Kidney stone differential diagnosis: Difference between revisions

Latest revision as of 22:27, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2] Amandeep Singh M.D.[3]

Overview

Nephrolithiasis should be differentiated from other conditions presenting with acute flank or upper abdominal pain, hematuria, nausea and vomiting.

Differentiating Nephrolithiasis from other Diseases

Nephrolithiasis should be differentiated from other conditions presenting with acute flank or upper abdominal pain, hematuria, nausea and vomiting. The differentials include the following:^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]^[16]^[17]^[18]^[19]^[20]^[21]^[22]^[23]^[24]^[25]^[26]^[27]^[28]^[29]^[30]^[31]^[32]^[33]^[34]

Category	Disease	Risk factors	Symptoms					Signs						Paraclinical studies
Category	Disease	Risk factors	Pain	N/V	Anorexia	Constipation	Urinary symptoms	Fever	HR	BP	Tenderness	Abdominopelvic exam	Rectal exam	CBC	Urinalysis	BUN	Cr	Urine Beta−hCG	LFT	Serum amylase & lipase	CT
Renal Pathology	Nephrolithiasis	Inadequate dietary calcium intake Renal tubular acidosis Infection	Flank/back pain radiating to groin	+	±	−	+	−	↑	Nl	−	Nl	Nl	Nl	Hematuria Hypercalciuria Hyperoxaluria Cystinuria	Nl	Nl	−	Nl	Nl	Radiolucent stone
	Pyelonephritis	Urinary tract obstruction Pregnancy Urinary instrumentation	Costovertebral angle	+	±	−	+	+	↑	↓	Positive renal punch sign Costovertebral angle tenderness	Urethritis Vaginitis	Nl	Leukocytosis	Microscopic hematuria Pyuria Positive leukocyte esterase	Nl	Nl	Might be +	Nl	Nl	Decreased contrast uptake Foci from abscess pockets
	Renal infarct	Sickle cell disease or trait Trauma	Flank pain	+	−	−	−	+	↑	↑	−	Nl	Nl	Leukocytosis	Hematuria Proteinuria	Nl to ↑	Nl	−	Nl	Nl	Decreased contrast uptake
	Renal papillary necrosis	Analgesic use Sickle cell disease Tuberculosis Cirrhosis Diabetes Vasculitis Renal vein thrombosis	Flank pain	−	−	−	+	+	±	↑	−	Nl	Nl	Nl	Bacteriuria Pyuria Microscopic hematuria	Nl to ↑	Nl	−	Nl	Nl	Blunted renal calyces Non−enhanced lesions surrounded by rings of excreted contrast material Hyperattenuated medullary calcifications
	Renal cell carcinoma	History of smoking Von−Hippel Lindau disease	Flank pain	+	+	±	−	−	−	↑	−	Flank mass	Nl	Anemia	Microscopic hematuria Renal cell casts Urinary aquaporin−1 (AQP1) and adipophilin (ADFP)	Nl	Nl	−	Nl	Nl	Soft tissue attenuation Calcification and necrosis Homogenous to irregular contrast enhancement
	Urethral stricture	Prior urinary tract surgery Congenital Urinary catheterization Direct penile trauma	−	−	−	−	+	−	−	Nl	−	Nl	Nl	−	Hematuria	Nl to ↑	Nl	−	Nl	Nl	Nl
Category	Disease	Risk factors	Pain	N/V	Anorexia	Constipation	Urinary symptoms	Fever	HR	BP	Tenderness	Abdominopelvic exam	Rectal exam	CBC	Urinalysis	BUN	Cr	Urine Beta−hCG	LFT	Serum amylase & lipase	CT
Gynecological pathology	Pelvic inflammatory disease	Cesarean section Septic abortion Tuberculosis Actinomycosis	Right/left upper quadrant	−	+	−	+	+	+	↓	Cervical motion tenderness Adnexal tenderness	Foul smelling vaginal/urtetheral discharge	Nl	Leukocytosis	Bacteriuria (Neisseria gonorrhoeae or Chlamydia trachomatis, polymicrobial) Pyuria	Nl	Nl	Might be +	Nl	Nl	Thickening of the uterosacral ligaments Periovarian stranding Enhancement of the adjacent peritoneum
	Ovarian torsion	NA	Acute unilateral poorly localized lower abdominal sharp colicky pain aggravated by walking	+	−	−	−	−	+	Nl	−	Adnexal tenderness Adnexal mass	Nl	−	−	−	−	−	Nl	Nl	Twisted and distended ovarian pedicle Enlarged ovary (>4.0 cm)
	Ectopic pregnancy	History of previous ectopic pregnancy Tubal surgery Intrauterine device usage History of pelvic surgery Increased maternal age Cigarette smoking	Lower abdominal Unilateral shoulder or neck pain (referred)	+	+	−	+	−	+	↓ (if ruptured)	Positive abdominal tenderness (if ruptured)	Vaginal bleeding	Nl	Low platelet distribution width (decreased platelet activation) Monocytosis	−	−	−	+	Might be abnormal	Nl	NA
Category	Disease	Risk factors	Pain	N/V	Anorexia	Constipation	Urinary symptoms	Fever	HR	BP	Tenderness	Abdominopelvic exam	Rectal exam	CBC	Urinalysis	BUN	Cr	Urine Beta−hCG	LFT	Serum amylase & lipase	CT
Prostate pathology	Prostatitis	Bacterial infection Prior history of prostatitis Urinary catheterization	Perineal pain Lower back pain Suprapubic pain	−	−	−	+	+	+	Nl	−	Nl	Enlarged prostate Rectal pain	Leukocytosis	Bacteriuria Pyuria Microscopic hematuria	−	−	−	Nl	Nl	Edema of the prostate gland with diffuse enlargement
Prostate pathology	Prostatic cancer	Family history of prostate cancer Germline mutation of HOXB13 Black ethnicity Age > 50 years	−	−	+	−	+	−	−	Nl	−	Nl	Enlarged prostate Firm and hard	Nl	Hematuria Positive prostate specific antigen High levels of TMPRSS2:ERG and PCA3	Nl	Nl	−	Nl	Nl	Focal areas of mass−like enhancement in the peripheral prostate Calcifications
Testicular pathology	Testicular torsion	Age 12 − 16 years Family history of testicular torsion Prematurity Undescended testes	Sudden onset unilateral testicular pain	+	±	−	±	−	+	Nl	−	Absent cremasteric reflex Testicle may be swollen, tender, and high−riding, with an abnormal transverse lie.	Nl	Nl	−	Nl	Nl	−	Nl	Nl	Doppler ultrasound > CT scan for diagnosis (absence of blood flow in the affected testis)
Testicular pathology	Orchitis	Unprotected sexual intercourse Mumps, coxsackie virus infection Congenital abnornmalities Prostatic hypertrophy or calculi	Abrupt onset of testicular pain	+	−	−	±	+	+	Nl	−	Testicular swelling and tenderness Normal cremasteric reflex	Nl	Leukocytosis	−	Nl	Nl	−	Nl	Nl	Ultrasound > CT scan for diagnosis (testicular masses or swollen testicles with hypoechoic and hypervascular areas)
Category	Disease	Risk factors	Pain	N/V	Anorexia	Constipation	Urinary symptoms	Fever	HR	BP	Tenderness	Abdominopelvic exam	Rectal exam	CBC	Urinalysis	BUN	Cr	Urine Beta−hCG	LFT	Serum amylase & lipase	CT
Abdominal pathology	Cholecystitis	Female gender Obesity Pregnancy Rapid weight loss Total parenteral nutrition	Right upper abdominal quadrant pain Flank pain	+	+	−	−	+	+	Nl	−	Nl	Nl	Leukocytosis	Bilirubin (pigment) stones Cholesterol stones	Nl	Nl	−	Might be abnormal	Might be abnormal	Gallbladder distention Wall thickening Pericholecystic fat stranding or fluid Gallstones
	Appendicitis	Adolescents Diet low in fiber and high in refined carbohydrates	Pain in umblical area Radiating to right lower abdominal quadrant	+	+	−	±	+	+	Nl	+	Nl	Nl	Leukocytosis	−	Nl	Nl	−	Nl	Abnormal (if perforation)	Appendiceal wall thickening Phlegmon Abscess Adenopathy
	Diverticulitis	Diverticulosis Low fiber diet Old age	Left lower abdominal quadrant	+	+	+	−	+	+	Nl	−	Nl	Bleeding Rectal mass Rectal tenderness	Leukocytosis	−	Nl	Nl	−	Nl	Abnormal (if perforation)	Colonic wall thickening Pericolic fat stranding
	Abdominal aortic aneurysm	Cigarette smoking Hypertension	Epigastric pain Deep boring pain in the back May radiate to flank	−	−	−	−	−	+	Nl	Positive abdominal tenderness (if rupture)	Pulsatile abdominal mass	Nl	−	−	Nl	Nl	−	Nl	Nl	CT scan accurately predict the aneurysmal size
	Disease	Risk factors	Pain	N/V	Anorexia	Constipation	Urinary symptoms	Fever	HR	BP	Tenderness	Abdominopelvic exam	Rectal exam	CBC	Urinalysis	BUN	Cr	Urine Beta−hCG	LFT	Serum amylase & lipase	CT
	Portal vein thrombosis	Coagulopathies Oral contraceptive use Cirrhosis Pregnancy and post−partum	Abdominal or lumbar pain	+	+	−	−	+	+	↓	Positive abdominal tenderness (if bowel ischemia or infarction)	Nl	Hematochezia	Anemia Thrombocytopenia	−	Nl	Nl	−	Might be abnormal	Abnormal (if bowel infarction, perforation)	Hyperdense thrombus on non−contrast CT Non−enhancing defect of bland thrombus on contrast CT
	Duodenal ulcer	Helicobacter pylori infection Tobacco smoking NSAID use EtOH use	Epigastric pain which relieved by intake of food	+	−	−	−	+	+	↓	Positive abdominal tenderness (if perforation)	Nl	Melena	Anemia	−	Nl	Nl	−	Nl	Abnormal (if bowel perforation)	Endoscopy > CT scan for diagnosis
	Ischemic colitis	Advanced age Hemodialysis Hypertension Diabetes mellitus	Acute−onset abdominal cramping	+	+	+	−	+	+	↑ or ↓ (if necrosis or sepsis)	Positive abdominal tenderness (if transmural necrosis)	Nl	Hematochezia	Leukocytosis (if necrosis) Anemia (if perforation and bleeding)	−	Nl to ↑	Nl	−	Nl	Abnormal (if bowel perforation)	Bowel wall thickening Thumbprinting Double halo or target sign Submucosal edema or hemorrhage Pneumatosis coli (if infarction)
Category	Disease	Risk factors	Pain	N/V	Anorexia	Constipation	Urinary symptoms	Fever	HR	BP	Tenderness	Abdominopelvic exam	Rectal exam	CBC	Urinalysis	BUN	Cr	Urine Beta−hCG	LFT	Serum amylase & lipase	CT

References

↑ Worcester EM, Coe FL (June 2008). "Nephrolithiasis". Prim. Care. 35 (2): 369–91, vii. doi:10.1016/j.pop.2008.01.005. PMC 2518455. PMID 18486720.
↑ Semins MJ, Matlaga BR (February 2010). "Medical evaluation and management of urolithiasis". Ther Adv Urol. 2 (1): 3–9. doi:10.1177/1756287210369121. PMC 3126068. PMID 21789078.
↑ Venkatesh L, Hanumegowda RK (June 2017). "Acute Pyelonephritis - Correlation of Clinical Parameter with Radiological Imaging Abnormalities". J Clin Diagn Res. 11 (6): TC15–TC18. doi:10.7860/JCDR/2017/27247.10033. PMC 5535453. PMID 28764263.
↑ Garin EH, Olavarria F, Araya C, Broussain M, Barrera C, Young L (July 2007). "Diagnostic significance of clinical and laboratory findings to localize site of urinary infection". Pediatr. Nephrol. 22 (7): 1002–6. doi:10.1007/s00467-007-0465-7. PMID 17375337.
↑ Lee DG, Jeon SH, Lee CH, Lee SJ, Kim JI, Chang SG (April 2009). "Acute pyelonephritis: clinical characteristics and the role of the surgical treatment". J. Korean Med. Sci. 24 (2): 296–301. doi:10.3346/jkms.2009.24.2.296. PMC 2672131. PMID 19399273.
↑ Saeed K (2012). "Renal infarction". Int J Nephrol Renovasc Dis. 5: 119–23. doi:10.2147/IJNRD.S33768. PMC 3437809. PMID 22969301.
↑ Mahamid M, Francis A, Abid A, Awawde M, Abu-Elhija O (2014). "Embolic renal infarction mimicking renal colic". Int J Nephrol Renovasc Dis. 7: 157–9. doi:10.2147/IJNRD.S59745. PMC 4011809. PMID 24812524.
↑ Korzets Z, Plotkin E, Bernheim J, Zissin R (October 2002). "The clinical spectrum of acute renal infarction". Isr. Med. Assoc. J. 4 (10): 781–4. PMID 12389340.
↑ Brix AE (2002). "Renal papillary necrosis". Toxicol Pathol. 30 (6): 672–4. doi:10.1080/01926230290166760. PMID 12512867.
↑ Eknoyan G, Qunibi WY, Grissom RT, Tuma SN, Ayus JC (March 1982). "Renal papillary necrosis: an update". Medicine (Baltimore). 61 (2): 55–73. PMID 7038374.
↑ Ng CS, Wood CG, Silverman PM, Tannir NM, Tamboli P, Sandler CM (October 2008). "Renal cell carcinoma: diagnosis, staging, and surveillance". AJR Am J Roentgenol. 191 (4): 1220–32. doi:10.2214/AJR.07.3568. PMID 18806169.
↑ Ares Valdés Y, Amador Sandoval B, Morales JC, Alonso Domínguez F, Carballo Velásquez L, Fragas Valdés R, Shou Rodríguez A (September 2004). "[The role of CT scan in the diagnosis of renal cell carcinoma]". Arch. Esp. Urol. (in Spanish; Castilian). 57 (7): 737–42. PMID 15536955.
↑ Leveridge MJ, Bostrom PJ, Koulouris G, Finelli A, Lawrentschuk N (June 2010). "Imaging renal cell carcinoma with ultrasonography, CT and MRI". Nat Rev Urol. 7 (6): 311–25. doi:10.1038/nrurol.2010.63. PMID 20479778.
↑ Tritschler S, Roosen A, Füllhase C, Stief CG, Rübben H (March 2013). "Urethral stricture: etiology, investigation and treatments". Dtsch Arztebl Int. 110 (13): 220–6. doi:10.3238/arztebl.2013.0220. PMC 3627163. PMID 23596502.
↑ Mundy AR, Andrich DE (January 2011). "Urethral strictures". BJU Int. 107 (1): 6–26. doi:10.1111/j.1464-410X.2010.09800.x. PMID 21176068.
↑ Maciejewski C, Rourke K (February 2015). "Imaging of urethral stricture disease". Transl Androl Urol. 4 (1): 2–9. doi:10.3978/j.issn.2223-4683.2015.02.03. PMC 4708283. PMID 26816803.
↑ Soper DE (August 2010). "Pelvic inflammatory disease". Obstet Gynecol. 116 (2 Pt 1): 419–28. doi:10.1097/AOG.0b013e3181e92c54. PMID 20664404.
↑ Paavonen J (October 1998). "Pelvic inflammatory disease. From diagnosis to prevention". Dermatol Clin. 16 (4): 747–56, xii. PMID 9891675.
↑ Lee MH, Moon MH, Sung CK, Woo H, Oh S (December 2014). "CT findings of acute pelvic inflammatory disease". Abdom Imaging. 39 (6): 1350–5. doi:10.1007/s00261-014-0158-1. PMID 24802548.
↑ Eggert J, Sundquist K, van Vuuren C, Fianu-Jonasson A (October 2006). "The clinical diagnosis of pelvic inflammatory disease--reuse of electronic medical record data from 189 patients visiting a Swedish university hospital emergency department". BMC Womens Health. 6: 16. doi:10.1186/1472-6874-6-16. PMC 1624808. PMID 17054801.
↑ Washington C, Carmichael JC (December 2012). "Management of ischemic colitis". Clin Colon Rectal Surg. 25 (4): 228–35. doi:10.1055/s-0032-1329534. PMC 3577613. PMID 24294125.
↑ Chawla YK, Bodh V (March 2015). "Portal vein thrombosis". J Clin Exp Hepatol. 5 (1): 22–40. doi:10.1016/j.jceh.2014.12.008. PMC 4415192. PMID 25941431.
↑ "Imaging of Abdominal Aortic Aneurysms - - American Family Physician".
↑ Aggarwal S, Qamar A, Sharma V, Sharma A (2011). "Abdominal aortic aneurysm: A comprehensive review". Exp Clin Cardiol. 16 (1): 11–5. PMC 3076160. PMID 21523201.
↑ Destigter KK, Keating DP (August 2009). "Imaging update: acute colonic diverticulitis". Clin Colon Rectal Surg. 22 (3): 147–55. doi:10.1055/s-0029-1236158. PMC 2780264. PMID 20676257.
↑ Hameed AM, Lam VW, Pleass HC (February 2015). "Significant elevations of serum lipase not caused by pancreatitis: a systematic review". HPB (Oxford). 17 (2): 99–112. doi:10.1111/hpb.12277. PMC 4299384. PMID 24888393.
↑ "Imaging for Suspected Appendicitis - - American Family Physician".
↑ "CT Findings of Acute Cholecystitis and Its Complications : American Journal of Roentgenology : Vol. 194, No. 6 (AJR)".
↑ "Epididymitis and Orchitis: An Overview - - American Family Physician".
↑ Jia JB, Houshyar R, Verma S, Uchio E, Lall C (January 2016). "Prostate cancer on computed tomography: A direct comparison with multi-parametric magnetic resonance imaging and tissue pathology". Eur J Radiol. 85 (1): 261–267. doi:10.1016/j.ejrad.2015.10.013. PMID 26526901.
↑ Bratt O, Lilja H (January 2015). "Serum markers in prostate cancer detection". Curr Opin Urol. 25 (1): 59–64. doi:10.1097/MOU.0000000000000128. PMC 4315142. PMID 25393274.
↑ "Prostate Cancer (Prostate Carcinoma): Symptoms - National Library of Medicine - PubMed Health".
↑ Eskicioğlu F, Özdemir AT, Turan GA, Gür EB, Kasap E, Genç M (November 2014). "The efficacy of complete blood count parameters in the diagnosis of tubal ectopic pregnancy". Ginekol. Pol. 85 (11): 823–7. PMID 25675798.
↑ Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW (October 2011). "Diagnosis and management of ectopic pregnancy". J Fam Plann Reprod Health Care. 37 (4): 231–40. doi:10.1136/jfprhc-2011-0073. PMC 3213855. PMID 21727242.

[pmid18486720-1] Worcester EM, Coe FL (June 2008). "Nephrolithiasis". Prim. Care. 35 (2): 369–91, vii. doi:10.1016/j.pop.2008.01.005. PMC 2518455. PMID 18486720.

[pmid21789078-2] Semins MJ, Matlaga BR (February 2010). "Medical evaluation and management of urolithiasis". Ther Adv Urol. 2 (1): 3–9. doi:10.1177/1756287210369121. PMC 3126068. PMID 21789078.

[pmid28764263-3] Venkatesh L, Hanumegowda RK (June 2017). "Acute Pyelonephritis - Correlation of Clinical Parameter with Radiological Imaging Abnormalities". J Clin Diagn Res. 11 (6): TC15–TC18. doi:10.7860/JCDR/2017/27247.10033. PMC 5535453. PMID 28764263.

[pmid17375337-4] Garin EH, Olavarria F, Araya C, Broussain M, Barrera C, Young L (July 2007). "Diagnostic significance of clinical and laboratory findings to localize site of urinary infection". Pediatr. Nephrol. 22 (7): 1002–6. doi:10.1007/s00467-007-0465-7. PMID 17375337.

[pmid19399273-5] Lee DG, Jeon SH, Lee CH, Lee SJ, Kim JI, Chang SG (April 2009). "Acute pyelonephritis: clinical characteristics and the role of the surgical treatment". J. Korean Med. Sci. 24 (2): 296–301. doi:10.3346/jkms.2009.24.2.296. PMC 2672131. PMID 19399273.

[pmid22969301-6] Saeed K (2012). "Renal infarction". Int J Nephrol Renovasc Dis. 5: 119–23. doi:10.2147/IJNRD.S33768. PMC 3437809. PMID 22969301.

[pmid24812524-7] Mahamid M, Francis A, Abid A, Awawde M, Abu-Elhija O (2014). "Embolic renal infarction mimicking renal colic". Int J Nephrol Renovasc Dis. 7: 157–9. doi:10.2147/IJNRD.S59745. PMC 4011809. PMID 24812524.

[pmid12389340-8] Korzets Z, Plotkin E, Bernheim J, Zissin R (October 2002). "The clinical spectrum of acute renal infarction". Isr. Med. Assoc. J. 4 (10): 781–4. PMID 12389340.

[pmid12512867-9] Brix AE (2002). "Renal papillary necrosis". Toxicol Pathol. 30 (6): 672–4. doi:10.1080/01926230290166760. PMID 12512867.

[pmid7038374-10] Eknoyan G, Qunibi WY, Grissom RT, Tuma SN, Ayus JC (March 1982). "Renal papillary necrosis: an update". Medicine (Baltimore). 61 (2): 55–73. PMID 7038374.

[pmid18806169-11] Ng CS, Wood CG, Silverman PM, Tannir NM, Tamboli P, Sandler CM (October 2008). "Renal cell carcinoma: diagnosis, staging, and surveillance". AJR Am J Roentgenol. 191 (4): 1220–32. doi:10.2214/AJR.07.3568. PMID 18806169.

[pmid15536955-12] Ares Valdés Y, Amador Sandoval B, Morales JC, Alonso Domínguez F, Carballo Velásquez L, Fragas Valdés R, Shou Rodríguez A (September 2004). "[The role of CT scan in the diagnosis of renal cell carcinoma]". Arch. Esp. Urol. (in Spanish; Castilian). 57 (7): 737–42. PMID 15536955.

[pmid20479778-13] Leveridge MJ, Bostrom PJ, Koulouris G, Finelli A, Lawrentschuk N (June 2010). "Imaging renal cell carcinoma with ultrasonography, CT and MRI". Nat Rev Urol. 7 (6): 311–25. doi:10.1038/nrurol.2010.63. PMID 20479778.

[pmid23596502-14] Tritschler S, Roosen A, Füllhase C, Stief CG, Rübben H (March 2013). "Urethral stricture: etiology, investigation and treatments". Dtsch Arztebl Int. 110 (13): 220–6. doi:10.3238/arztebl.2013.0220. PMC 3627163. PMID 23596502.

[pmid21176068-15] Mundy AR, Andrich DE (January 2011). "Urethral strictures". BJU Int. 107 (1): 6–26. doi:10.1111/j.1464-410X.2010.09800.x. PMID 21176068.

[pmid26816803-16] Maciejewski C, Rourke K (February 2015). "Imaging of urethral stricture disease". Transl Androl Urol. 4 (1): 2–9. doi:10.3978/j.issn.2223-4683.2015.02.03. PMC 4708283. PMID 26816803.

[pmid20664404-17] Soper DE (August 2010). "Pelvic inflammatory disease". Obstet Gynecol. 116 (2 Pt 1): 419–28. doi:10.1097/AOG.0b013e3181e92c54. PMID 20664404.

[pmid9891675-18] Paavonen J (October 1998). "Pelvic inflammatory disease. From diagnosis to prevention". Dermatol Clin. 16 (4): 747–56, xii. PMID 9891675.

[pmid24802548-19] Lee MH, Moon MH, Sung CK, Woo H, Oh S (December 2014). "CT findings of acute pelvic inflammatory disease". Abdom Imaging. 39 (6): 1350–5. doi:10.1007/s00261-014-0158-1. PMID 24802548.

[pmid17054801-20] Eggert J, Sundquist K, van Vuuren C, Fianu-Jonasson A (October 2006). "The clinical diagnosis of pelvic inflammatory disease--reuse of electronic medical record data from 189 patients visiting a Swedish university hospital emergency department". BMC Womens Health. 6: 16. doi:10.1186/1472-6874-6-16. PMC 1624808. PMID 17054801.

[pmid24294125-21] Washington C, Carmichael JC (December 2012). "Management of ischemic colitis". Clin Colon Rectal Surg. 25 (4): 228–35. doi:10.1055/s-0032-1329534. PMC 3577613. PMID 24294125.

[pmid25941431-22] Chawla YK, Bodh V (March 2015). "Portal vein thrombosis". J Clin Exp Hepatol. 5 (1): 22–40. doi:10.1016/j.jceh.2014.12.008. PMC 4415192. PMID 25941431.

[urlImaging_of_Abdominal_Aortic_Aneurysms_-_-_American_Family_Physician-23] "Imaging of Abdominal Aortic Aneurysms - - American Family Physician".

[pmid21523201-24] Aggarwal S, Qamar A, Sharma V, Sharma A (2011). "Abdominal aortic aneurysm: A comprehensive review". Exp Clin Cardiol. 16 (1): 11–5. PMC 3076160. PMID 21523201.

[pmid20676257-25] Destigter KK, Keating DP (August 2009). "Imaging update: acute colonic diverticulitis". Clin Colon Rectal Surg. 22 (3): 147–55. doi:10.1055/s-0029-1236158. PMC 2780264. PMID 20676257.

[pmid24888393-26] Hameed AM, Lam VW, Pleass HC (February 2015). "Significant elevations of serum lipase not caused by pancreatitis: a systematic review". HPB (Oxford). 17 (2): 99–112. doi:10.1111/hpb.12277. PMC 4299384. PMID 24888393.

[urlImaging_for_Suspected_Appendicitis_-_-_American_Family_Physician-27] "Imaging for Suspected Appendicitis - - American Family Physician".

[urlCT_Findings_of_Acute_Cholecystitis_and_Its_Complications_:_American_Journal_of_Roentgenology_:_Vol._194,_No._6_(AJR)-28] "CT Findings of Acute Cholecystitis and Its Complications : American Journal of Roentgenology : Vol. 194, No. 6 (AJR)".

[urlEpididymitis_and_Orchitis:_An_Overview_-_-_American_Family_Physician-29] "Epididymitis and Orchitis: An Overview - - American Family Physician".

[pmid26526901-30] Jia JB, Houshyar R, Verma S, Uchio E, Lall C (January 2016). "Prostate cancer on computed tomography: A direct comparison with multi-parametric magnetic resonance imaging and tissue pathology". Eur J Radiol. 85 (1): 261–267. doi:10.1016/j.ejrad.2015.10.013. PMID 26526901.

[pmid25393274-31] Bratt O, Lilja H (January 2015). "Serum markers in prostate cancer detection". Curr Opin Urol. 25 (1): 59–64. doi:10.1097/MOU.0000000000000128. PMC 4315142. PMID 25393274.

[urlProstate_Cancer_(Prostate_Carcinoma):_Symptoms_-_National_Library_of_Medicine_-_PubMed_Health-32] "Prostate Cancer (Prostate Carcinoma): Symptoms - National Library of Medicine - PubMed Health".

[pmid25675798-33] Eskicioğlu F, Özdemir AT, Turan GA, Gür EB, Kasap E, Genç M (November 2014). "The efficacy of complete blood count parameters in the diagnosis of tubal ectopic pregnancy". Ginekol. Pol. 85 (11): 823–7. PMID 25675798.

[pmid21727242-34] Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW (October 2011). "Diagnosis and management of ectopic pregnancy". J Fam Plann Reprod Health Care. 37 (4): 231–40. doi:10.1136/jfprhc-2011-0073. PMC 3213855. PMID 21727242.

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-| align="center" style="background:#F5F5F5;" + |
+| align="left" style="background:#F5F5F5;" + |
 * Edema of the [[prostate gland]] with diffuse enlargement
 |-
 ! align="center" style="background:#DCDCDC;" + |[[Prostatic cancer]]
 | align="left" style="background:#F5F5F5;" + |
-* [[Family history]] of [[Prostate cancer|prostate cance]]<nowiki/>r (1st degree relatives)
+* [[Family history]] of [[Prostate cancer|prostate cancer]]
-* [[Germline mutation]] of [[HOXB13]] (G84E variant)
+* [[Germline mutation]] of [[HOXB13]]
 * Black ethnicity
 * Age > 50 years
@@ Line 428: / Line 428: @@
 * Enlarged [[prostate]]
 * Firm and hard
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
 | align="left" style="background:#F5F5F5;" + |
 * [[Hematuria]]
-* Positive [[prostate specific antigen]] (PSA)
+* Positive [[prostate specific antigen]]
 * High levels of [[TMPRSS2]]:ERG and [[PCA3]]
-| align="center" style="background:#F5F5F5;" + |
+| align="center" style="background:#F5F5F5;" + |Nl
-| align="center" style="background:#F5F5F5;" + |
+| align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |−
 | align="center" style="background:#F5F5F5;" + |Nl
@@ Line 446: / Line 446: @@
 | align="left" style="background:#F5F5F5;" + |
 * Age 12 − 16 years
-* Previous history of [[testicular torsion]]
 * [[Family history]] of [[testicular torsion]]
 * [[Prematurity]]
 * [[Undescended testes]]
-* [[Low birth weight]]
 | align="left" style="background:#F5F5F5;" + |
 * Sudden onset unilateral [[testicular pain]]
@@ Line 464: / Line 462: @@
 * Absent [[cremasteric reflex]]
 * [[Testicle]] may be swollen, tender, and high−riding, with an abnormal transverse lie.
+| align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |−
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
-| align="center" style="background:#F5F5F5;" + |−
 | align="center" style="background:#F5F5F5;" + |−
 | align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |Nl
 | align="left" style="background:#F5F5F5;" + |
-* [[Doppler ultrasound]] > [[Computed tomography|CT scan]] for diagnosis (abscence of [[blood]] flow in the affected [[Testicle|testis]])
+* [[Doppler ultrasound]] > [[Computed tomography|CT scan]] for diagnosis (absence of [[blood]] flow in the affected [[Testicle|testis]])
 |-
 ! align="center" style="background:#DCDCDC;" + |[[Orchitis]]
@@ Line 479: / Line 477: @@
 * Unprotected sexual intercourse
 * [[Mumps]], [[Coxsackie virus|coxsackie]] virus infection
-* Concurrent [[epididymitis]]
 * [[Congenital disorder|Congenital abnornmalities]]
-* [[Prostatitis]]
 * [[Prostatic hypertrophy]] or [[calculi]]
 | align="left" style="background:#F5F5F5;" + |
@@ Line 500: / Line 496: @@
 * [[Leukocytosis]]
 | align="center" style="background:#F5F5F5;" + |−
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |−
 | align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |Nl
 | align="left" style="background:#F5F5F5;" + |
-* [[Ultrasound]] > [[Computed tomography|CT scan]] for diagnosis ([[Testicular masses]] or swollen [[testicles]] with hypoechoic and hypervascular areas)
+* [[Ultrasound]] > [[Computed tomography|CT scan]] for diagnosis ([[Scrotal mass|testicular masses]] or swollen [[testicles]] with hypoechoic and hypervascular areas)
 |-
 ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Category
@@ Line 536: / Line 532: @@
 * Female gender
 * [[Obesity]]
-* [[Pregnancy]] (increased [[progesterone]] promotes biliary stasis)
+* [[Pregnancy]]
 * Rapid [[weight loss]]
-* [[Oral contraceptive|Oral contraceptive use]]
-* Increasing age
 * [[Total parenteral nutrition]]
 | align="left" style="background:#F5F5F5;" + |
@@ Line 559: / Line 553: @@
 * [[Bilirubin]] (pigment) stones
 * [[Cholesterol]] stones
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |−
 | align="center" style="background:#F5F5F5;" + |Might be abnormal
@@ Line 567: / Line 561: @@
 * [[Gallbladder]] distention
 * Wall thickening
-* Mucosal hyperenhancement,
 * Pericholecystic fat stranding or fluid
 * [[Gallstones]]
@@ Line 573: / Line 566: @@
 ! align="center" style="background:#DCDCDC;" + |[[Appendicitis]]
 | align="left" style="background:#F5F5F5;" + |
-* Male gender
 * [[Adolescent|Adolescents]]
 * Diet low in fiber and high in refined [[carbohydrates]]
-* History of [[appendicitis]] in first degree relatives
 | align="left" style="background:#F5F5F5;" + |
 * [[Pain]] in umblical area
@@ Line 593: / Line 584: @@
 * Leukocytosis
 | align="center" style="background:#F5F5F5;" + |−
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |−
 | align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + | Abnormal (if [[Perforation of inflamed diverticulum|perforation]])
 | align="left" style="background:#F5F5F5;" + |
-* Larger than 6 mm in diameter,
 * [[Vermiform appendix|Appendiceal]] wall thickening
-* Wall enhancement after contrast media infusion
-* [[Inflammatory]] fat stranding
 * [[Phlegmon]]
-* Free fluid
-* Free air bubbles
 * [[Abscess]]
 * [[Adenopathy]]
@@ Line 632: / Line 618: @@
 * [[Leukocytosis]]
 | align="center" style="background:#F5F5F5;" + |−
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |−
 | align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + | Abnormal (if [[Perforation of inflamed diverticulum|perforation]])
 | align="left" style="background:#F5F5F5;" + |
-* [[Colon|Colonic]] wall thickening (wall thickness is greater than 3 mm on the short axis of the lumen)
+* [[Colon|Colonic]] wall thickening
 * Pericolic fat stranding
 |-
 ! align="center" style="background:#DCDCDC;" + |[[Abdominal aortic aneurysm]]
 | align="left" style="background:#F5F5F5;" + |
+* [[Cigarette smoking]]
 * [[Hypertension]]
-* [[Cigarette smoking]]
-* [[Pulsatile Flow|Pulsatile]] [[abdominal mass]]
 | align="left" style="background:#F5F5F5;" + |
 * [[Epigastric pain]]
@@ Line 659: / Line 644: @@
 | align="left" style="background:#F5F5F5;" + |
 * Positive abdominal tenderness (if rupture)
-| align="center" style="background:#F5F5F5;" + |Nl
+| align="center" style="background:#F5F5F5;" + |
+* [[Pulsatile Flow|Pulsatile]] [[abdominal mass]]
 | align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |−
 | align="center" style="background:#F5F5F5;" + |−
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |−
 | align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |Nl
 | align="left" style="background:#F5F5F5;" + |
-* Ultrasound more sensitive than CT scan
+* CT scan accurately predict the aneurysmal size
-* CT scan may accurately predict the aneurysmal size
-* Helical CT has faster scanning time (30 to 60 seconds) and the ability to obtain all images in one breath hold
 |-
 ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
@@ Line 697: / Line 681: @@
 ! align="center" style="background:#DCDCDC;" + |[[Portal vein thrombosis]]
 | align="left" style="background:#F5F5F5;" + |
-* Mutated JAK2 V617F
+* Coagulopathies
-* [[Antiphospholipid syndrome|Anti−phospholipid syndrome]]
-* [[Paroxysmal nocturnal hemoglobinuria]]
-* [[Homocysteinuria]]
-* [[Factor V Leiden]]
-* [[Prothrombin G20210A mutation|Prothrombin mutation G20210A]]
-* [[Protein C deficiency|Protein C]] or [[Protein S deficiency|S deficiency]]
 * [[Oral contraceptive|Oral contraceptive use]]
 * [[Cirrhosis]]
@@ Line 717: / Line 695: @@
 | align="center" style="background:#F5F5F5;" + |↓
 | align="left" style="background:#F5F5F5;" + |
-* Positive abdominal tenderness (if [[bowel]] [[ischemia]] or [[infarction]]−secondary to extension of [[thrombus]] to [[superior mesenteric vein]])
+* Positive abdominal tenderness (if [[bowel]] [[ischemia]] or [[infarction]])
 | align="center" style="background:#F5F5F5;" + |Nl
 | align="left" style="background:#F5F5F5;" + |
@@ Line 725: / Line 703: @@
 * [[Thrombocytopenia]]
 | align="center" style="background:#F5F5F5;" + |−
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
-| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |−
 | align="center" style="background:#F5F5F5;" + |Might be abnormal
 | align="center" style="background:#F5F5F5;" + |Abnormal (if [[bowel]] [[infarction]], [[perforation]])
 | align="left" style="background:#F5F5F5;" + |
-* On non−contrast CT:
+* Hyperdense thrombus on non−contrast CT
-** Hyperdense thrombus
+* Non−enhancing defect of bland thrombus on contrast CT
-* On contrast CT
-** Non−enhancing defect of bland thrombus
-** Tumor thrombus exhibits enhancement
 |-
 ! align="center" style="background:#DCDCDC;" + |[[Duodenal ulcer]]
 | align="left" style="background:#F5F5F5;" + |
-* Pain relieved by intake of food
 * [[Helicobacter pylori infection]]
 * [[Tobacco smoking]]
 * [[NSAID|NSAID use]]
 * [[Alcohol|EtOH use]]
-* Older age
-* Female gender
-* [[Family history]] of [[Duodenal ulcer|duodenal ulcers]]
 | align="left" style="background:#F5F5F5;" + |
-* [[Epigastric pain]]
+* [[Epigastric pain]] which relieved by intake of food
 | align="center" style="background:#F5F5F5;" + |<nowiki>+</nowiki>
 | align="center" style="background:#F5F5F5;" + |−
@@ Line 764: / Line 735: @@
 * [[Anemia]]
 | align="center" style="background:#F5F5F5;" + |−
-| align="center" style="background:#F5F5F5;" + |
+| align="center" style="background:#F5F5F5;" + |Nl
-| align="center" style="background:#F5F5F5;" + |
+| align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |−
 | align="center" style="background:#F5F5F5;" + |Nl
@@ Line 774: / Line 745: @@
 ! align="center" style="background:#DCDCDC;" + |[[Ischemic colitis]]
 | align="left" style="background:#F5F5F5;" + |
-* Age > 60 years
+* Advanced age
 * [[Hemodialysis]]
 * [[Hypertension]]
-* [[Hypoalbuminemia]]
 * [[Diabetes mellitus]]
 | align="left" style="background:#F5F5F5;" + |
@@ Line 797: / Line 767: @@
 * [[Anemia]] (if [[Gastrointestinal perforation|perforation]] and [[bleeding]])
 | align="center" style="background:#F5F5F5;" + |−
-| align="center" style="background:#F5F5F5;" + |
+| align="center" style="background:#F5F5F5;" + |Nl to ↑
-| align="center" style="background:#F5F5F5;" + |
+| align="center" style="background:#F5F5F5;" + |Nl
 | align="center" style="background:#F5F5F5;" + |−
 | align="center" style="background:#F5F5F5;" + |Nl
-| align="center" style="background:#F5F5F5;" + |Abnormal (if bowel perforation)
+| align="center" style="background:#F5F5F5;" + |Abnormal (if bowel [[perforation]])
 | align="left" style="background:#F5F5F5;" + |
 * [[Bowel]] wall thickening
 * Thumbprinting
-* Pericolonic stranding with or without ascites.
 * [[Halo sign|Double halo]] or target sign
 * [[Submucosal]] [[edema]] or [[hemorrhage]]
@@ Line 836: / Line 805: @@
 ==References==
 {{Reflist|2}}
 [[Category:Medicine]]
 [[Category:Nephrology]]
 [[Category:Urology]]
 [[Category:Up-To-Date]]
-[[Category:Primary care]]
 [[Category:Emergency medicine]]

Kidney stone differential diagnosis: Difference between revisions

Latest revision as of 22:27, 29 July 2020

Overview

Differentiating Nephrolithiasis from other Diseases

References

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