DIAGNOSIS CHECKLIST
for Pancreas symptoms

Why: to determine if acute or chronic.

Why: The pancreas has two main functions: the exocrine half helps digestion by producing digestive enzymes, and the endocrine half produces insulin and other hormones for the processing of glucose in the blood. Damage to the digestive side of the pancreas can cause various digestive symptoms and be caused by several types of pancreas damage or disease. Failure of the endocrine pancreas interferes with glucose tolerance and leads to conditions such as diabetes.

Why: e.g. Type 1 diabetes patients are usually younger and lean, Type 2 diabetes patients are usually older and overweight. Most people with cancer of the pancreas are over 60 years of age. Cystic fibrosis presents in childhood.

Why: may suggest gestational diabetes.

Why: e.g. previous impaired glucose tolerance or impaired fasting glycemia test; Aboriginal and Torres strait Islanders aged 35 years and over; certain high risk non- English speaking background groups aged 35 years and over (such as Pacific Islanders, Indian subcontinent, Chinese); people aged 45 years and over who have one of more of the following risk factors including obesity with BMI of greater or equal to 30, high blood pressure or first degree relative with Type 2 diabetes; previous heart attack, angina or stroke; previous gestational diabetes; obese women with polycystic ovarian syndrome.

Why: e.g. Conditions which may cause secondary diabetes mellitus include polycystic ovarian syndrome, cirrhosis, cystic fibrosis, chronic pancreatitis, hemochromatosis, pancreatic cancer, Cushing's syndrome, Acromegaly, thyrotoxicosis, phaeochromocytoma, Friedreich's ataxia and myotonic dystrophy; Acute pancreatitis may be caused by chronic alcohol abuse, gallstones, mumps, pancreatic tumors or elevated blood lipids; Chronic pancreatitis is usually caused by chronic alcohol abuse but other causes include elevated calcium in the blood and trauma to the pancreas.

Why: e.g. pancreatectomy (removal of the pancreas) may cause secondary diabetes; Endoscopic retrograde cholangiopancreatography (ERCP) may cause acute pancreatitis.

Why: some medications may cause elevated blood sugars such as thiazide diuretics, corticosteroids, estrogens, beta agonist medications; some medications may cause acute pancreatitis including azathioprine, estrogens and corticosteroids.

Why: alcohol has many effects on the body, especially if you have diabetes e.g. increases the risk of hypoglycemia, makes diabetic control more difficult, increases weight, worsens peripheral neuropathy, worsen diabetic eye disease, increases blood pressure and blood triglycerides; Chronic alcohol abuse increases risk of acute pancreatitis and chronic pancreatitis; Chronic pancreatitis is a cause of diabetes mellitus.

Why: e.g. type 1 or 2 diabetes mellitus, hemochromatosis, cystic fibrosis, chronic pancreatitis.

Why: Type 2 Diabetes is often associated with truncal obesity. Cushing's syndrome is also associated with truncal obesity.

Why: may suggest acute pancreatitis.

Why: may suggest acute or chronic pancreatitis, cancer of the pancreas or Zollinger-Ellison syndrome.

Why: Diabetes, particularly Type 2 diabetes is the most common cause of elevated blood sugars and diabetes-like symptoms e.g. frequency of urination, excessive thirst, weight loss (especially in Type 1 Diabetes mellitus), tiredness, fatigue, increased infections especially of the skin and genitals, blurry vision.

Why: e.g. staphylococcal skin infections, tingling or numbness of the feet, impotence, heart attack, intermittent claudication due to peripheral vascular disease - these complications may be the presenting features of diabetes.

Why: e.g. fatigue, painful joints, impotence, bronze discoloration of skin. Hemochromatosis may cause secondary Diabetes mellitus.

Why: e.g. coarse oily skin, large tongue, increased teeth spacing, increased shoe size, thick enlarged hands, deepening of voice.

Why: e.g. episodic periods of headache, feelings of fear, palpitations, sweating, nausea, tremor, weight loss.

Why: e.g. muscle wasting, thin skin, stretch marks, truncal obesity, easy bruising, fluid retention, moon-face, poor wound healing.

Why: e.g. weakness, frequency of urine, excessive thirst.

Why: e.g. sudden onset of severe central upper abdominal pain that may radiate to the back. Usually associated with nausea, vomiting, sweating and weakness.

Why: e.g. central upper abdominal pain radiating into the back. Pain is milder and more persistent than acute pancreatitis. May be associated with reduced appetite, weight loss, steatorrhea (fatty, pale colored, extremely smelly stools that float in the toilet and are difficult to flush away due to excess fat in the stool). Chronic pancreatitis may also cause secondary Diabetes mellitus.

Why: e.g. recurrent chest infections since childhood, blood in sputum, shortness of breath, infertility in males, steatorrhea (fatty, pale colored, extremely smelly stools that float in the toilet and are difficult to flush away due to excess fat in the stool). Cystic fibrosis is a secondary cause of diabetes mellitus.

Why: Symptoms depend on where the cancer is located. Cancer of the head of the pancreas may present with jaundice and weight loss, but usually has little pain. Cancer of the body or tail of the pancreas usually presents with abdominal pain (dull pain that radiates through to the back, relived by sitting forward), reduced appetite, weight loss and diabetes.

Why: e.g. symptoms of peptic ulcers including intermittent gnawing or burning-type pain in the epigastrium (midline, under the ribs) which can be located by finger point, pain is worse before meals and relieved by taking antacids or food. Pain may waken the person at night. Diarrhea is also a common feature.