Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]Amandeep Singh M.D.[3]
Abbreviations:
RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram
Disease
|
Clinical manifestations
|
Diagnosis
|
Comments
|
Symptoms
|
Signs
|
Abdominal Pain
|
Fever
|
Rigors and chills
|
Nausea or vomiting
|
Jaundice
|
Constipation
|
Diarrhea
|
Weight loss
|
GI bleeding
|
Hypo-
tension
|
Guarding
|
Rebound Tenderness
|
Bowel sounds
|
Lab Findings
|
Imaging
|
Acute appendicitis
|
Starts in epigastrium, migrates to RLQ
|
+
|
Positive in pyogenic appendicitis
|
+
|
−
|
−
|
±
|
−
|
−
|
Positive in perforated appendicitis
|
+
|
+
|
Hypoactive
|
|
|
- Positive Rovsing sign
- Positive Obturator sign
- Positive Iliopsoas sign
|
Acute diverticulitis
|
LLQ
|
+
|
±
|
+
|
−
|
+
|
±
|
−
|
+
|
Positive in perforated diverticulitis
|
+
|
+
|
Hypoactive
|
|
|
|
Inflammatory bowel disease
|
Diffuse
|
±
|
−
|
−
|
±
|
−
|
+
|
+
|
+
|
−
|
−
|
−
|
Normal or hyperactive
|
|
|
Extra intestinal findings:
|
Whipple's disease
|
Diffuse
|
±
|
−
|
−
|
±
|
−
|
+
|
+
|
−
|
±
|
−
|
−
|
N
|
|
Endoscopy is used to confirm diagnosis.
Images used to find complications
|
Extra intestinal findings:
|
Disease
|
Abdominal Pain
|
Fever
|
Rigors and chills
|
Nausea or vomiting
|
Jaundice
|
Constipation
|
Diarrhea
|
Weight loss
|
GI bleeding
|
Hypo-
tension
|
Guarding
|
Rebound Tenderness
|
Bowel sounds
|
Lab Findings
|
Imaging
|
Comments
|
Toxic megacolon
|
Diffuse
|
+
|
−
|
−
|
−
|
−
|
+
|
−
|
−
|
+
|
±
|
+
|
Hypoactive
|
|
CT and Ultrasound shows:
- Loss of colonic haustration
- Hypoechoic and thickened bowel walls with irregular internal margins in the sigmoid and descending colon
- Prominent dilation of the transverse colon (>6 cm)
- Insignificant dilation of ileal bowel loops (diameter >18 mm) with increased intraluminal gas and fluid
|
|
Tropical sprue
|
Diffuse
|
+
|
−
|
−
|
−
|
−
|
+
|
+
|
−
|
−
|
−
|
−
|
N
|
|
Barium studies:
- Dilation and edema of mucosal folds
|
|
Infective colitis
|
Diffuse
|
+
|
−
|
±
|
−
|
−
|
+
|
−
|
+
|
Positive in fulminant colitis
|
±
|
±
|
Hyperactive
|
|
CT scan
- Bowel wall thickening
- Edema
|
|
Disease
|
Abdominal Pain
|
Fever
|
Rigors and chills
|
Nausea or vomiting
|
Jaundice
|
Constipation
|
Diarrhea
|
Weight loss
|
GI bleeding
|
Hypo-
tension
|
Guarding
|
Rebound Tenderness
|
Bowel sounds
|
Lab Findings
|
Imaging
|
Comments
|
Viral hepatitis
|
RUQ
|
+
|
−
|
+
|
+
|
−
|
Positive in Hep A and E
|
+
|
−
|
Positive in fulminant hepatitis
|
Positive in acute
|
+
|
N
|
- Abnormal LFTs
- Viral serology
|
|
- Hep A and E have fecal-oral route of transmission
- Hep B and C transmits via blood transfusion and sexual contact.
|
Liver abscess
|
RUQ
|
+
|
+
|
+
|
+
|
−
|
±
|
+
|
−
|
+
|
+
|
±
|
Normal or hypoactive
|
|
|
|
Spontaneous bacterial peritonitis
|
Diffuse
|
+
|
−
|
−
|
Positive in cirrhotic patients
|
−
|
+
|
−
|
−
|
±
|
+
|
+
|
Hypoactive
|
- Ascitic fluid PMN>250 cells/mm³
- Culture: Positive for single organism
|
- Ultrasound for evaluation of liver cirrhosis
|
|
Mesenteric ischemia
|
Periumbilical
|
Positive if bowel becomes gangrenous
|
−
|
+
|
−
|
−
|
+
|
+
|
+
|
Positive if bowel becomes gangrenous
|
Positive if bowel becomes gangrenous
|
−
|
Hyperactive to absent
|
|
CT angiography
|
- Also known as abdominal angina that worsens with eating
|
Acute ischemic colitis
|
Diffuse
|
+
|
±
|
+
|
−
|
−
|
+
|
+
|
+
|
+
|
+
|
+
|
Hyperactive then absent
|
|
Abdominal x-ray
- Distension and pneumatosis
CT scan
- Double halo appearance, thumbprinting
- Thickening of bowel
|
|
Pneumonia
|
RUQ/LUQ
|
+
|
+
|
+
|
−
|
−
|
±
|
−
|
−
|
+
|
−
|
−
|
Normal or hypoactive
|
- ABGs
- Leukocytosis
- Pancytopenia
|
- CXR
- CT chest
- Bronchoscopy
|
- Shortness of breath
- Cough
|
|