Chronic pancreatitis: Difference between revisions
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==Clinical Features<ref>Braganza, J. M., Lee, S. H., McCloy, R. F., & McMahon, M. J. (2011). Chronic pancreatitis. Lancet, 377(9772), 1184–1197. doi:10.1016/S0140-6736(10)61852-1</ref> | ==Clinical Features<ref>Braganza, J. M., Lee, S. H., McCloy, R. F., & McMahon, M. J. (2011). Chronic pancreatitis. Lancet, 377(9772), 1184–1197. doi:10.1016/S0140-6736(10)61852-1</ref><ref>Steer, M. L., Waxman, I., & Freedman, S. (1995). Chronic pancreatitis. New England Journal of Medicine, 332(22), 1482–1490. doi:10.1056/NEJM199506013322206</ref>== | ||
* Pain | * Pain | ||
** Episodic (1wk) or constant | ** Episodic (1wk) or constant | ||
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* Labs | * Labs | ||
** Lipase: Normal or slightly elevated | ** Lipase: Normal or slightly elevated | ||
** Increased bilirubin, alkaline phosphatase: Associated with compression of intrapancreatic bile duct (10-15%) | ** Increased [[Hyperbilirubinemia|bilirubin]], alkaline phosphatase: Associated with compression of intrapancreatic bile duct (10-15%) | ||
** Pancreatic function tests: Secretin stimulation | ** Pancreatic function tests: Secretin stimulation | ||
** Gamma-globulin IgG elevation (IgG4) in autoimmune | ** Gamma-globulin IgG elevation (IgG4) in autoimmune | ||
* Imaging<ref>Choueiri, N. E., Balci, N. C., Alkaade, S., & Burton, F. R. (2010). Advanced imaging of chronic pancreatitis. Current gastroenterology reports, 12(2), 114–120. doi:10.1007/s11894-010-0093-4</ref> | * Imaging<ref>Choueiri, N. E., Balci, N. C., Alkaade, S., & Burton, F. R. (2010). Advanced imaging of chronic pancreatitis. Current gastroenterology reports, 12(2), 114–120. doi:10.1007/s11894-010-0093-4</ref><ref>Remer, E. M., & Baker, M. E. (2002). Imaging of chronic pancreatitis. Radiologic clinics of North America, 40(6), 1229–42– v.</ref> | ||
** Plain film: pancreatic calcifications (30%) | ** [[Abd xray|Plain film]]: pancreatic calcifications (30%) | ||
** CT: intraductal calcifications (insensitive for early disease) | ** CT: intraductal calcifications (insensitive for early disease) | ||
** ERCP: gold standard | ** ERCP: gold standard | ||
Revision as of 16:38, 11 June 2016
Clinical Features[1][2]
- Pain
- Episodic (1wk) or constant
- Epigastric, radiating to back and left infrascapular region
- Associated with nausea/vomiting
- Improved with sitting up or leaning forward
- Steatorrhea/DM
- Late finding
- Requires >80-90% loss of exocrine and endocrine function
- Erythema ab igne
- Hyperpigmentation of upper abdomen
Differential Diagnosis
Epigastric Pain
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- Myocardial Ischemia
- Splenic Infarctionenlargement/rupture/aneurysm
- Pericarditis/Myocarditis
- Aortic dissection
- Hepatitis
- Pyelonephritis
- Pneumonia
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Bowel obstruction
- SMA syndrome
- Pulmonary embolism
- Bezoar
- Ingested foreign body
Diagnosis
- Labs
- Lipase: Normal or slightly elevated
- Increased bilirubin, alkaline phosphatase: Associated with compression of intrapancreatic bile duct (10-15%)
- Pancreatic function tests: Secretin stimulation
- Gamma-globulin IgG elevation (IgG4) in autoimmune
- Imaging[3][4]
- Plain film: pancreatic calcifications (30%)
- CT: intraductal calcifications (insensitive for early disease)
- ERCP: gold standard
See Also
Pancreatitis Pancreatitis Guidelines
References
- ↑ Braganza, J. M., Lee, S. H., McCloy, R. F., & McMahon, M. J. (2011). Chronic pancreatitis. Lancet, 377(9772), 1184–1197. doi:10.1016/S0140-6736(10)61852-1
- ↑ Steer, M. L., Waxman, I., & Freedman, S. (1995). Chronic pancreatitis. New England Journal of Medicine, 332(22), 1482–1490. doi:10.1056/NEJM199506013322206
- ↑ Choueiri, N. E., Balci, N. C., Alkaade, S., & Burton, F. R. (2010). Advanced imaging of chronic pancreatitis. Current gastroenterology reports, 12(2), 114–120. doi:10.1007/s11894-010-0093-4
- ↑ Remer, E. M., & Baker, M. E. (2002). Imaging of chronic pancreatitis. Radiologic clinics of North America, 40(6), 1229–42– v.