Pancreatite crônica
Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- dor abdominal
- esteatorreia
- icterícia
Other diagnostic factors
- perda de peso e desnutrição
- diabetes mellitus/intolerância à glicose
- náuseas e vômitos
- distensão abdominal e/ou flatulência excessiva
- nódulos cutâneos
- dor nas articulações
- fratura por baixo impacto
- distensão abdominal
- dispneia
Risk factors
- bebidas alcoólicas
- tabagismo
- história familiar
- doença celíaca
- psoríase
- dieta com alto teor de gordura e proteína
- geografia tropical
Diagnostic investigations
1st investigations to order
- tomografia computadorizada (TC) ou ressonância nuclear magnética (RNM)
- ultrassonografia endoscópica (USE)
- colangiopancreatografia por ressonância magnética com contraste de secretina (CPRM-s)
Investigations to consider
- exame histológico
- teste genético
- teste indireto da função pancreática (elastase-1 fecal)
- gordura fecal
- esteatócrito
- testes diretos da função pancreática
- níveis de IgG4
- tentativa terapêutica com corticosteroides
Treatment algorithm
dor aguda episódica intermitente
controle da dor persistente
Contributors
Authors
Matthew J. DiMagno, MD
Professor of Internal Medicine
Division of Gastroenterology and Hepatology
University of Michigan School of Medicine
Ann Arbor
MI
Disclosures
MJD sits on committees, advisory boards, and/or editorial boards for the National Pancreas Foundation Michigan Chapter, Faculty of 1000 Research, Pancreatology, the Pancreapedia, and Pancreas. MJD has been a speaker for AGA Invited Speaker Symposium and NPF and Michigan Medicine 7th Annual Patient and Family Centered Care for Pancreatic Diseases.
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 consulted for GSK and Atmo Biosciences.
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Dominguez-Munoz JE, Drewes AM, Lindkvist B, et al. Recommendations from the United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis. Pancreatology. 2018 Dec;18(8):847-54. Abstract
Whitcomb DC, Buchner AM, Forsmark CE. AGA clinical practice update on the epidemiology, evaluation, and management of exocrine pancreatic insufficiency: expert review. Gastroenterology. 2023 Nov;165(5):1292-301.Full text Abstract
Gardner TB, Adler DG, Forsmark CE, et al. ACG clinical guideline: chronic pancreatitis. Am J Gastroenterol. 2020 Mar;115(3):322-39. Abstract
ASGE Standards of Practice Committee, Sheth SG, Machicado JD, et al. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of chronic pancreatitis: summary and recommendations. Gastrointest Endosc. 2024 Oct;100(4):584-94.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Câncer de pâncreas
- Pancreatite aguda
- Cólica biliar
More DifferentialsGuidelines
- American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of chronic pancreatitis
- Chronic pancreatitis
More GuidelinesPatient information
Câncer de pâncreas
Pancreatite crônica
More Patient informationVideos
Venopunção e flebotomia – Vídeo de demonstração
More videos
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer