Pancreatic fistula differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Pancreatic_fistula}}
{{Pancreatic_fistula}}
==[[Overview]]==
{{CMG}}; {{AE}} {{Zamani}}
 
==Overview==
 
Differential diagnosis of [[pancreatic]] [[fistula]] may include [[chronic liver disease]], [[Renal failure, chronic|renal failure,]] [[heart failure]], [[malignancy]], [[pleural effusion]], [[pancreatitis]], [[retroperitoneal bleeding]] and [[bowel ischemia]].
Differential diagnosis of [[pancreatic]] [[fistula]] may include [[chronic liver disease]], [[Renal failure, chronic|renal failure,]] [[heart failure]], [[malignancy]], [[pleural effusion]], [[pancreatitis]], [[retroperitoneal bleeding]] and [[bowel ischemia]].
==[[Differentiating Pancreatic fistula from other Diseases]]==
==Differentiating Pancreatic fistula from other Diseases==
[[Differential diagnosis]] of a [[pancreatic]] [[fistula]] may include evaluation for:<ref name="pmid25893120">{{cite journal| author=Cochrane J, Schlepp G| title=Acute on chronic pancreatitis causing a highway to the colon with subsequent road closure: pancreatic colonic fistula presenting as a large bowel obstruction treated with pancreatic duct stenting. | journal=Case Rep Gastrointest Med | year= 2015 | volume= 2015 | issue=  | pages= 794282 | pmid=25893120 | doi=10.1155/2015/794282 | pmc=4381724 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25893120  }} </ref>
[[Differential diagnosis]] of a [[pancreatic]] [[fistula]] may include evaluation for:<ref name="pmid25893120">{{cite journal| author=Cochrane J, Schlepp G| title=Acute on chronic pancreatitis causing a highway to the colon with subsequent road closure: pancreatic colonic fistula presenting as a large bowel obstruction treated with pancreatic duct stenting. | journal=Case Rep Gastrointest Med | year= 2015 | volume= 2015 | issue=  | pages= 794282 | pmid=25893120 | doi=10.1155/2015/794282 | pmc=4381724 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25893120  }} </ref><ref name="pmid17898101">{{cite journal| author=Meyer TW, Hostetter TH| title=Uremia. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 13 | pages= 1316-25 | pmid=17898101 | doi=10.1056/NEJMra071313 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17898101  }}</ref><ref name="Hunt">Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid15123522">{{cite journal| author=Dokainish H, Zoghbi WA, Lakkis NM, Al-Bakshy F, Dhir M, Quinones MA et al.| title=Optimal noninvasive assessment of left ventricular filling pressures: a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters. | journal=Circulation | year= 2004 | volume= 109 | issue= 20 | pages= 2432-9 | pmid=15123522 | doi=10.1161/01.CIR.0000127882.58426.7A | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15123522  }}</ref><ref name="pmid21478382">{{cite journal| author=Kelder JC, Cowie MR, McDonagh TA, Hardman SM, Grobbee DE, Cost B et al.| title=Quantifying the added value of BNP in suspected heart failure in general practice: an individual patient data meta-analysis. | journal=Heart | year= 2011 | volume= 97 | issue= 12 | pages= 959-63 | pmid=21478382 | doi=10.1136/hrt.2010.220426 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21478382  }}</ref><ref name="pmid15110205">{{cite journal| author=Dokainish H, Zoghbi WA, Lakkis NM, Quinones MA, Nagueh SF| title=Comparative accuracy of B-type natriuretic peptide and tissue Doppler echocardiography in the diagnosis of congestive heart failure. | journal=Am J Cardiol | year= 2004 | volume= 93 | issue= 9 | pages= 1130-5 | pmid=15110205 | doi=10.1016/j.amjcard.2004.01.042 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15110205  }}</ref><ref name="pmid12798574">{{cite journal| author=Maisel AS, McCord J, Nowak RM, Hollander JE, Wu AH, Duc P et al.| title=Bedside B-Type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly Multinational Study. | journal=J Am Coll Cardiol | year= 2003 | volume= 41 | issue= 11 | pages= 2010-7 | pmid=12798574 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12798574  }}</ref><ref name="pmid18290826">{{cite journal |author=Ewald B, Ewald D, Thakkinstian A, Attia J |title=Meta-analysis of B type natriuretic peptide and N-terminal pro B natriuretic peptide in the diagnosis of clinical heart failure and population screening for left ventricular systolic dysfunction |journal=Intern Med J |volume=38 |issue=2 |pages=101–13 |year=2008 |pmid=18290826 |doi=10.1111/j.1445-5994.2007.01454.x |url=http://www.blackwell-synergy.com/doi/abs/10.1111/j.1445-5994.2007.01454.x}}</ref><ref name="pmid9106577">{{cite journal| author=Heffner JE, Brown LK, Barbieri CA| title=Diagnostic value of tests that discriminate between exudative and transudative pleural effusions. Primary Study Investigators. | journal=Chest | year= 1997 | volume= 111 | issue= 4 | pages= 970-80 | pmid=9106577 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9106577  }}</ref><ref name="pmid16626953">{{cite journal| author=Porcel JM, Peña JM, Vicente de Vera C, Esquerda A, Vives M, Light RW| title=Bayesian analysis using continuous likelihood ratios for identifying pleural exudates. | journal=Respir Med | year= 2006 | volume= 100 | issue= 11 | pages= 1960-5 | pmid=16626953 | doi=10.1016/j.rmed.2006.02.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16626953  }}</ref>
#[[Chronic liver disease]] leading to [[abdominal]] [[ascites]]
#[[Renal failure]]
#[[Heart failure]]
#[[Malignancy]]
#Conditions leading to [[pleural effusion]] such as [[malignancy]], [[trauma]] and [[infections]]
#[[Pancreatitis]]
#[[Retroperitoneal bleeding]]
#[[Bowel ischemia]]


{| style="border: 2px solid #4479BA; align="left"
{| class="wikitable"
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|200px}}
|+
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|300px}}
!Diseases
! style="width: 400px; background: #4479BA;" | {{fontcolor|#FFF|400px}}
!'''Symptoms'''
!Physical examination
!Lab Findings
|-
|[[Chronic liver disease]]
|
*[[Jaundice]]
*[[Ascites]]
*[[Pruritus]]
|
*[[Spider angiomas]]
*[[Palmar erythema]]
*[[Yellow skin]]
|
*Prolonged [[Prothrombin time (PT)|prothrombin time]] (INR>1.5)
*Elevated [[aminotransferase]] level
*Elevated [[bilirubin]] level
*low [[platelet]] count
|-
|[[Renal failure]]
|
*[[Abdominal]] distention ([[serositis]])
*[[Bleeding]] tendency
*Unintentional weight loss
*Decreased mental acquity
|
*[[Uremia|Uremic]] fetor (foul smell)
*[[Bruises]]
*[[Pericardial friction rub]] ([[Uremic pericarditis|uremic]] [[pericarditis]])
|
*[[Albuminuria]]
*[[Hematuria]]
*[[Pyuria]]
*[[Metabolic acidosis]]
|-
|[[Heart failure]]
|
*Ankle [[edema]] or swelling of the feet and legs
*[[Dyspnea]] on ordinary exertion or greater [[shortness of breath]] with usual activities
*[[Confusion]] and [[altered mentation]]
*[[Syncope]]
|
*[[Pleural effusion]] with dullness to [[percussion]] at the bases
*[[Jugular vein distention]]
*[[Third heart sound]] (S3) and a gallop rhythm
|
*[[Electrolyte disturbances]] such as [[hyponatremia]], [[hypokalemia]], [[hyperkalemia]] and [[hypomagnesemia]]
*[[Anemia]]
*Raised [[natriuretic peptides]] such as [[BNP]] or [[NT-proBNP]]
|-
|[[Pancreatitis]]
|
*[[Nausea]] and/or [[vomiting]]
*[[Weight loss]]
*[[Jaundice]]
*Pancreatic [[ascites]]
|
*[[Jaundice]]
*[[Pallor]]
*[[Bruises]]
|
*72-hour quantitative [[fecal]] [[fat]]
*Fecal [[elastase]] measurement
*[[Pancreatic]] function tests
|-
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | The width of this column is 200px
|[[Retroperitoneal bleeding]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | The width of this column is 300px
|
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | The width of this column is 400px
*[[Tachycardia]] and [[hypotension]]
*[[Abdominal pain]]
*Intense flank pain or [[back pain]]
|
*[[Grey Turner's sign|Grey-Turner's sign]] with bulging flanks
*[[Pallor]]
|
*[[Anemia]]
|-
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | The width of this column is 200px
|[[Bowel ischemia]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | The width of this column is 300px
|
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | The width of this column is 400px
*[[Abdominal pain|Abdominal Pain]]
*[[Vomiting]]
*[[Diarrhea]]
*[[Constipation]]
*Blood per [[rectum]]
*[[Abdominal distension|Abdominal distention]]
|
*[[Abdominal distension|Abdominal distention]]
*Generalized [[Abdominal tenderness]]
*[[Rebound tenderness]]
*[[Guarding]] may be present
|
*[[Leukocytosis]]
*[[Hyperphosphatemia]]
*[[Hyperkalemia]]
*[[High anion gap metabolic acidosis]]
|-
|-
|[[pleural effusion]]
|
*[[Chest pain]], usually a sharp pain that is worse with cough or deep breaths
*[[Cough]]
*[[Rapid breathing]]
*[[Shortness of breath]]
*[[Orthopnea]]
|
*Asymmetric chest expansion
*Diminished [[fremitus]], dullness on [[percussion]]
*Decreased or absent [[breath sounds]]
*Reduced vocal resonance
|
*Appearance of fluid: milky, bloody, or clear
*Culture
*Cytology
*[[Antinuclear antibody]] ([[ANA]]) >1 (systemic lupus erythematosus)
*[[Amylase]] and severe [[acidosis]] ([[esophageal rupture]])
*[[Triglycerides]] (>110mg/dL = chylothorax)
*[[Hematocrit]] (pleural fluid to blood >0.5)
*[[Glucose]] 300 to 400 ([[peritoneal dialysis]])
|}
|}


Latest revision as of 14:57, 28 April 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zarlakhta Zamani, M.B.B.S[zamanizarlashta@yahoo.com]

Overview

Differential diagnosis of pancreatic fistula may include chronic liver disease, renal failure, heart failure, malignancy, pleural effusion, pancreatitis, retroperitoneal bleeding and bowel ischemia.

Differentiating Pancreatic fistula from other Diseases

Differential diagnosis of a pancreatic fistula may include evaluation for:[1][2][3][4][5][6][7][8][9][10]

Diseases Symptoms Physical examination Lab Findings
Chronic liver disease
Renal failure
Heart failure
Pancreatitis
Retroperitoneal bleeding
Bowel ischemia
pleural effusion

References

  1. ↑ Cochrane J, Schlepp G (2015). "Acute on chronic pancreatitis causing a highway to the colon with subsequent road closure: pancreatic colonic fistula presenting as a large bowel obstruction treated with pancreatic duct stenting". Case Rep Gastrointest Med. 2015: 794282. doi:10.1155/2015/794282. PMC 4381724. PMID 25893120.
  2. ↑ Meyer TW, Hostetter TH (2007). "Uremia". N Engl J Med. 357 (13): 1316–25. doi:10.1056/NEJMra071313. PMID 17898101.
  3. ↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
  4. ↑ Dokainish H, Zoghbi WA, Lakkis NM, Al-Bakshy F, Dhir M, Quinones MA; et al. (2004). "Optimal noninvasive assessment of left ventricular filling pressures: a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters". Circulation. 109 (20): 2432–9. doi:10.1161/01.CIR.0000127882.58426.7A. PMID 15123522.
  5. ↑ Kelder JC, Cowie MR, McDonagh TA, Hardman SM, Grobbee DE, Cost B; et al. (2011). "Quantifying the added value of BNP in suspected heart failure in general practice: an individual patient data meta-analysis". Heart. 97 (12): 959–63. doi:10.1136/hrt.2010.220426. PMID 21478382.
  6. ↑ Dokainish H, Zoghbi WA, Lakkis NM, Quinones MA, Nagueh SF (2004). "Comparative accuracy of B-type natriuretic peptide and tissue Doppler echocardiography in the diagnosis of congestive heart failure". Am J Cardiol. 93 (9): 1130–5. doi:10.1016/j.amjcard.2004.01.042. PMID 15110205.
  7. ↑ Maisel AS, McCord J, Nowak RM, Hollander JE, Wu AH, Duc P; et al. (2003). "Bedside B-Type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly Multinational Study". J Am Coll Cardiol. 41 (11): 2010–7. PMID 12798574.
  8. ↑ Ewald B, Ewald D, Thakkinstian A, Attia J (2008). "Meta-analysis of B type natriuretic peptide and N-terminal pro B natriuretic peptide in the diagnosis of clinical heart failure and population screening for left ventricular systolic dysfunction". Intern Med J. 38 (2): 101–13. doi:10.1111/j.1445-5994.2007.01454.x. PMID 18290826.
  9. ↑ Heffner JE, Brown LK, Barbieri CA (1997). "Diagnostic value of tests that discriminate between exudative and transudative pleural effusions. Primary Study Investigators". Chest. 111 (4): 970–80. PMID 9106577.
  10. ↑ Porcel JM, Peña JM, Vicente de Vera C, Esquerda A, Vives M, Light RW (2006). "Bayesian analysis using continuous likelihood ratios for identifying pleural exudates". Respir Med. 100 (11): 1960–5. doi:10.1016/j.rmed.2006.02.025. PMID 16626953.

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