Diagnostic Considerations

Recognizing patients with severe acute pancreatitis as soon as possible is critical for achieving optimal outcomes.

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

Acute peritonitis
Macroamylasemia
Macrolipasemia
Malabsorption syndromes/processes
Perforated viscus

Differential Diagnoses

Workup

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Media Gallery

Acute pancreatitis. Suspected acute pancreatitis. Etiologic factors and forms of acute pancreatitis. Ranson criteria.
Acute pancreatitis. Mild pancreatitis. Favorable prognostic signs for acute pancreatitis. Medical management and studies used for acute pancreatitis.
Acute pancreatitis. Prognostic indicators for severe pancreatitis and intensive care unit management.
Acute pancreatitis. Diagnosis and treatment of necrotizing pancreatitis.
Acute pancreatitis. Treatment of and studies used for pancreatic pseudocysts.
Acute pancreatitis. Idiopathic recurrent pancreatitis. Etiologies for acute pancreatitis.
Acute pancreatitis. Pancreatic abscess. Definition of an abscess.
Acute pancreatitis. A patient with acute gallstone pancreatitis underwent endoscopic retrograde cholangiopancreatography. The cholangiogram showed no stones in the common bile duct and multiple small stones in the gallbladder. The pancreatogram shows narrowing of the pancreatic duct in the area of genu, resulting from extrinsic compression of the ductal system by inflammatory changes in the pancreas.
Acute pancreatitis. This image was obtained from a patient with pancreas divisum associated with minor papilla stenosis causing recurrent pancreatitis. Because pancreas divisum is relatively common in the general population, it is best regarded as a variant of normal anatomy and not necessarily as a cause of pancreatitis. In this case, note the bulbous contour of the duct adjacent to the cannula. This appearance has been termed Santorinicele. Dorsal duct outflow obstruction is a probable cause of pancreatitis when Santorinicele is present, and it is associated with a minor papilla that accommodates only a guide wire.
Acute pancreatitis. A normal-appearing ventral pancreas is seen in a patient with recurrent acute pancreatitis. Dorsal pancreas (not pictured) showed evidence of chronic pancreatitis.
Acute pancreatitis. Endoscopic retrograde cholangiopancreatography excluded suppurative cholangitis and established the presence of anular pancreas divisum. The dorsal pancreatogram showed extravasation into the retroperitoneum, and sphincterotomy was performed on the minor papilla. A pigtail nasopancreatic tube was then inserted into the dorsal duct and out into the retroperitoneal fluid collection. The other end of the tube was attached to bulb suction and monitored every shift.
Acute pancreatitis. Although percutaneous drains remove loculated fluid collections elsewhere in the abdomen, a nasopancreatic tube drains the retroperitoneal fluid collection. One week later, the retroperitoneal fluid collection was much smaller (the image is reversed in a horizontal direction). By this time, the patient was off pressors and was ready to be extubated.
Acute pancreatitis. Recurrent pancreatitis was associated with pancreas divisum in an elderly man. The pancreatogram of the dorsal duct shows distal stenosis with upstream chronic pancreatitis. After the stenosis was dilated and stented, his pain resolved and the patient improved clinically during 1 year of quarterly stent exchanges. Follow-up computed tomography (CT) scans showed resolution of the inflammatory mass. Although ductal biopsies and cytology were repeatedly negative, the patient's pain and pancreatitis returned when the stents were removed. He developed duodenal outflow obstruction and was sent to surgery; during the Whipple procedure, periampullary adenocarcinoma (of minor papilla) was revealed.

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Author

Jeffrey C F Tang, MD Senior Staff Gastroenterologist, Henry Ford Health System

Jeffrey C F Tang, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Medical Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

Johnathon T Markus, MD Fellow, Department of Gastroenterology, Henry Ford Hospital

Johnathon T Markus, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Tushar Patel, MB, ChB Professor of Medicine, Ohio State University Medical Center

Tushar Patel, MB, ChB is a member of the following medical societies: American Association for the Study of Liver Diseases and American Gastroenterological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Noel Williams, MD Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Paul Yakshe, MD Assistant Professor of Medicine, University of Minnesota, Medical Director of Pancreas and Biliary Clinic, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Fairview University Medical Center

Paul Yakshe, MD is a member of the following medical societies: American College of Gastroenterology, American Pancreatic Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acute Pancreatitis Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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