Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- dor abdominal
- esteatorreia
- icterícia
Outros fatores diagnósticos
- 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
Fatores de risco
- bebidas alcoólicas
- tabagismo
- história familiar
- doença celíaca
- psoríase
- dieta com alto teor de gordura e proteína
- geografia tropical
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- tomografia computadorizada (TC) ou ressonância nuclear magnética (RNM)
- ultrassonografia endoscópica (USE)
- colangiopancreatografia por ressonância magnética com contraste de secretina (CPRM-s)
Investigações a serem consideradas
- 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
Algoritmo de tratamento
dor aguda episódica intermitente
controle da dor persistente
Colaboradores
Autores
Matthew J. DiMagno, MD
Professor of Internal Medicine
Division of Gastroenterology and Hepatology
University of Michigan School of Medicine
Ann Arbor
MI
Declarações
MJD has received 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, Chiesi, Nestlé, and Vivus. 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
Declarações
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
Declarações
AL has received grant funding from the National Institutes of Health.
Revisores
Christopher Forsmark, MD
Professor of Medicine
Chief
Division of Gastroenterology, Hepatology, and Nutrition
University of Florida
Gainesville
FL
Declarações
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
Divulgaciones
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.
Referencias
Artículos principales
Sherman S, Freeman ML, Tarnasky PR, et al. Administration of secretin (RG1068) increases the sensitivity of detection of duct abnormalities by magnetic resonance cholangiopancreatography in patients with pancreatitis. Gastroenterology. 2014;147:646-54.e2.Texto completo Resumen
Gurusamy KS, Lusuku C, Davidson BR. Pregabalin for decreasing pancreatic pain in chronic pancreatitis. Cochrane Database Syst Rev. 2016;(2):CD011522.Texto completo Resumen
Ahmed Ali U, Jens S, Busch OR, et al. Antioxidants for pain in chronic pancreatitis. Cochrane Database Syst Rev. 2014 Aug 21;(8):CD008945.Texto completo Resumen
Ahmed Ali U, Pahlplatz JM, Nealon WH, et al. Endoscopic or surgical intervention for painful obstructive chronic pancreatitis. Cochrane Database Syst Rev. 2015 Mar 19;(3):CD007884.Texto completo Resumen
Gurusamy KS, Lusuku C, Halkias C, et al. Duodenum-preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis. Cochrane Database Syst Rev. 2016 Feb 3;(2):CD011521.Texto completo Resumen
Bachmann K, Tomkoetter L, Erbes J, et al. Beger and Frey procedures for treatment of chronic pancreatitis: comparison of outcomes at 16-year follow-up. J Am Coll Surg. 2014 Aug;219(2):208-16. Resumen
Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med. 2007;356:676-84. Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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