Bowel obstruction differential diagnosis: Difference between revisions
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{{ | [[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Bowel_obstruction]] | ||
{{CMG}};{{AE}}{{HM}} | |||
==Overview== | |||
Bowel obstruction must be differentiated from other diseases that cause [[abdominal pain]], [[nausea and vomiting]], and [[constipation]], such as [[irritable bowel syndrome]], [[volvulus]] and acute [[diverticulitis]]. | |||
==Differentiating bowel obstruction from other Diseases== | |||
Bowel obstruction must be differentiated from other diseases that cause [[abdominal pain]], [[nausea and vomiting]], and [[constipation]], such as [[irritable bowel syndrome]], [[volvulus]] and acute [[diverticulitis]]. | |||
The following tables discusses differential diagnoses based on [[abdominal pain]] with [[nausea and vomiting]]: | |||
<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> | |||
<small><small> | |||
{| 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" |Acute suppurative cholangitis | |||
| 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" | − | |||
| 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" | | |||
*Abnormal [[LFT]] | |||
*WBC >10,000 | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ultrasound shows [[biliary]] dilatation/stents/tumor | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Septic shock occurs with features of [[SIRS]] | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute cholecystitis|Acute cholecystitis]] | |||
| 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" |<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="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" |Hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Hyperbilirubinemia]] | |||
* [[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows: | |||
* Gallstone | |||
* Inflammation | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Murphy's sign|Murphy’s sign]] | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute pancreatitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[Epigastric]] | |||
| 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="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" | | |||
* Increased [[amylase]] / [[lipase]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ultrasound shows evidence of [[inflammation]] | |||
* CT scan shows severity of pancreatitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Pain radiation to back | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Chronic pancreatitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]] | |||
| 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" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Increased [[amylase]] / [[lipase]] | |||
* Increased stool fat content | |||
* Pancreatic function test | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan | |||
* Calcification | |||
* Pseudocyst | |||
* Dilation of main pancreatic duct | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Predisposes to pancreatic cancer | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pancreatic carcinoma]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]] | |||
| 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="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* ↑ [[Alkaline phosphatase]] | |||
* ↑ [[Bilirubin|serum bilirubin]] | |||
* ↑ [[gamma-glutamyl transpeptidase]] | |||
* ↑ [[CA 19-9]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Computed tomography|MDCT]] with [[Positron emission tomography|PET]]/[[Computed tomography|CT]] | |||
* MRI | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
[[Skin]] manifestations may include: | |||
* [[Bullous pemphigoid]] | |||
* [[Mucous membrane pemphigoid|Cicatricial pemphigoid]] | |||
* [[Thrombophlebitis|Migratory superficial thrombophlebitis]] (classic [[Trousseau's syndrome]]) | |||
* [[Panniculitis|Pancreatic panniculitis]] | |||
|- | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Disease | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | |||
! 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 | |||
! 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 | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cholelithiasis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]/[[Epigastric]] | |||
| 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" |Normal to hyperactive for dislodged stone | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ultrasound shows [[gallstone]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Fatty food intolerance | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Peptic Ulcer Disease|Peptic ulcer 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" | <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" | | |||
* Gastric ulcer- [[melena]] and [[hematemesis]] | |||
* Duodenal ulcer- [[melena]] and [[hematochezia]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if perforated | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if perforated | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if perforated | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ascitic fluid | |||
** [[LDH]] > serum [[LDH]] | |||
** Glucose < 50mg/dl | |||
** Total protein > 1g/dl | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Air under [[diaphragm]] in upright [[CXR]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Upper GI [[endoscopy]] for diagnosis | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastritis|Gastritis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]] | |||
| 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" | Positive in chronic gastritis | |||
| 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" | | |||
* [[H.pylori infection diagnostic tests]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Endoscopy]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[H.pylori gastritis guideline recommendation]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastroesophageal reflux disease|Gastroesophageal reflux disease]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]] | |||
| 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" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Gastric emptying studies | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Esophageal]] [[manometry]] | |||
* [[Endoscopy]] for alarm signs | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastric outlet obstruction|Gastric outlet obstruction]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]] | |||
| 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" |Hyperactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Complete blood count]] | |||
* [[Basic metabolic panel]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Abdominal x-ray]]- air fluid level | |||
* Barium upper GI studies- narrowed pylorus | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Succussion splash | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gastroparesis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Epigastric | |||
| 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="center" |Hyperactive/hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
*Hemoglobin | |||
*Fasting plasma glucose | |||
*Serum total protein, albumin, thyrotropin (TSH), and an antinuclear antibody (ANA) titer | |||
*HbA1c | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
*Scintigraphic gastric emptying | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
*Succussion splash | |||
*Single photon emission computed tomography (SPECT) | |||
*Full thickness gastric and small intestinal biopsy | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Dumping syndrome]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Lower and then 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" |Hyperactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Glucose challenge test | |||
* Hydrogen breath test | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Upper GI series | |||
* Gastric emptying study | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Postgastrectomy | |||
|- | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Disease | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | |||
! 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 | |||
! 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 | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute appendicitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Starts in [[epigastrium]], migrates to RLQ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in pyogenic appendicitis | |||
| 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="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in perforated appendicitis | |||
| 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" | | |||
* Positive Rovsing sign | |||
* Positive Obturator sign | |||
* Positive Iliopsoas sign | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diverticulitis|Acute diverticulitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |LLQ | |||
| 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 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]] | |||
|- | |||
| 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" |[[Hepatitis|Viral hepatitis]] | |||
| 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" |<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" | Positive in Hep A and E | |||
| 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 in fulminant hepatitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in acute | |||
| 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" | | |||
* Abnormal LFTs | |||
* Viral serology | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* US | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Hep A and E have fecal-oral route of transmission | |||
* Hep B and C transmits via blood transfusion and sexual contact. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver abscess]] | |||
| 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" |<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" |Normal or hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* CBC | |||
* Blood cultures | |||
* Abnormal [[Liver function test|liver function tests]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* US | |||
* CT | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
|- | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Disease | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | |||
! 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 | |||
! 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 | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pyelonephritis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Unilateral | |||
| 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="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" |Hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Urinalysis | |||
* Urine culture | |||
* Blood culture | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* CT | |||
* MRI | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
*CVA tenderness | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Renal colic]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Flank pain]] | |||
| 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="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" | | |||
* [[Hematuria]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ultrasound | |||
* CT scan | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Colicky [[abdominal pain]] | |||
* [[Dysuria]] | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Small [[bowel obstruction]] | |||
| 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" |<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" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Leukocytosis]] with left shift indicates complications | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Abdominal X-ray|Abdominal X ray]] | |||
* Dilated loops of bowel with air fluid levels | |||
* Gasless abdomen | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* "Target sign"– , indicative of intussusception | |||
* Venous cut-off sign" – suggests thrombosis | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Volvulus]] | |||
| 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" |<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 perforated cases | |||
| 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="left" |Hyperactive then absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and [[Abdominal x-ray|abdominal X ray]] | |||
* U shaped sigmoid colon | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* "Whirl sign" | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Biliary colic]] | |||
| 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" |<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="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" | | |||
* ↑ [[bilirubin]] and [[alkaline phosphatase]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ultrasound | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
|- | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Disease | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | |||
! 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 | |||
! 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 | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | |||
|- | |||
| 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]] | |||
|- | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Disease | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | |||
! 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 | |||
! 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 | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Torsion of the cyst | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RLQ / LLQ | |||
| 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="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" | | |||
* ↑ [[ESR]] | |||
* ↑ [[CRP]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ultrasound | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Sudden onset & severe pain | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cyst rupture | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RLQ / LLQ | |||
| 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="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" | | |||
* ↑ [[ESR]] | |||
* ↑ [[CRP]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ultrasound | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ruptured [[ectopic pregnancy]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RLQ / LLQ | |||
| 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="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" | | |||
* Positive [[pregnancy test]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ultrasound | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of | |||
* Missed period | |||
* Vaginal bleeding | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pneumonia]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ/LUQ | |||
| 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="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 hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* ABGs | |||
* Leukocytosis | |||
* Pancytopenia | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
*CXR | |||
*CT chest | |||
*Bronchoscopy | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Shortness of breath | |||
* Cough | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Myocardial Infarction]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]] | |||
| 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="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in cardiogenic shock | |||
| 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" | | |||
* [[Cardiac enzymes]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[ECG]] | |||
[[Echocardiogram]] | |||
* Wall motion abnormality | |||
* Wall rupture | |||
* Septal rupture | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Chest pain, tightness, diaphoresis | |||
Complications: | |||
* [[Arrythmias]] | |||
* [[Mitral regurgitation]] | |||
* Ventricular wall rupture | |||
* Septal rupture | |||
|- | |||
|} | |||
|} | |||
<small></small> | |||
===The following table discusses differential diagnoses of [[abdominal pain]] with [[constipation]]:=== | |||
<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" |LLQ | |||
| 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 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]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Irritable bowel syndrome]] | |||
| 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" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Symptomatic treatment | |||
* High [[dietary fiber]] | |||
* [[Osmotic]] [[laxatives]] | |||
* [[Antispasmodic]] drugs | |||
|- | |||
| 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 | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Small [[bowel obstruction]] | |||
| 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" |<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" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Leukocytosis]] with left shift indicates complications | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Abdominal X-ray|Abdominal X ray]] | |||
* Dilated loops of bowel with air fluid levels | |||
* Gasless abdomen | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* "Target sign"– , indicative of intussusception | |||
* Venous cut-off sign" – suggests thrombosis | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Volvulus]] | |||
| 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" |<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 perforated cases | |||
| 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="left" |Hyperactive then absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and [[Abdominal x-ray|abdominal X ray]] | |||
* U shaped sigmoid colon | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* "Whirl sign" | |||
|- | |||
|} | |||
|} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category: | [[Category:Surgery]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category: | [[Category:Up-To-Date]] | ||
[[Category: | [[Category:Emergency medicine]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} |
Latest revision as of 20:29, 13 February 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Bowel obstruction must be differentiated from other diseases that cause abdominal pain, nausea and vomiting, and constipation, such as irritable bowel syndrome, volvulus and acute diverticulitis.
Differentiating bowel obstruction from other Diseases
Bowel obstruction must be differentiated from other diseases that cause abdominal pain, nausea and vomiting, and constipation, such as irritable bowel syndrome, volvulus and acute diverticulitis.
The following tables discusses differential diagnoses based on abdominal pain with nausea and vomiting:
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
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The following table discusses differential diagnoses of abdominal pain with constipation:
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