Meckel's diverticulum differential diagnosis: Difference between revisions
No edit summary |
|||
(10 intermediate revisions by 3 users not shown) | |||
Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Meckel's diverticulum}} | {{Meckel's diverticulum}} | ||
{{CMG}} | {{CMG}} {{AE}} {{Cherry}} | ||
==Overview== | |||
The common diseases responsible for [[Lower gastrointestinal bleeding|lower GI bleeding]] that must be differentiated from Meckel's diverticulum inlcude [[diverticulosis]], [[angiodysplasia]], [[hemorrhoids]], [[Anal fissure|anal fissures]], [[Mesenteric ischemia|mesenteric Ischemia]], and [[Colorectal cancer|colorectal carcinoma]]. Meckel's [[diverticulitis]] is a common complication of Meckel's diverticulum in adults and must be differentiated from other causes of [[abdominal pain]] and [[lower gastrointestinal bleeding]] such as [[infective colitis]], [[Inflammatory bowel disease|IBD]] and [[Ischemic colitis|acute ischemic colitis]]. | |||
==Differentiating Meckel's Diverticulum from other Diseases== | ==Differentiating Meckel's Diverticulum from other Diseases== | ||
=== | The common diseases responsible for [[Lower gastrointestinal bleeding|lower GI bleeding]] that must be differentiated from Meckel's diverticulum inlcude [[diverticulosis]], [[angiodysplasia]], [[hemorrhoids]], [[anal fissures]], [[mesenteric Ischemia]], [[ischemic colitis]], [[inflammatory bowel disease]], and [[colorectal carcinoma]].<ref name="urlMeckels Diverticulum Overview">{{cite web |url=http://www.healthinplainenglish.com/health/digestive/meckels_diverticulum/ |title=Meckel's Diverticulum Overview |format= |work= |accessdate=2013-04-01}}</ref> | ||
*[[Crohn's disease]] | {| class="wikitable" | ||
*[[ | ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease | ||
*[[ | ! colspan="7" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms | ||
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features | |||
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis | |||
|- | |||
!style="background:#4479BA; color: #FFFFFF;" align="center" + |Abdominal pain | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" +| Rectal pain | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" +| Weightloss | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Fever | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Type of GI bleeding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Diarrhea | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Constipation | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Laboratory findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Radio-Imaging findings | |||
|- | |||
|[[Meckel's diverticulum|'''Meckel's diverticulum''']] | |||
| - | |||
| - | |||
| - | |||
| - | |||
|Frank [[blood]] | |||
| - | |||
| - | |||
| | |||
* Painless [[bleeding]] | |||
* May present with complications such as: | |||
** [[Intestine|Bowel]] [[obstruction]] | |||
** [[Intussusception]] | |||
** [[Diverticulitis]] | |||
** [[Perforation]] | |||
|Signs of [[iron deficiency anemia]] may be present such as: | |||
* Decreased [[Hematocrit]] | |||
* Decreased [[Hemoglobin]] | |||
* Positive [[Stool guaiac test|stool guaiac]] test | |||
| | |||
* [[Technetium-99m|Technetium-99m pertechnetate scanning]] helps in the detection of a symptomatic [[bleeding]] Meckel’s diverticulum. | |||
** [[Upper gastrointestinal series|Upper GI series]] with small-bowel follow-through may help in the detection of a [[diverticulum]]. | |||
** Appearance of [[Meckel's diverticulum]] on [[Upper gastrointestinal series|upper GI series]]: | |||
*** Smooth | |||
*** Globular | |||
*** White | |||
*** Location: | |||
**** Arising from the antimesenteric border of the [[ileum]] | |||
**** 50cm proximal to the [[ileocecal valve]] | |||
|- | |||
|[[Diverticulosis|'''Diverticulosis''']] | |||
| - | |||
| - | |||
| - | |||
| - | |||
|Red or maroon-colored [[blood]] | |||
| - | |||
| + | |||
| | |||
* Self limiting | |||
* Seen in elderly | |||
|Normal | |||
| | |||
Globular outpouchings on [[CT scan]] | |||
|- | |||
|[[Angiodysplasia|'''Angiodysplasia''']] | |||
| - | |||
| - | |||
| - | |||
| - | |||
|Frank [[blood]] | |||
| - | |||
| - | |||
| | |||
* Painless [[bleeding]] | |||
* [[Iron deficiency anemia]] | |||
|Normal | |||
|Normal | |||
|- | |||
|[[Hemorrhoids|'''Hemorrhoids''']] | |||
| - | |||
| + | |||
| - | |||
| - | |||
|[[Blood]] on [[tissues]] | |||
| - | |||
| + | |||
| | |||
* [[Pain]] during [[defecation]] | |||
* [[Anemia]] | |||
| - | |||
|Tortuous dilated vessels on [[anoscopy]] | |||
|- | |||
|[[Anal fissures|'''Anal fissures''']] | |||
| - | |||
| + | |||
| - | |||
| - | |||
|[[Blood]] on [[tissues]] | |||
| - | |||
| + | |||
| | |||
* [[Pain]] during [[defecation]] | |||
* [[Pain]] recurs with every [[bowel movement]] | |||
|Normal except mild [[leucocytosis]] | |||
|[[Anoscopy]] | |||
|- | |||
|[[Mesenteric Ischemia|'''Mesenteric Ischemia''']] | |||
| + | |||
| - | |||
| + | |||
| + | |||
|Frank blood | |||
| + | |||
| - | |||
| | |||
* [[Pain]] alters with eating habits | |||
* Associated with other comorbid conditions | |||
| | |||
* [[Leukocytosis]] | |||
* Increased [[hematocrit]] | |||
* [[High anion gap metabolic acidosis critical pathways|High anion gap metabolic acidosis]] | |||
* [[Lactic acidosis]] | |||
* [[Hyperphosphatemia|High phosphate levels]] | |||
| | |||
* [[Mesenteric]] [[edema]] | |||
* [[Bowel]] dilatation | |||
* Bowel wall thickening | |||
* Intramural gas | |||
* [[Mesenteric]] stranding | |||
|- | |||
|[[Ischemic colitis|'''Ischemic colitis''']] | |||
| + | |||
| - | |||
| - | |||
| + | |||
|Frank blood | |||
| + | |||
| - | |||
|3 phases | |||
* [[Hyperactive]] phase | |||
* [[Paralytic]] phase (absent bowel sounds) | |||
* [[Shock]] phase | |||
| | |||
* [[Elevated white blood cell count]] more than 15,000/mm<sup>3</sup> in 20 patients (27%) | |||
* The [[serum bicarbonate]] level was less than 24 mmol/L in 26 patients (36%) | |||
| | |||
* Mild moderate diffuse bowel wall thickening | |||
* Marked hyperenhancement of the [[mucosa]] | |||
|- | |||
|[[Crohn's disease|'''Crohn's disease''']] | |||
| + | |||
| - | |||
| + | |||
| + | |||
|Blood mixed with stools | |||
| + | |||
| + | |||
|Extra intestinal manifestations | |||
*[[Uveitis]] | |||
* [[Sacroiliitis]] | |||
* [[Anemia]] | |||
* [[Peripheral neuropathy]] | |||
| | |||
* [[Anemia]] | |||
* [[Leukocytosis]] | |||
* [[Thrombocytosis]] | |||
* [[Anti saccharomyces cerevisiae antibodies|Anti-Saccharomyces cerevisiae antibodies]] | |||
| | |||
* Skip lesions | |||
* Bowel wall thickening | |||
* Surrounding [[inflammation]], [[abscess]], and [[fistulae]] | |||
|- | |||
|[[Ulcerative colitis|'''Ulcerative colitis''']] | |||
| + | |||
| + | |||
| + | |||
| + | |||
|Blood mixed with stools | |||
| + | |||
| + | |||
| | |||
* [[Joint swelling]] | |||
* [[Joint pain]] | |||
* [[Inflammation]] of the eye | |||
* [[Skin]] involvement | |||
* [[Fatty liver]] | |||
* [[Thromboembolism]] | |||
* [[Parenchymal lung disease]] | |||
| | |||
* [[Anemia]] | |||
* [[Thrombocytosis]] | |||
* A high [[platelet]] count | |||
| | |||
* Loss of the vascular appearance of the [[colon]] | |||
* [[Erythema]] (or redness of the [[mucosa]]) and friability of the [[mucosa]] | |||
* Superficial [[ulceration]], which may be confluent | |||
* [[Polyp (medicine)|Pseudopolyps]] | |||
|- | |||
|[[Colon carcinoma|'''Colon carcinoma''']] | |||
| + | |||
| -† | |||
| + | |||
| + | |||
|[[Fecal occult blood|Occult bleeding]] | |||
| + | |||
| +† | |||
| | |||
| + [[FOBT]] (fecal occult blood test) | |||
↑ [[CEA]]( and CA 19-9 | |||
[[Hypercalcemia]] | |||
| | |||
* [[Biopsy]] | |||
|} | |||
The following table differentiates Meckel's [[diverticulitis]] from other causes of [[abdominal pain]] and [[lower gastrointestinal bleeding]]: | |||
<span style="font-size:85%">'''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]]</span> | |||
{| align="center" | |||
|- | |||
| | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease | |||
| colspan="13" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestations''' | |||
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diagnosis | |||
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | |||
|- | |||
| colspan="9" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Symptoms''' | |||
! colspan="4" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Signs | |||
|- | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Fever | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo- | |||
tension | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Guarding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diverticulitis|Acute diverticulitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Left lower quadrant abdominal pain resident survival guide|LLQ]] or [[Right lower quadrant abdominal pain resident survival guide|RLQ]] (in case of Meckel's diverticulitis) | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in [[Perforation|perforated]] diverticulitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* CT scan | |||
* Ultrasound | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* History of [[constipation]] | |||
* History of painless [[Lower gastrointestinal bleeding|lower GI bleed]] (in case of Meckel's diverticulitis) | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Inflammatory bowel disease]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal or hyperactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Anti-neutrophil cytoplasmic antibody]] ([[P-ANCA]]) in [[Ulcerative colitis]] | |||
* [[Anti saccharomyces cerevisiae antibodies]] (ASCA) in [[Crohn's disease]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[String sign]] on [[abdominal x-ray]] in [[Crohn's disease]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
Extra intestinal findings: | |||
* [[Uveitis]] | |||
* [[Arthritis]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Infective colitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in fulminant colitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Stool culture]] and studies | |||
* Shiga toxin in bloody diarrhea | |||
* [[PCR]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan | |||
* Bowel wall thickening | |||
* Edema | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Colon carcinoma | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse/localized | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Normal or hyperactive if obstruction present | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* CBC | |||
* Carcinoembryonic antigen (CEA) | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Colonoscopy | |||
* Flexible sigmoidoscopy | |||
* Barium enema | |||
* CT colonography | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* PILLCAM 2: A colon capsule for CRC screening may be used in patients with an incomplete colonoscopy who lacks obstruction | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hemochromatosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in cirrhotic patients | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* >60% TS | |||
* >240 μg/L SF | |||
* Raised LFT <br>Hyperglycemia | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ultrasound shows evidence of cirrhosis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Extra intestinal findings: | |||
* [[Hyperpigmentation]] | |||
* [[Diabetes mellitus]] | |||
* [[Arthralgia]] | |||
* [[Erectile dysfunction|Impotence]] in males | |||
* [[Cardiomyopathy]] | |||
* [[Atherosclerosis]] | |||
* [[Hypopituitarism]] | |||
* [[Hypothyroidism]] | |||
* Extrahepatic cancer | |||
* Prone to specific infections | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Periumbilical | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive if bowel becomes gangrenous | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if bowel becomes gangrenous | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if bowel becomes gangrenous | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive to absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Leukocytosis]] and [[lactic acidosis]] | |||
* [[Amylase]] levels | |||
* [[D-dimer]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT angiography | |||
* SMA or SMV thrombosis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Also known as abdominal angina that worsens with eating | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ischemic colitis|Acute ischemic colitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Abdominal x-ray]] | |||
* Distension and pneumatosis | |||
CT scan | |||
* Double halo appearance, thumbprinting | |||
* Thickening of bowel | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* May lead to shock | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ruptured abdominal aortic aneurysm]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Fibrinogen]] | |||
* [[D-dimer]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Focused Assessment with Sonography in Trauma (FAST) | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Unstable hemodynamics | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intra-abdominal or [[retroperitoneal hemorrhage]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* ↓ Hb | |||
* ↓ Hct | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* CT scan | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* History of [[trauma]] | |||
|- | |||
|} | |||
|} | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
{{WS}} | |||
{{WH}} |
Latest revision as of 16:43, 8 January 2018
Meckel's diverticulum Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Meckel's diverticulum differential diagnosis On the Web |
American Roentgen Ray Society Images of Meckel's diverticulum differential diagnosis |
Risk calculators and risk factors for Meckel's diverticulum differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]
Overview
The common diseases responsible for lower GI bleeding that must be differentiated from Meckel's diverticulum inlcude diverticulosis, angiodysplasia, hemorrhoids, anal fissures, mesenteric Ischemia, and colorectal carcinoma. Meckel's diverticulitis is a common complication of Meckel's diverticulum in adults and must be differentiated from other causes of abdominal pain and lower gastrointestinal bleeding such as infective colitis, IBD and acute ischemic colitis.
Differentiating Meckel's Diverticulum from other Diseases
The common diseases responsible for lower GI bleeding that must be differentiated from Meckel's diverticulum inlcude diverticulosis, angiodysplasia, hemorrhoids, anal fissures, mesenteric Ischemia, ischemic colitis, inflammatory bowel disease, and colorectal carcinoma.[1]
Disease | Symptoms | Other features | Diagnosis | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Abdominal pain | Rectal pain | Weightloss | Fever | Type of GI bleeding | Diarrhea | Constipation | Laboratory findings | Radio-Imaging findings | ||
Meckel's diverticulum | - | - | - | - | Frank blood | - | - |
|
Signs of iron deficiency anemia may be present such as:
|
|
Diverticulosis | - | - | - | - | Red or maroon-colored blood | - | + |
|
Normal |
Globular outpouchings on CT scan |
Angiodysplasia | - | - | - | - | Frank blood | - | - |
|
Normal | Normal |
Hemorrhoids | - | + | - | - | Blood on tissues | - | + |
|
- | Tortuous dilated vessels on anoscopy |
Anal fissures | - | + | - | - | Blood on tissues | - | + |
|
Normal except mild leucocytosis | Anoscopy |
Mesenteric Ischemia | + | - | + | + | Frank blood | + | - |
|
| |
Ischemic colitis | + | - | - | + | Frank blood | + | - | 3 phases
|
|
|
Crohn's disease | + | - | + | + | Blood mixed with stools | + | + | Extra intestinal manifestations |
| |
Ulcerative colitis | + | + | + | + | Blood mixed with stools | + | + |
|
|
|
Colon carcinoma | + | -† | + | + | Occult bleeding | + | +† | + FOBT (fecal occult blood test)
↑ CEA( and CA 19-9 |
The following table differentiates Meckel's diverticulitis from other causes of abdominal pain and lower gastrointestinal bleeding:
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
|
References
- ↑ "Meckel's Diverticulum Overview". Retrieved 2013-04-01.