Chronic pancreatitis differential diagnosis: Difference between revisions

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Revision as of 14:37, 31 January 2018

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

Overview

Chronic pancreatitis should be differentiated from other diseases presenting with similar symptoms such as abdominal pain, diarrhea and weight loss.

Differentiating Chronic Pancreatitis from Other Diseases

Differentials based upon abdominal pain, weight loss and diarrhea:

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function tests, 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, US= Ultrasound, 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

	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
Disease	Clinical manifestations													Diagnosis		Comments
	Symptoms									Signs				Diagnosis
Chronic pancreatitis	Epigastric	−	−	±	±	−	+	+	−	−	−	−	N	Increased amylase / lipase Increased stool fat content Pancreatic function test	CT scan Calcification Pseudocyst Dilation of main pancreatic duct	Predisposes to pancreatic cancer
Pancreatic carcinoma	Epigastric	−	−	+	+	−	+	+	−	−	−	−	N	↑ Alkaline phosphatase ↑ serum bilirubin ↑ gamma-glutamyl transpeptidase ↑ CA 19-9	MDCT with PET/CT MRI	Skin manifestations may include: Bullous pemphigoid Cicatricial pemphigoid Migratory superficial thrombophlebitis (classic Trousseau's syndrome) Pancreatic panniculitis
Dumping syndrome	Lower and then diffuse	−	−	+	−	−	+	+	−	+	−	−	Hyperactive	Glucose challenge test Hydrogen breath test	Upper GI series Gastric emptying study	Postgastrectomy
Inflammatory bowel disease	Diffuse	±	−	−	±	−	+	+	+	−	−	−	Normal or hyperactive	Anti-neutrophil cytoplasmic antibody (P-ANCA) in Ulcerative colitis Anti saccharomyces cerevisiae antibodies (ASCA) in Crohn's disease	String sign on abdominal x-ray in Crohn's disease	Extra intestinal findings: Uveitis Arthritis
Irritable bowel syndrome	Diffuse	−	−	−	−	±	±	+	−	−	−	−	N	Normal	Normal	Symptomatic treatment High dietary fiber Osmotic laxatives Antispasmodic drugs
Whipple's disease	Diffuse	±	−	−	±	−	+	+	−	±	−	−	N	Thrombocytopenia Hypoalbuminemia Small intestinal biopsy for Tropheryma whipplei	Endoscopy is used to confirm diagnosis. Images used to find complications Chest and joint x-ray CT MRI Echocardiography	Extra intestinal findings: Uveitis Endocarditis Encephalitis Dementia Hepatosplenomegaly Arthritis Ascites
Disease	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	Comments
Tropical sprue	Diffuse	+	−	−	−	−	+	+	−	−	−	−	N	Fat soluble vitamin deficiency Hypoalbuminemia Fecal stool test	Barium studies: Dilation and edema of mucosal folds	Steatorrhea- 10-40 g/day (Normal=5 g/day)
Celiac disease	Diffuse	−	−	−	−	−	+	+	−	−	−	−	Hyperactive	IgA endomysial antibody IgA tissue transglutaminase antibody Anti-gliadin antibody Small bowel biopsy	US: Bull’s eye or target pattern Pseudokidney sign	Gluten allergy
Colon carcinoma	Diffuse/localized	−	−	−	−	±	±	+	+	±	−	−	Normal or hyperactive if obstruction present	CBC Carcinoembryonic antigen (CEA)	Colonoscopy Flexible sigmoidoscopy Barium enema CT colonography	PILLCAM 2: A colon capsule for CRC screening may be used in patients with an incomplete colonoscopy who lacks obstruction
Viral hepatitis	RUQ	+	−	+	+	−	Positive in Hep A and E	+	−	Positive in fulminant hepatitis	Positive in acute	+	N	Abnormal LFTs Viral serology	US	Hep A and E have fecal-oral route of transmission Hep B and C transmits via blood transfusion and sexual contact.
Liver abscess	RUQ	+	+	+	+	−	±	+	−	+	+	±	Normal or hypoactive	CBC Blood cultures Abnormal liver function tests	US CT
Mesenteric ischemia	Periumbilical	Positive if bowel becomes gangrenous	−	+	−	−	+	+	+	Positive if bowel becomes gangrenous	Positive if bowel becomes gangrenous	−	Hyperactive to absent	Leukocytosis and lactic acidosis Amylase levels D-dimer	CT angiography SMA or SMV thrombosis	Also known as abdominal angina that worsens with eating
Acute ischemic colitis	Diffuse	+	±	+	−	−	+	+	+	+	+	+	Hyperactive then absent	Leukocytosis	Abdominal x-ray Distension and pneumatosis CT scan Double halo appearance, thumbprinting Thickening of bowel	May lead to shock

To review the differential diagnosis of Abdominal pain, click here.

References

Template:WikiDoc Sources

@@ Line 4: / Line 4: @@
 ==Overview==
-Chronic pancreatitis needs to be differentiated from other diseases presenting with similar complaints such as abdominal pain, [[diarrhea]] and [[weight loss]].
+Chronic pancreatitis should be differentiated from other diseases presenting with similar [[symptoms]] such as [[abdominal pain]], [[diarrhea]] and [[weight loss]].
 ==Differentiating Chronic Pancreatitis from Other Diseases==
@@ Line 10: / Line 10: @@
 === Differentials based upon abdominal pain, weight loss and diarrhea: ===
 <span style="font-size:85%">'''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]]
+'''[[RUQ]]'''= Right upper quadrant of the abdomen, '''LUQ'''= Left upper quadrant, '''LLQ'''= Left lower quadrant, '''RLQ'''= Right lower quadrant, '''LFT'''= [[Liver function tests]], '''SIRS'''= [[Systemic inflammatory response syndrome]], '''[[ERCP]]'''= [[Endoscopic retrograde cholangiopancreatography]], '''IV'''= [[Intravenous]], '''N'''= Normal, '''AMA'''= Anti mitochondrial antibodies, '''[[LDH]]'''= [[Lactate dehydrogenase]], '''GI'''= [[Gastrointestinal tract|Gastrointestinal]], '''CXR'''= [[Chest X-ray|Chest X ray]], '''US'''= Ultrasound, '''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]]
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