Fast Five Quiz: Exocrine Pancreatic Insufficiency Signs and Symptoms

Romesh Khardori, MD, PhD


March 08, 2021

Although the diagnosis of EPI is primarily clinical, on abdominal examination, orthostatic hypotension may be present. The abdomen may be distended, and bowel sounds may become hyperactive. In severe hypoproteinemia, ascites may be present. Peripheral edema also may be observed.

In addition, signs of weight loss, muscle wasting, and loss of subcutaneous fat are often noted.

Signs of EPI on dermatologic examination include: pale skin that may suggest anemia, as well as ecchymoses due to vitamin K deficiency. Dermatitis herpetiformis, erythema nodosum, and pyoderma gangrenosum may be observed. Pellagra, alopecia, or seborrheic dermatitis may be noted. Examination of the mouth may reveal cheilosis, glossitis, or aphthous ulcers.

Signs of EPI on neurologic examination include: motor weakness, peripheral neuropathy, or ataxia. The Chvostek sign or the Trousseau sign may be observed, resulting from hypocalcemia or hypomagnesemia.

Learn more about physical examination in EPI.


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