:25, 13 March 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

Overview

Pancreatic cancer must be distinguished from other pancreatobiliary pathologies that cause abdominal pain and jaundice such as acute suppurative cholangitis, acute cholecystitis, cholelithiasis, chronic pancreatitis, primary biliary cirrhosis and primary sclerosing cholangitis. Pancreatic cancer must also be differentiated from other pancreatic pathologies such as autoimmune pancreatitis, pancreatic pseudocyst, and neuroendocrine tumors of the pancreas. Pathologies of the bile duct and duodenum such as Choledocholithiasis, gallstones (cholelithiasis), choledochal cysts, Cholangiocarcinoma, Bile duct strictures and ampullary cancer should be differentiated from pancreatic cancer based on imaging and biopsy findings. Metastasis from different sites and vascular causes such as abdominal aortic aneurysms may also mimic pancreatic cancer.

Differentiating Pancreatic Cancer from other Diseases

Pancreatic cancer may also be distinguished from other causes of abdominal pain and jaundice as depicted in the table below:

Classification of pain in the abdomen based on etiology Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Fever Rigors and chills Abdominal Pain Jaundice Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Abdominal causes Inflammatory causes Pancreato-biliary disorders Acute suppurative cholangitis + + RUQ + + + + N
  • Abnormal LFT
  • WBC >10,000
 Ultrasound shows biliary dilatation/stents/tumor Septic shock occurs with features of SIRS
Acute cholangitis + − RUQ + − − − N Abnormal LFT Ultrasound shows biliary dilatation/stents/tumor Biliary drainage (ERCP) + IV antibiotics
Acute cholecystitis + − RUQ + − − − Hypoactive Ultrasound shows gallstone and evidence of inflammation Murphy’s sign
Acute pancreatitis + − Epigastric ± ± − − N Increased amylase / lipase Ultrasound shows evidence of inflammation Pain radiation to back
Primary biliary cirrhosis − − RUQ/Epigastric + − − − N Increased AMA level, abnormal LFTs
Primary sclerosing cholangitis + − RUQ + − − − N
Cholelithiasis ± − RUQ/Epigastric ± − + + N to hyperactive for dislodged stone Leukocytosis Ultrasound shows gallstone Murphy’s sign
Pancreatic cancer − − Epigastric ± − − − N

 ill defined hypoechoic mass is seen infiltrating into a bright pancreatic parenchyma

Signs of metastatic disease include: 
Gastric causes Gastrointestinal perforation + ± Diffuse ± + + ± WBC> 10,000 Air under diaphragm in upright CXR
Intestinal causes Whipple's disease ± − Diffuse ± ± − − N *Endoscopy is used to confirm diagnosis.

Images used to find complications

Extra intestinal findings:
Celiac disease − − Diffuse ±, also dermatitis herpetiformis − − − Hyperactive (increased sounds)
Hepatic causes Viral hepatitis + − RUQ + − +
Liver masses + + in Liver abscess RUQ ± + in sepsis
Budd-Chiari syndrome ± − RUQ −
Hemochromatosis − − RUQ ± + in cirrhotic patients may be in cardicmyopathy − − >60% TS
>240 μg/L SF
Raised LFT
Hyperglycemia 		Ultrasound shows evidence of cirrhosis Extra intestinal findings:
Cirrhosis + − RUQ + −
Peritoneal causes Spontaneous bacterial peritonitis + − Diffuse + in cirrhotic patients ± − − Hypoactive
  • Culture: Positive for single organism
 Ultrasound for evaluation of liver cirrhosis
Hollow Viscous Obstruction Biliary colic − − RUQ + − − − N Increased bilirubin and alkaline phosphatase Ultrasound Nausea & vomiting

Differentials based on weight loss, nausea, vomiting, diarrhea, fatigue and abdominal pain

Pancreatic carcinoma should be differentiated from other diseases presenting with weight loss, 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
  • Predisposes to pancreatic cancer
Pancreatic carcinoma Epigastric − − + + − + + − − − − N

Skin manifestations may include:

Dumping syndrome Lower and then diffuse − − + − − + + − + − − Hyperactive
  • Upper GI series
  • Gastric emptying study

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

To review a comprehensive differential diagnosis of diseases presenting with abdominal pain, click here.

Differentiating Pancreatic Carcinoma on the basis of involved Organ

The differentials for pancreatic cancer mainly involve pathologies of the pancreas, bile duct, duodenum, lymphovascular tissue or metastasis from other sites. It is difficult to differentiate pancreatic cancer from other neoplasms as they all present with non specific constitutional symptoms. Hence, differentiation is primarily based on anatomic location:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]

Origin Disease Diagnostic study of choice
Pancreas
Bile duct
Duodenum
Lymphovascular

tissue

Metastasis

References

  1. ↑ He XK, Ding Y, Sun LM (2017). "Contrast-enhanced endoscopic ultrasound for differential diagnosis of pancreatic cancer: an updated meta-analysis". Oncotarget. 8 (39): 66392–66401. doi:10.18632/oncotarget.18915. PMC 5630421. PMID 29029521.
  2. ↑ Steinman J, Zaheer A, Kluger MD, Remotti H, Hecht EM (2017). "Rare pancreatic tumors". Abdom Radiol (NY). doi:10.1007/s00261-017-1342-x. PMID 29022085.
  3. ↑ Ran L, Zhao W, Zhao Y, Bu H (2017). "Value of contrast-enhanced ultrasound in differential diagnosis of solid lesions of pancreas (SLP): A systematic review and a meta-analysis". Medicine (Baltimore). 96 (28): e7463. doi:10.1097/MD.0000000000007463. PMC 5515757. PMID 28700485.
  4. ↑ Kołodziejczyk E, Wejnarska K, Oracz G (2016). "Autoimmune pancreatitis in the paediatric population - review of the literature and own experience". Dev Period Med. 20 (4): 279–286. PMID 28216481.
  5. ↑ Zhu L, Xue HD, Liu W, Wang X, Sui X, Wang Q, Zhang D, Li P, Jin ZY (2017). "Enhancing pancreatic mass with normal serum CA19-9: key MDCT features to characterize pancreatic neuroendocrine tumours from its mimics". Radiol Med. 122 (5): 337–344. doi:10.1007/s11547-017-0734-x. PMID 28197876.
  6. ↑ Sano I, Katanuma A, Yane K, Kin T, Nagai K, Yamazaki H, Koga H, Kitagawa K, Yokoyama K, Ikarashi S, Takahashi K, Maguchi H, Omori Y, Shinohara T (2017). "Pancreatic Metastasis from Rectal Cancer that was Diagnosed by Endoscopic Ultrasonography-guided Fine Needle Aspiration (EUS-FNA)". Intern. Med. 56 (3): 301–305. doi:10.2169/internalmedicine.56.7213. PMC 5348454. PMID 28154274.
  7. ↑ Salaria SN, Shi C (2016). "Pancreatic Neuroendocrine Tumors". Surg Pathol Clin. 9 (4): 595–617. doi:10.1016/j.path.2016.05.006. PMID 27926362.
  8. ↑ Kawasaki K, Kawaguchi Y, Suzuki Y, Tanaka N (2016). "Renal neuroendocrine tumour and synchronous pancreas metastasis: histopathological diagnosis using prostatic acid phosphatase". BMJ Case Rep. 2016. doi:10.1136/bcr-2016-214759. PMID 27803081.
  9. ↑ Nassour I, Choti MA (2016). "Diagnosis and Treatment of Pancreatic Cystic Neoplasms". JAMA. 316 (12): 1326. doi:10.1001/jama.2016.9130. PMID 27673319.
  10. ↑ Javadi S, Menias CO, Korivi BR, Shaaban AM, Patnana M, Alhalabi K, Elsayes KM (2017). "Pancreatic Calcifications and Calcified Pancreatic Masses: Pattern Recognition Approach on CT". AJR Am J Roentgenol. 209 (1): 77–87. doi:10.2214/AJR.17.17862. PMID 28418702.
  11. ↑ Bergmann F (2016). "[Pancreatic acinar neoplasms : Comparative molecular characterization]". Pathologe (in German). 37 (Suppl 2): 191–195. doi:10.1007/s00292-016-0235-z. PMID 27807633.
  12. ↑ Cheng SK, Chuah KL (2016). "Metastatic Renal Cell Carcinoma to the Pancreas: A Review". Arch. Pathol. Lab. Med. 140 (6): 598–602. doi:10.5858/arpa.2015-0135-RS. PMID 27232353.
  13. ↑ Haage P, Schwartz CA, Scharwächter C (2016). "[Ductal adenocarcinoma and unusual differential diagnosis]". Radiologe (in German). 56 (4): 325–37. doi:10.1007/s00117-016-0090-1. PMID 27000276.
  14. ↑ Scialpi M, Reginelli A, D'Andrea A, Gravante S, Falcone G, Baccari P, Manganaro L, Palumbo B, Cappabianca S (2016). "Pancreatic tumors imaging: An update". Int J Surg. 28 Suppl 1: S142–55. doi:10.1016/j.ijsu.2015.12.053. PMID 26777740.
  15. ↑ Senosiain Lalastra C, Foruny Olcina JR (2015). "[Autoimmune pancreatitis]". Gastroenterol Hepatol (in Spanish; Castilian). 38 (9): 549–55. doi:10.1016/j.gastrohep.2015.01.006. PMID 25799073.
  16. ↑ Barbier L, Delpero JR (2014). "[Pancreatic tumours]". Rev Prat (in French). 64 (9): 1307–12. PMID 25638877.
  17. ↑ Díte P, Uvírová M, Bojková M, Novotný I, Dvorácková J, Kianicka B, Nechutová H, Dovrtelová L, Floreánová K, Martínek A (2014). "Differentiating autoimmune pancreatitis from pancreatic cancer". Minerva Gastroenterol Dietol. 60 (4): 247–53. PMID 25288201.
  18. ↑ Lalwani N, Mannelli L, Ganeshan DM, Shanbhogue AK, Dighe MK, Tiwari HA, Maximin S, Monti S, Ragucci M, Prasad SR (2015). "Uncommon pancreatic tumors and pseudotumors". Abdom Imaging. 40 (1): 167–80. doi:10.1007/s00261-014-0189-7. PMID 25063236.
  19. ↑ Dite P, Nechutova H, Uvirova M, Dvorackova J, Kianicka B, Martinek A (2014). "Autoimmune pancreatitis". Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 158 (1): 17–22. doi:10.5507/bp.2013.094. PMID 24572485.
  20. ↑ Mastoraki A, Tzortzopoulou A, Tsela S, Danias N, Sakorafas G, Smyrniotis V, Arkadopoulos N (2014). "Hereditary pancreatitis: dilemmas in differential diagnosis and therapeutic approach". J Gastrointest Cancer. 45 (1): 22–6. doi:10.1007/s12029-013-9559-6. PMID 24242859.
  21. ↑ Beyer G, Menzel J, Krüger PC, Ribback S, Lerch MM, Mayerle J (2013). "[Autoimmune pancreatitis]". Dtsch. Med. Wochenschr. (in German). 138 (46): 2359–70, quiz 2371–4. doi:10.1055/s-0033-1349475. PMID 24193862.
  22. ↑ Al-Hawary MM, Kaza RK, Azar SF, Ruma JA, Francis IR (2013). "Mimics of pancreatic ductal adenocarcinoma". Cancer Imaging. 13 (3): 342–9. doi:10.1102/1470-7330.2013.9012. PMC 3800430. PMID 24060833.
  23. ↑ Bednar F, Scheiman JM, McKenna BJ, Simeone DM (2013). "Breast cancer metastases to the pancreas". J. Gastrointest. Surg. 17 (10): 1826–31. doi:10.1007/s11605-013-2291-5. PMID 23918083.
  24. ↑ DiMagno MJ, DiMagno EP (2013). "Chronic pancreatitis". Curr. Opin. Gastroenterol. 29 (5): 531–6. doi:10.1097/MOG.0b013e3283639370. PMC 4387887. PMID 23852141.
  25. ↑ Berger AW, Seufferlein T, Kleger A (2017). "[Cystic pancreatic tumors: diagnostics and new biomarkers]". Chirurg (in German). 88 (11): 905–912. doi:10.1007/s00104-017-0493-1. PMID 28831506.
  26. ↑ Nougaret S, Mannelli L, Pierredon MA, Schembri V, Guiu B (2016). "Cystic pancreatic lesions: From increased diagnosis rate to new dilemmas". Diagn Interv Imaging. 97 (12): 1275–1285. doi:10.1016/j.diii.2016.08.017. PMID 27840080.
  27. ↑ Xu MM, Yin S, Siddiqui AA, Salem RR, Schrope B, Sethi A, Poneros JM, Gress FG, Genkinger JM, Do C, Brooks CA, Chabot JA, Kluger MD, Kowalski T, Loren DE, Aslanian H, Farrell JJ, Gonda TA (2017). "Comparison of the diagnostic accuracy of three current guidelines for the evaluation of asymptomatic pancreatic cystic neoplasms". Medicine (Baltimore). 96 (35): e7900. doi:10.1097/MD.0000000000007900. PMC 5585501. PMID 28858107.
  28. ↑ Dong J, Cong L, Zhang TP, Zhao YP (2016). "Pancreatic metastasis of renal cell carcinoma". HBPD INT. 15 (1): 30–8. PMID 26818541.

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