Last reviewed: 2 Nov 2021
Last updated: 01 Apr 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • abdominal pain
  • steatorrhoea
  • jaundice

Other diagnostic factors

  • weight loss and malnutrition
  • diabetes mellitus/glucose intolerance
  • nausea and vomiting
  • skin nodules
  • painful joints
  • low-trauma fracture
  • abdominal distension
  • shortness of breath

Risk factors

  • alcohol
  • smoking
  • family history
  • coeliac disease
  • psoriasis
  • high-fat, high-protein diet
  • tropical geography

Diagnostic investigations

1st investigations to order

  • computed tomography (CT) or magnetic resonance imaging (MRI)
  • endoscopic ultrasonography (EUS)
  • secretin-enhanced magnetic resonance cholangiopancreatography (s-MRCP)

Investigations to consider

  • histological examination
  • genetic testing
  • indirect pancreatic function test (faecal elastase-1)
  • faecal fat
  • steatocrit
  • direct pancreatic function tests
  • IgG4 levels
  • therapeutic trial of corticosteroids

Treatment algorithm

Contributors

Authors

Matthew J. DiMagno, MD

Associate Professor of Internal Medicine

Division of Gastroenterology and Hepatology

University of Michigan School of Medicine

Ann Arbor

MI

Disclosures

MJD receives grant support from National Institutes of Health. MJD has received honoraria and/or royalties from Oakstone Publishing and William M. Steinberg Board Review in Gastroenterology and Best Practices Course for publications and presentations related to pancreatic disorders. He has consulted for AbbVie. MJD sits on committees, advisory boards, and/or editorial boards for the AGA Institute, National Pancreas Foundation Michigan Chapter, Faculty of 1000 Research, Pancreatology, the Pancreapedia, and Pancreas.

Erik-Jan Wamsteker, MD

Associate Professor of Internal Medicine

Division of Gastroenterology and Hepatology

University of Michigan School of Medicine

Ann Arbor

MI

Disclosures

EJW declares that he has no competing interests.

Allen Lee, MD

Assistant Professor of Internal Medicine

Division of Gastroenterology and Hepatology

University of Vermont College of Medicine

Burlington

VT

Disclosures

AL has received grant funding from the National Institutes of Health.

Peer reviewers

Christopher Forsmark, MD

Professor of Medicine

Chief

Division of Gastroenterology, Hepatology, and Nutrition

University of Florida

Gainesville

FL

Disclosures

CF is an author of a number of references cited in this topic.

Jakob R. Izbicki, MD, FACS

Chairman, Surgeon in Chief

Department of General, Visceral and Thoracic Surgery

University Hospital Hamburg-Eppendorf

Hamburg

Germany

Disclosures

JRI declares that he has no competing interests.

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