Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with [subacute/chronic] epigastric pain radiating to the back, associated with [obstructive jaundice/steatorrhea/weight loss]. History significant for IgG4-related systemic involvement (e.g., sialadenitis, retroperitoneal fibrosis). No history of heavy alcohol use or biliary lithiasis. Symptoms are [improving/worsening] with current steroid regimen.
Clinical Examination Findings
Abdominal exam: Mild epigastric tenderness, no rebound or guarding. Scleral icterus present/absent. Skin: No evidence of xanthomas. Lymphadenopathy: [Palpable/Non-palpable] cervical or submandibular nodes. General: Patient appears [well-nourished/cachectic]. Vitals stable.
Treatment Protocol
Initiate/Continue Prednisone [dosage] mg daily with planned taper over [duration] weeks. Monitor serum IgG4 levels and CA 19-9. Consider steroid-sparing agents (e.g., Azathioprine/Rituximab) if relapse occurs or steroid dependency develops. Maintain pancreatic enzyme replacement therapy (PERT) if exocrine insufficiency is present.