Pancreatic fistula differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zarlakhta Zamani, M.B.B.S[zamanizarlashta@yahoo.com]

Overview

Differential diagnosis of pancreatic fistula may include chronic liver disease, renal failure, heart failure, malignancy, pleural effusion, pancreatitis, retroperitoneal bleeding and bowel ischemia.

Differentiating Pancreatic fistula from other Diseases

Differential diagnosis of a pancreatic fistula may include evaluation for:^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]


Diseases	Symptoms	Physical examination	Lab Findings
Chronic liver disease	Jaundice Ascites Pruritus	Spider angiomas Palmar erythema Yellow skin	Prolonged prothrombin time (INR>1.5) Elevated aminotransferase level Elevated bilirubin level low platelet count
Renal failure	Abdominal distention (serositis) Bleeding tendency Unintentional weight loss Decreased mental acquity	Uremic fetor (foul smell) Bruises Pericardial friction rub (uremic pericarditis)	Albuminuria Hematuria Pyuria Metabolic acidosis
Heart failure	Ankle edema or swelling of the feet and legs Dyspnea on ordinary exertion or greater shortness of breath with usual activities Confusion and altered mentation Syncope	Pleural effusion with dullness to percussion at the bases Jugular vein distention Third heart sound (S3) and a gallop rhythm	Electrolyte disturbances such as hyponatremia, hypokalemia, hyperkalemia and hypomagnesemia Anemia Raised natriuretic peptides such as BNP or NT-proBNP
Pancreatitis	Nausea and/or vomiting Weight loss Jaundice Pancreatic ascites	Jaundice Pallor Bruises	72-hour quantitative fecal fat Fecal elastase measurement Pancreatic function tests
Retroperitoneal bleeding	Tachycardia and hypotension Abdominal pain Intense flank pain or back pain	Grey-Turner's sign with bulging flanks Pallor	Anemia
Bowel ischemia	Abdominal Pain Vomiting Diarrhea Constipation Blood per rectum Abdominal distention	Abdominal distention Generalized Abdominal tenderness Rebound tenderness Guarding may be present	Leukocytosis Hyperphosphatemia Hyperkalemia High anion gap metabolic acidosis
pleural effusion	Chest pain, usually a sharp pain that is worse with cough or deep breaths Cough Rapid breathing Shortness of breath Orthopnea	Asymmetric chest expansion Diminished fremitus, dullness on percussion Decreased or absent breath sounds Reduced vocal resonance	Appearance of fluid: milky, bloody, or clear Culture Cytology Antinuclear antibody (ANA) >1 (systemic lupus erythematosus) Amylase and severe acidosis (esophageal rupture) Triglycerides (>110mg/dL = chylothorax) Hematocrit (pleural fluid to blood >0.5) Glucose 300 to 400 (peritoneal dialysis)

References

↑ Cochrane J, Schlepp G (2015). "Acute on chronic pancreatitis causing a highway to the colon with subsequent road closure: pancreatic colonic fistula presenting as a large bowel obstruction treated with pancreatic duct stenting". Case Rep Gastrointest Med. 2015: 794282. doi:10.1155/2015/794282. PMC 4381724. PMID 25893120.
↑ Meyer TW, Hostetter TH (2007). "Uremia". N Engl J Med. 357 (13): 1316–25. doi:10.1056/NEJMra071313. PMID 17898101.
↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
↑ Dokainish H, Zoghbi WA, Lakkis NM, Al-Bakshy F, Dhir M, Quinones MA; et al. (2004). "Optimal noninvasive assessment of left ventricular filling pressures: a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters". Circulation. 109 (20): 2432–9. doi:10.1161/01.CIR.0000127882.58426.7A. PMID 15123522.
↑ Kelder JC, Cowie MR, McDonagh TA, Hardman SM, Grobbee DE, Cost B; et al. (2011). "Quantifying the added value of BNP in suspected heart failure in general practice: an individual patient data meta-analysis". Heart. 97 (12): 959–63. doi:10.1136/hrt.2010.220426. PMID 21478382.
↑ Dokainish H, Zoghbi WA, Lakkis NM, Quinones MA, Nagueh SF (2004). "Comparative accuracy of B-type natriuretic peptide and tissue Doppler echocardiography in the diagnosis of congestive heart failure". Am J Cardiol. 93 (9): 1130–5. doi:10.1016/j.amjcard.2004.01.042. PMID 15110205.
↑ Maisel AS, McCord J, Nowak RM, Hollander JE, Wu AH, Duc P; et al. (2003). "Bedside B-Type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly Multinational Study". J Am Coll Cardiol. 41 (11): 2010–7. PMID 12798574.
↑ Ewald B, Ewald D, Thakkinstian A, Attia J (2008). "Meta-analysis of B type natriuretic peptide and N-terminal pro B natriuretic peptide in the diagnosis of clinical heart failure and population screening for left ventricular systolic dysfunction". Intern Med J. 38 (2): 101–13. doi:10.1111/j.1445-5994.2007.01454.x. PMID 18290826.
↑ Heffner JE, Brown LK, Barbieri CA (1997). "Diagnostic value of tests that discriminate between exudative and transudative pleural effusions. Primary Study Investigators". Chest. 111 (4): 970–80. PMID 9106577.
↑ Porcel JM, Peña JM, Vicente de Vera C, Esquerda A, Vives M, Light RW (2006). "Bayesian analysis using continuous likelihood ratios for identifying pleural exudates". Respir Med. 100 (11): 1960–5. doi:10.1016/j.rmed.2006.02.025. PMID 16626953.

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[pmid25893120-1] Cochrane J, Schlepp G (2015). "Acute on chronic pancreatitis causing a highway to the colon with subsequent road closure: pancreatic colonic fistula presenting as a large bowel obstruction treated with pancreatic duct stenting". Case Rep Gastrointest Med. 2015: 794282. doi:10.1155/2015/794282. PMC 4381724. PMID 25893120.

[pmid17898101-2] Meyer TW, Hostetter TH (2007). "Uremia". N Engl J Med. 357 (13): 1316–25. doi:10.1056/NEJMra071313. PMID 17898101.

[Hunt-3] Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202

[pmid15123522-4] Dokainish H, Zoghbi WA, Lakkis NM, Al-Bakshy F, Dhir M, Quinones MA; et al. (2004). "Optimal noninvasive assessment of left ventricular filling pressures: a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters". Circulation. 109 (20): 2432–9. doi:10.1161/01.CIR.0000127882.58426.7A. PMID 15123522.

[pmid21478382-5] Kelder JC, Cowie MR, McDonagh TA, Hardman SM, Grobbee DE, Cost B; et al. (2011). "Quantifying the added value of BNP in suspected heart failure in general practice: an individual patient data meta-analysis". Heart. 97 (12): 959–63. doi:10.1136/hrt.2010.220426. PMID 21478382.

[pmid15110205-6] Dokainish H, Zoghbi WA, Lakkis NM, Quinones MA, Nagueh SF (2004). "Comparative accuracy of B-type natriuretic peptide and tissue Doppler echocardiography in the diagnosis of congestive heart failure". Am J Cardiol. 93 (9): 1130–5. doi:10.1016/j.amjcard.2004.01.042. PMID 15110205.

[pmid12798574-7] Maisel AS, McCord J, Nowak RM, Hollander JE, Wu AH, Duc P; et al. (2003). "Bedside B-Type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly Multinational Study". J Am Coll Cardiol. 41 (11): 2010–7. PMID 12798574.

[pmid18290826-8] Ewald B, Ewald D, Thakkinstian A, Attia J (2008). "Meta-analysis of B type natriuretic peptide and N-terminal pro B natriuretic peptide in the diagnosis of clinical heart failure and population screening for left ventricular systolic dysfunction". Intern Med J. 38 (2): 101–13. doi:10.1111/j.1445-5994.2007.01454.x. PMID 18290826.

[pmid9106577-9] Heffner JE, Brown LK, Barbieri CA (1997). "Diagnostic value of tests that discriminate between exudative and transudative pleural effusions. Primary Study Investigators". Chest. 111 (4): 970–80. PMID 9106577.

[pmid16626953-10] Porcel JM, Peña JM, Vicente de Vera C, Esquerda A, Vives M, Light RW (2006). "Bayesian analysis using continuous likelihood ratios for identifying pleural exudates". Respir Med. 100 (11): 1960–5. doi:10.1016/j.rmed.2006.02.025. PMID 16626953.

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Pancreatic fistula differential diagnosis

Overview

Differentiating Pancreatic fistula from other Diseases

References

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