Gallstone disease differential diagnosis: Difference between revisions

Latest revision as of 21:48, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Gallstone disease must be differentiated from other diseases that cause right upper quadrant pain including gastroesophageal reflux disorder, peptic ulcer disease,hepatitis,sphincter of Oddi dysfunction,appendicitis, bile duct stricture, chronic pancreatitis, irritable bowel syndrome, ischemic heart disease, pyelonephritis, ureteral calculi and complications of gallstone disease include: acute cholecystitis, choledocholithiasis, acute pancreatitis, and acute cholangitis.

Differentiating Gallstone disease from other Diseases

Gallstone disease can manifest in a variety of clinical forms.
The presence of biliary colic is an important diagnostic feature to distinguish between gallstones and non-biliary stone disorders.
Patients who present with biliary colic are more likely to have gallstones detected on imaging. ^[1]
However, it is important to note that biliary colic can be concomitant in patients with other biliary disorders such as acute cholecystitis, choledocholithiasis, sphincter of Oddi dysfunction, and functional gallbladder disorder.^[2]^[3]

Differential diagnosis

The differential diagnosis of diseases presenting with abdominal pain, fever and jaundice is discussed below.

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

				Abdominal Pain	Fever	Rigors and chills	Jaundice	Diarrhea	GI Bleed	Hypo- tension	Guarding	Rebound Tenderness	Bowel sounds	Lab Findings	Imaging
Classification of pain in the abdomen based on etiology			Disease	Clinical manifestations										Diagnosis		Comments
				Symptoms						Signs				Diagnosis
Abdominal causes	Inflammatory causes	Pancreato-biliary disorders	Acute suppurative cholangitis	RUQ	+	+	+	−	−	+	+	+	N	Abnormal LFT WBC >10,000	Ultrasound shows biliary dilatation/stents/tumor	Septic shock occurs with features of SIRS
			Acute cholangitis	RUQ	+	−	+	−	−	−	−	−	N	Abnormal LFT	Ultrasound shows biliary dilatation/stents/tumor	Biliary drainage (ERCP) + IV antibiotics
			Acute cholecystitis	RUQ	+	−	+	−	−	−	−	−	Hypoactive	Hyperbilirubinemia Leukocytosis	Ultrasound shows gallstone and evidence of inflammation	Murphy’s sign
			Acute pancreatitis	Epigastric	+	−	±	−	−	±	+	+	N	Increased amylase / lipase	Ultrasound shows evidence of inflammation CT scan shows severity of pancreatitis	Pain radiation to back
			Primary sclerosing cholangitis	RUQ	+	−	+	−	−	−	−	−	N	Increased liver enzymes Increased IgM, IgG4 Anti-neutrophil cytoplasmic antibody (p-ANCA) Anti-nuclear antibody (ANA) Anti-smooth muscle antibody (Anti-Sm) Anti-endothelial antibody Anti-cardiolipin antibody	ERCP and MRCP shows Multiple segmental strictures Mural irregularities Biliary dilatation and diverticula Distortion of biliary tree	The risk of cholangiocarcinoma in patients with primary sclerosing cholangitis is 400 times higher than the risk in the general population.
			Cholelithiasis	RUQ/Epigastric	±	−	±	−	−	−	−	−	Normal to hyperactive for dislodged stone	Leukocytosis	Ultrasound shows gallstone	Fatty food intolerance
		Gastric causes	Gastrointestinal perforation	Diffuse	+	±	±	−	+, depends on site	+	+	±	Hyperactive/hypoactive	WBC> 10,000	Air under diaphragm in upright CXR	Hamman's sign
		Intestinal causes	Inflammatory bowel disease	Diffuse	±	−	±	±	Hematochezia	−	−	−	Normal/ Hyperactive	Anti-neutrophil cytoplasmic antibody (P-ANCA) in Ulcerative colitis Anti saccharomyces cerevisiae antibodies (ASCA) in Crohn's disease	String sign on abdominal x-ray in Crohn's disease	Extra intestinal findings: Uveitis Arthritis
		Intestinal causes	Whipple's disease	Diffuse	±	−	±	+	−	±	−	−	Normal	Thrombocytopenia Hypoalbuminemia Small intestinal biopsy for Tropheryma whipplei	Endoscopy is used to confirm diagnosis. Images used to find complications Chest and joint x-ray CT MRI Echocardiography	Extra intestinal findings: Uveitis Endocarditis Encephalitis Dementia Hepatosplenomegaly Arthritis Ascites
		Hepatic causes	Viral hepatitis	RUQ	+	−	+	+ in Hep A and Hep E	−	+ in fulminant hepatitis	+in acute	+	Normal	Abnormal LFTs Viral serology	Ultrasound	Hep Aand Hep E have fecoral route of transmission and Hep B and Hep C transmits via blood transfusion and sexual contact.
			Liver masses	RUQ	+	+ in Liver abscess	±	−	+ in Hepatocellular carcinoma	+ in sepsis	+ in Liver abscess	+ in Liver abscess	Normal	CBC LFTs	Ultrasound
			Liver abscess	RUQ	+	+	+	±	-	+	+	±	Normal/hypoactive	CBC Blood cultures Abnormal liver function tests	Ultrasound CT
			Hepatocellular carcinoma/Metastasis	RUQ	+	-	+	-	-	-	-	-	Normal Hyperactive if obstruction present	High levels of AFP in serum Abnormal liver function tests	Ultrasound CT Liver biopsy	Other symptoms: Splenomegaly Variceal bleeding Ascites Spider nevi Asterixis
			Budd-Chiari syndrome	RUQ	±	−	±	−	+ in liver failure leading to varices	−	−	−	Normal	Elevated serum aspartate aminotransferase and alanine aminotransferase levels may be more than five times the upper limit of the normal range. Elevated serum alkaline phosphatase and bilirubin levels, decreased serum albumin level.	Findings on CT scan suggestive of Budd-Chiari syndrome include: Early enhancement of the caudate lobe and central liver around the inferior vena cava Delayed enhancement of the peripheral liver with accompanying central low density (flip-flop appearance) Peripheral zones of the liver show reversed portal venous blood flow In the chronic phase, there is caudate lobe enlargement and atrophy of the peripheral liver in affected areas	Ascitic fluid examination shows: Total protein more than 2.5 g per deciliter White blood cells are usually less than 500/μL.
		Peritoneal causes	Spontaneous bacterial peritonitis	Diffuse	+	+	+ in cirrhotic patients	+	−	±	+	+	Hypoactive	Ascitic fluid PMN>250 cells/mm³ Culture: Positive for single organism	Ultrasound for evaluation of liver cirrhosis

To review a differential diagnosis for abdominal pain, click here

References

↑ Kraag N, Thijs C, Knipschild P (1995). "Dyspepsia--how noisy are gallstones? A meta-analysis of epidemiologic studies of biliary pain, dyspeptic symptoms, and food intolerance". Scand. J. Gastroenterol. 30 (5): 411–21. PMID 7638565.
↑ Portincasa P, Moschetta A, Palasciano G (2006). "Cholesterol gallstone disease". Lancet. 368 (9531): 230–9. doi:10.1016/S0140-6736(06)69044-2. PMID 16844493.
↑ Center SA (2009). "Diseases of the gallbladder and biliary tree". Vet. Clin. North Am. Small Anim. Pract. 39 (3): 543–98. doi:10.1016/j.cvsm.2009.01.004. PMID 19524793.

Template:WH Template:WS

[pmid7638565-1] Kraag N, Thijs C, Knipschild P (1995). "Dyspepsia--how noisy are gallstones? A meta-analysis of epidemiologic studies of biliary pain, dyspeptic symptoms, and food intolerance". Scand. J. Gastroenterol. 30 (5): 411–21. PMID 7638565.

[pmid16844493-2] Portincasa P, Moschetta A, Palasciano G (2006). "Cholesterol gallstone disease". Lancet. 368 (9531): 230–9. doi:10.1016/S0140-6736(06)69044-2. PMID 16844493.

[pmid19524793-3] Center SA (2009). "Diseases of the gallbladder and biliary tree". Vet. Clin. North Am. Small Anim. Pract. 39 (3): 543–98. doi:10.1016/j.cvsm.2009.01.004. PMID 19524793.

[1]

[2]

[3]

@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Gallstone disease}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Gallstone_disease]]
 {{CMG}}; {{AE}} {{HM}}
 ==Overview==
-Gallstone disease must be differentiated from other diseases that cause epigastric, and left and right hypochondriac pain (right upper quadrant) such as: [[Abdominal pain]], [[Chest pain|esophageal chest pain]],[[gastroesophageal reflux disease|gastroesophageal reflux disorder]], [[peptic ulcer|peptic ulcer disease]], non-ulcer [[dyspepsia]],[[hepatitis]], functional gallbladder disorder, [[sphincter of Oddi dysfunction]],[[appendicitis]], bile duct stricture, [[chronic pancreatitis]], [[irritable bowel syndrome]], [[coronary heart disease|ischemic heart disease]], [[pyelonephritis]], [[ureter|ureteral]] calculi and complications of gallstone disease include: [[cholecystitis|acute cholecystitis]], [[choledocholithiasis]], [[acute pancreatitis]], and acute [[cholangitis]].<ref name="pmid16844493">{{cite journal |vauthors=Portincasa P, Moschetta A, Palasciano G |title=Cholesterol gallstone disease |journal=Lancet |volume=368 |issue=9531 |pages=230–9 |year=2006 |pmid=16844493 |doi=10.1016/S0140-6736(06)69044-2 |url=}}</ref><ref name="pmid19524793">{{cite journal |vauthors=Center SA |title=Diseases of the gallbladder and biliary tree |journal=Vet. Clin. North Am. Small Anim. Pract. |volume=39 |issue=3 |pages=543–98 |year=2009 |pmid=19524793 |doi=10.1016/j.cvsm.2009.01.004 |url=}}</ref>
+Gallstone disease must be differentiated from other diseases that cause right upper quadrant pain including [[Gastroesophageal reflux disease|gastroesophageal reflux disorder]], [[peptic ulcer|peptic ulcer disease]],[[hepatitis]],[[sphincter of Oddi dysfunction]],[[appendicitis]], bile duct stricture, [[chronic pancreatitis]], [[irritable bowel syndrome]], [[coronary heart disease|ischemic heart disease]], [[pyelonephritis]], [[ureter|ureteral]] calculi and complications of gallstone disease include: [[cholecystitis|acute cholecystitis]], [[choledocholithiasis]], [[acute pancreatitis]], and acute [[cholangitis]].
 ==Differentiating Gallstone disease from other Diseases==
+* Gallstone disease can manifest in a variety of clinical forms.
-As Gallstone disease manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. The presence of biliary colic is an important diagnostic feature to distinguish between gallstones and non-biliary disorders. It has been shown that this feature is predictive of finding stones on imaging. <ref name="pmid7638565">{{cite journal |vauthors=Kraag N, Thijs C, Knipschild P |title=Dyspepsia--how noisy are gallstones? A meta-analysis of epidemiologic studies of biliary pain, dyspeptic symptoms, and food intolerance |journal=Scand. J. Gastroenterol. |volume=30 |issue=5 |pages=411–21 |year=1995 |pmid=7638565 |doi= |url=}}</ref>
+* The presence of biliary colic is an important diagnostic feature to distinguish between gallstones and non-biliary stone disorders.
-'''However, it is important to note that biliary colic concomitant in patients with other biliary disorders such as [[Cholecystitis|acute cholecystitis]], [[choledocholithiasis]], [[sphincter of Oddi dysfunction]], and functional gallbladder disorder.'''
+* Patients who present with biliary colic are more likely to have gallstones detected on imaging. <ref name="pmid7638565">{{cite journal |vauthors=Kraag N, Thijs C, Knipschild P |title=Dyspepsia--how noisy are gallstones? A meta-analysis of epidemiologic studies of biliary pain, dyspeptic symptoms, and food intolerance |journal=Scand. J. Gastroenterol. |volume=30 |issue=5 |pages=411–21 |year=1995 |pmid=7638565 |doi= |url=}}</ref>
+* '''However, it is important to note that biliary colic can be concomitant in patients with other biliary disorders such as [[Cholecystitis|acute cholecystitis]], [[choledocholithiasis]], [[sphincter of Oddi dysfunction]], and functional [[gallbladder]] disorder.'''<ref name="pmid16844493">{{cite journal |vauthors=Portincasa P, Moschetta A, Palasciano G |title=Cholesterol gallstone disease |journal=Lancet |volume=368 |issue=9531 |pages=230–9 |year=2006 |pmid=16844493 |doi=10.1016/S0140-6736(06)69044-2 |url=}}</ref><ref name="pmid19524793">{{cite journal |vauthors=Center SA |title=Diseases of the gallbladder and biliary tree |journal=Vet. Clin. North Am. Small Anim. Pract. |volume=39 |issue=3 |pages=543–98 |year=2009 |pmid=19524793 |doi=10.1016/j.cvsm.2009.01.004 |url=}}</ref>
-Laboratory studies can be helpful, along side clinical presentation in making a preliminary diagnosis:
-*Liver biochemical tests (serum [[aminotransferases]], total [[bilirubin]], [[alkaline phosphatase]]), which may be abnormal in patients with [[hepatitis]], biliary tract obstruction, or (less commonly) acute [[cholecystitis]]
-*Serum [[amylase]] and [[lipase]], which are elevated in [[acute pancreatitis]]
-*[[Complete blood count|Complete blood count,]] which may show an elevated [[White blood cell|white blood cell count]] in patients with acute [[cholecystitis]] or acute [[cholangitis]]
-*Urine analysis, which may show indicate a [[urinary tract infection]] or ureteral [[calculi]]<ref name="pmid23533021">{{cite journal |vauthors=Poupon R, Rosmorduc O, Boëlle PY, Chrétien Y, Corpechot C, Chazouillères O, Housset C, Barbu V |title=Genotype-phenotype relationships in the low-phospholipid-associated cholelithiasis syndrome: a study of 156 consecutive patients |journal=Hepatology |volume=58 |issue=3 |pages=1105–10 |year=2013 |pmid=23533021 |doi=10.1002/hep.26424 |url=}}</ref>
-Other tests that may be indicated depending upon the patient's symptoms and history including:
-*Upper [[endoscopy]] to look for [[Peptic ulcer|peptic ulcer disease]]
-*Endoscopic [[Medical ultrasonography|ultrasonography]] to look for [[chronic pancreatitis]]
-*[[Endoscopic retrograde cholangiopancreatography|Endoscopic retrograde cholangiopancreatography (ERCP)]] with [[sphincter of Oddi]] [[Pressure measurement|manometry]] to look for [[sphincter of Oddi dysfunction]]
-*[[HIDA scan|Cholescintigraphy]] with or without [[cholecystokinin]] (CCK)-stimulation to look for acute [[cholecystitis]] and functional gallbladder disorder, respectively
-*Testing for [[Coronary heart disease|ischemic heart disease]]
-*[[Esophageal motility study|Esophageal manometry]] to look for esophageal sources of chest pain, such as [[Diffuse esophageal spasm (patient information)|esophageal spasm]]<ref name="pmid15802102">{{cite journal |vauthors=Shaffer EA |title=Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? |journal=Curr Gastroenterol Rep |volume=7 |issue=2 |pages=132–40 |year=2005 |pmid=15802102 |doi= |url=}}</ref><ref name="pmid26895902">{{cite journal |vauthors=Julliard O, Hauters P, Possoz J, Malvaux P, Landenne J, Gherardi D |title=Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors |journal=Surg Endosc |volume=30 |issue=10 |pages=4539–43 |year=2016 |pmid=26895902 |doi=10.1007/s00464-016-4790-4 |url=}}</ref>
-To review a table of differential diagnoses for disease symptoms including [[jaundice]], [[abdominal pain]] and [[fever]], please click here:
 ==Differential diagnosis==
+The differential diagnosis of diseases presenting with [[abdominal pain]], [[fever]] and [[jaundice]] is discussed below.
 <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>
+'''[[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'''= [[Antimitochondrial antibodies|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>
 {| align="center"
 |-
@@ Line 60: / Line 45: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
 |-
-! rowspan="47" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal causes
+! rowspan="15" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal causes
-! colspan="1" rowspan="34" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Inflammatory causes
+! colspan="1" rowspan="15" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Inflammatory causes
-! rowspan="9" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pancreato-biliary disorders
+! rowspan="6" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pancreato-biliary disorders
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Acute suppurative cholangitis
+| 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" | +
@@ Line 73: / Line 58: @@
 | 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="center" |N
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * Abnormal [[LFT]]
-* WBC >10,000
+* [[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" |[[Ultrasound]] shows [[biliary]] [[dilatation]]/[[stents]]/[[tumor]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Septic shock occurs with features of [[SIRS]]
+| 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" | [[Cholangitis|Acute cholangitis]]
@@ Line 90: / Line 75: @@
 | 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="center" |N
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * Abnormal [[LFT]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[biliary]] dilatation/stents/tumor
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]] shows [[biliary]] [[dilatation]]/[[stents]]/[[tumor]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Biliary drainage ([[Endoscopic retrograde cholangiopancreatography|ERCP]]) + IV antibiotics
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Biliary]] drainage ([[Endoscopic retrograde cholangiopancreatography|ERCP]]) + IV [[antibiotics]]
 |-
 | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute cholecystitis|Acute cholecystitis]]
@@ Line 106: / Line 91: @@
 | 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="center" |Hypoactive
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * [[Hyperbilirubinemia]]
 * [[Leukocytosis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows gallstone and evidence of inflammation
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]] shows gallstone and evidence of [[inflammation]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]]
 |-
@@ Line 123: / Line 108: @@
 | 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="center" |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]]
+* [[Ultrasound]] shows evidence of [[inflammation]]
-* CT scan shows severity of pancreatitis
+* [[CT scan]] shows severity of [[pancreatitis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Pain radiation to back
+| 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" |−
-| 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]]
-* 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" |+
-| 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" |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]]
-|-
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Primary biliary cirrhosis]]
-| 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" | + in late presentation
-| 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 AMA level, abnormal [[LFTs]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 |-
 | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Primary sclerosing cholangitis]]
@@ Line 205: / Line 126: @@
 | 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="center" |N
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Increased liver enzymes
+* Increased [[liver enzymes]]
 * Increased [[IgM]], [[IgG]]4
 * [[Anti-neutrophil cytoplasmic antibody]] ([[p-ANCA]])
@@ Line 213: / Line 134: @@
 * [[Anti-smooth muscle antibody]] (Anti-Sm)
 * Anti-endothelial antibody
-* Anti-cardiolipin antibody
+* [[Anticardiolipin antibody|Anti-cardiolipin antibody]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |ERCP and MRCP shows
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Endoscopic retrograde cholangiopancreatography|ERCP]] and [[Magnetic resonance cholangiopancreatography|MRCP]] shows
 * Multiple segmental [[strictures]]
 * Mural irregularities
-* [[Biliary]] dilatation and diverticula
+* [[Biliary]] [[dilatation]] and [[diverticula]]
-* Distortion of biliary tree
+* Distortion of [[biliary tree]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |The risk of [[cholangiocarcinoma]] in patients with primary sclerosing cholangitis is 400 times higher than the risk in the general population.
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |The risk of [[cholangiocarcinoma]] in patients with [[primary sclerosing cholangitis]] is 400 times higher than the risk in the general population.
 |-
 | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cholelithiasis]]
@@ Line 231: / Line 152: @@
 | 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 to hyperactive for dislodged stone
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |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" |[[Ultrasound]] shows [[gallstone]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |Fatty food intolerance
 |-
-! colspan="1" rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Gastric causes
+! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gastric causes
-| 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" | −
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
-| 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" | + in perforated
-| 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" |
-* 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" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + 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="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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Esophageal]] [[manometry]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Gastric emptying studies
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[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" |−
-| 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" |-
-| 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" |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" |[[Gastrointestinal perforation]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
@@ Line 341: / Line 169: @@
 | 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/hypoactive
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Hyperactive/hypoactive
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* WBC> 10,000
+* [[WBC]]> 10,000
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |Air under [[diaphragm]] in upright [[CXR]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Hamman's sign]]
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Dumping syndrome]]
+! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intestinal causes
-| 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" |−
-| 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" |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
-|-
-! rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intestinal causes
-| 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" | +in pyogenic appendicitis
-| 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" | + 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" |Ultrasound shows evidence of [[inflammation]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], [[decreased appetite]]
-|-
-| 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" | −
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[Hematochezia]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + 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 and ultrasound shows evidence of inflammation
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of [[constipation]]
-|-
 | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Inflammatory bowel disease]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
@@ Line 409: / Line 186: @@
 | 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/ Hyperactive
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal/ Hyperactive
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * [[Anti-neutrophil cytoplasmic antibody]] ([[P-ANCA]]) in [[Ulcerative colitis]]
@@ Line 415: / Line 192: @@
 | 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:
+Extra [[Intestine|intestinal]] findings:
 * [[Uveitis]]
 * [[Arthritis]]
-|-
-| 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" | −
-| 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" |Tests done to exclude other diseases as it diagnosis of exclusion
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Tests done to exclude other diseases as it diagnosis of exclusion
-| 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" |[[Whipple's disease]]
@@ Line 448: / Line 206: @@
 | 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="center" |Normal
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * [[Thrombocytopenia]]
@@ Line 468: / Line 226: @@
 * [[Ascites]]
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Toxic megacolon]]
+! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatic causes
-| 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="left" |Hypoactive
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* [[Anemia]]
-*[[Leukocytosis]] especially in patients with [[Clostridium difficile infection|''Clostridium difficile'' infection]]
-*[[Hypoalbuminemia]]
-*[[Metabolic alkalosis]] associated with a poor [[prognosis]]
-*[[Metabolic acidosis]] secondary to [[ischemic colitis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan shows:
-*Dilated [[transverse colon]]
-*Loss of colonic haustrations
-*Segmental parietal thinning
-*[[Intraluminal]] soft-tissue masses
-[[Ultrasound]] shows:
-*Loss of haustra coli of the colon
-*Hypoechoic and thickened bowel walls with irregular internal margins in the [[sigmoid]] and descending colon
-*Prominent dilation of the transverse colon (>6 cm)
-* Insignificant dilation of ileal bowel loops (diameter >18 mm) with increased intraluminal gas and fluid
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tropical sprue]]
-| 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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Fat soluble vitamin deficiency
-* [[Hypoalbuminemia]]
-* Fecal stool test
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Barium studies show dilation and edema of mucosal folds
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Steatorrhea]]- 10-40 g/day (Normal=5 g/day)
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Celiac 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" | −
-| 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" |
-* [[IgA]] endomysial antibody
-* [[IgA]] [[tissue transglutaminase]] antibody
-* [[Anti-gliadin antibodies|Anti-gliadin antibody]]
-* Small bowel biopsy
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |USG
-* Bull’s eye or target pattern
-* Pseudokidney sign
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Gluten allergy
-|-
-| 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" |[[Hematochezia]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + 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" |-
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Normal
-* 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
-|-
-! rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatic causes
 | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis|Viral hepatitis]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
@@ Line 586: / Line 232: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in Hep A and E
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in [[Hepatitis|Hep A]] and [[Hepatitis|Hep E]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in fulminant hepatitis
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in fulminant [[Hepatitis|hepatitis]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +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="center" |Normal
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Abnormal LFTs
+* Abnormal [[LFTs]]
-* Viral serology
+* [[Viral]] [[serology]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |USG
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hep A and E have fecoral route of transmission and Hep B and C transmits via blood transfusion and sexual contact.
+* [[Ultrasound]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Hepatitis|Hep A]]and [[Hepatitis|Hep E]] have fecoral route of transmission and [[Hepatitis|Hep B]] and [[Hepatitis|Hep C]] transmits via [[blood transfusion]] and [[sexual contact]].
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver mass|Liver masses]]
@@ Line 608: / Line 255: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in [[Liver abscess]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in [[Liver abscess]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[CBC]]
+* [[LFTs]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* CBC
+* [[Ultrasound]]
-* LFTs
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |USG
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 |-
 | 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" |+
+| 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="center" |Normal/hypoactive
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* CBC
+* [[CBC]]
-* Blood cultures
+* [[Blood cultures]]
 * Abnormal [[Liver function test|liver function tests]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* US
+* [[Ultrasound]]
-* CT
+* [[CT]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatocellular carcinoma]]/Metastasis
 | 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="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
@@ Line 652: / Line 300: @@
 * Abnormal [[Liver function test|liver function tests]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* US
+* [[Ultrasound]]
-* CT
+* [[CT]]
-* Liver biopsy
+* [[Liver biopsy]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 Other symptoms:
@@ Line 669: / Line 317: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in liver failure leading to varices
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in [[liver failure]] leading to [[varices]]
 | 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="center" |Normal
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *Elevated [[Aspartate aminotransferase|serum aspartate aminotransferase]] and [[alanine aminotransferase]] levels may be more than five times the upper limit of the normal range.
 *Elevated serum [[alkaline phosphatase]] and [[Bilirubin|bilirubin levels]], decreased [[Albumin|serum albumin level]].
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Findings on [[CT scan]] suggestive of [[Budd-Chiari syndrome]] include:
-{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
-|-
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Findings on [[CT scan]] suggestive of Budd-Chiari syndrome include:
 *Early enhancement of the [[caudate lobe]] and [[central liver]] around the [[Inferior vena cavae|inferior vena cava]]
 *Delayed enhancement of the peripheral [[liver]] with accompanying central low density (flip-flop appearance)
 *Peripheral zones of the [[liver]] show reversed [[portal]] [[venous]] [[blood flow]]
 *In the [[chronic]] phase, there is [[caudate lobe]] enlargement and [[atrophy]] of the [[Liver|peripheral liver]] in affected areas
-|}
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ascitic tap|Ascitic fluid examination]] shows:
 *[[Total protein]] more than 2.5 g per deciliter
 *[[White blood cells]] are usually less than 500/μL.
-|-
-| 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" | + 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="center" |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
-* Impotence in males
-* Cardiomyopathy
-* Atherosclerosis
-* Hypopituitarism
-* Hypothyroidism
-* Extrahepatic cancer
-* Prone to specific infections
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cirrhosis|Cirrhosis]]
-| 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" |[[varices]]
-| 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" |
-* [[Hypoalbuminemia]]
-* Prolonged PT
-* Abnormal LFTs
-* [[Hyponatremia]]
-* [[Thrombocytopenia]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |USG
-* Nodular, shrunken liver
-* [[Ascites]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Stigmata of liver disease
-* Cruveilhier- Baumgarten murmur
 |-
 ! style="padding: 5px 5px; background: #DCDCDC;" align="center" | Peritoneal causes
@@ Line 747: / Line 339: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in cirrhotic patients
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in [[cirrhotic]] patients
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
@@ Line 753: / Line 345: @@
 | 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="center" |Hypoactive
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * Ascitic fluid [[PMN]]>250 cells/mm<small>³</small>
 * Culture: Positive for single organism
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound for evaluation of liver cirrhosis
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]] for evaluation of [[liver cirrhosis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-! colspan="2" rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Renal causes
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pyelonephritis
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Lumbar region
-| 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" |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" |
-*Renal punch positive
-|-
-| 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" | −
-| 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" |CT scan and ultrasound
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Colicky [[abdominal pain]]
-* [[Dysuria]]
-|-
-! colspan="2" rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Hollow Viscous Obstruction
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Small intestine 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" | −
-| 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" |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 abdonen
 | 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" | +in perforated cases
-| 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" | +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" | +
-| 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 [[bilirubin]] and [[alkaline phosphatase]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
-|-
-! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Vascular Disorders
-! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ischemic causes
-| 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" | + if bowel becomes gangrenous
-| 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" |[[Hematochezia]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + if bowel becomes gangrenous
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + 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, 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" | −
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Massive
-| 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" |Can lead to shock
-|-
-! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hemorrhagic causes
-| 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" | −
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Herald to massive
-| 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" | Massive
-| 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" |[[Anemia]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of [[trauma]]
-|-
-! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gynaecological Causes
-! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Tubal causes
-| 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" | −
-| 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 [[ESR]] and [[CRP]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset & severe pain with [[nausea and vomiting]]
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Salpingitis|Acute salpingitis]]
-| 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" | −
-| 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" |[[Leukocytosis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Pelvic ultrasound]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Vaginal discharge]]
-|-
-| 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" | −
-| 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 [[ESR]] and [[CRP]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]]
-|-
-! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pregnancy
-| 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" | −
-| 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 and [[vaginal bleeding]]
-|-
-! rowspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra-abdominal causes
-! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pulmonary disorders
-| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pleural empyema]]
-| 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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Thoracentesis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Chest X-ray]]
-* Pleural opacity
-USG
-* Localization of effusion
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Physical examination
-* Crackles
-* [[Egophony]]
-* Increased [[tactile fremitus]]
-|-
-| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pulmonary embolism
-| 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" |-
-| 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" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* ABGs
-* D-dimer
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* CXR
-* V/Q scan
-* Spiral [[CT pulmonary angiogram]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-! colspan="2" 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" |-
-| 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" |N/Hypoactive
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* ABGs
-* Eosinophilia
-* Pancytopenia
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
-* CXR
-* CT chest
-* Bronchoscopy
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
-|-
-! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cardiovascular disorders
-| colspan="2" 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" | −
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + 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" |
-* [[ECG]]
-* [[Cardiac enzymes]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Echocardiogram]]
-* Wall motion abnormality
-* Wall rupture
-* Septal rupture
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Complications:
-* [[Arrythmias]]
-* [[Mitral regurgitation]]
-* Ventricular wall rupture
-* Septal rupture
 |-
 |}
 |}
 </small>
-{|
+To review a differential diagnosis for abdominal pain, [[Abdominal pain differential diagnosis|click here]]
-|-
-|
-[[Image:Right_upper_quadrant.PNG|link=Right upper quadrant abdominal pain resident survival guide|339x339px]]
-|
-[[Image:Epigastric_quadrant_pain.PNG|link=Epigastric pain resident survival guide|179x179px]]
-|
-[[Image:Left_upper_quadrant.PNG|link=Left upper quadrant abdominal pain resident survival guide|329x329px]]
-|-
-|
-[[Image:Right_flank_quadrant.PNG|link=Right flank pain resident survival guide|338x338px]]
-|
-[[Image:Umbilical_pain.PNG|link=Umbilical region pain resident survival guide|165x165px]]
-|
-[[Image:Left_flank_quadrant.PNG|link=Left flank quadrant abdominal pain resident survival guide|335x335px]]
-|-
-|
-[[Image:Right_lower_quadrant.PNG|link=Right lower quadrant abdominal pain resident survival guide|338x338px]]
-|
-[[Image:Hypogastric.PNG|link=Hypogastric pain resident survival guide|199x199px]]
-|
-[[Image:Left_lower_quadrant.PNG|link=Left lower quadrant abdominal pain resident survival guide|335x335px]]
-|}
 ==References==
 {{Reflist|2}}
+{{WH}}
+{{WS}}
 [[Category:Gastroenterology]]
 [[Category:Hepatology]]
 [[Category:Surgery]]
-[[Category:Primary care]]
-{{WH}}
-{{WS}}
-|}