Toxic megacolon differential diagnosis: Difference between revisions
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==Differentiating Toxic Megacolon from other Diseases== | |||
*Toxic megacolon must be differentiated from other diseases that cause [[abdominal pain]], [[fever]],[[diarrhea]] such as [[acute appendicitis]], [[acute diverticulitis]], [[inflammatory bowel disease]], [[whipple's disease]], [[tropical sprue]], [[infective colitis]], [[viral hepatitis]] ([[hepatitis A]] and [[hepatitis E]]), [[liver abscess]], [[spontaneous bacterial peritonitis]], [[mesenteric ischemia]], and [[Acute (medicine)|acute]] [[ischemic colitis]]. | |||
== | ===Preferred Table=== | ||
[ | <span style="font-size:85%">'''Abbreviations:''' | ||
'''[[RUQ]]'''= Right upper quadrant of the abdomen, '''LUQ'''= Left upper quadrant, '''LLQ'''= Left lower quadrant, '''RLQ'''= Right lower quadrant, '''LFT'''= Liver function test, SIRS= [[Systemic inflammatory response syndrome]], '''[[ERCP]]'''= [[Endoscopic retrograde cholangiopancreatography]], '''IV'''= Intravenous, '''N'''= Normal, '''AMA'''= Anti mitochondrial antibodies, '''[[LDH]]'''= [[Lactate dehydrogenase]], '''GI'''= Gastrointestinal, '''CXR'''= Chest X ray, '''IgA'''= [[Immunoglobulin A]], '''IgG'''= [[Immunoglobulin G]], '''IgM'''= [[Immunoglobulin M]], '''CT'''= [[Computed tomography]], '''[[PMN]]'''= Polymorphonuclear cells, '''[[ESR]]'''= [[Erythrocyte sedimentation rate]], '''[[CRP]]'''= [[C-reactive protein]], TS= [[Transferrin saturation]], SF= Serum [[Ferritin]], SMA= [[Superior mesenteric artery]], SMV= [[Superior mesenteric vein]], ECG= [[Electrocardiogram]]</span> | |||
{| align="center" | |||
|- | |||
| | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
== | ! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease | ||
*[ | | colspan="13" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestations''' | ||
*[ | ! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diagnosis | ||
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | |||
* | |- | ||
| colspan="9" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Symptoms''' | |||
=== | ! colspan="4" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Signs | ||
|- | |||
| | ! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | ||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Fever | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation | |||
| | ! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea | ||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo- | |||
tension | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Guarding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Toxic megacolon|'''Toxic megacolon''']] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |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 and [[Ultrasound]] shows: | |||
*Loss of colonic haustration | |||
*Hypoechoic and thickened bowel walls with irregular internal margins in the [[sigmoid]] and descending colon | |||
*Prominent dilation of the transverse colon (>6 cm) | |||
* Insignificant dilation of ileal bowel loops (diameter >18 mm) with increased intraluminal gas and fluid | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute appendicitis|'''Acute appendicitis''']] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Starts in [[epigastrium]], migrates to RLQ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in pyogenic appendicitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in perforated appendicitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ct scan | |||
* Ultrasound | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Positive Rovsing sign | |||
* Positive Obturator sign | |||
* Positive Iliopsoas sign | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diverticulitis|'''Acute diverticulitis''']] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |LLQ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in perforated diverticulitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* CT scan | |||
* Ultrasound | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* History of [[constipation]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Inflammatory bowel disease|'''Inflammatory bowel disease''']] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal or hyperactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Anti-neutrophil cytoplasmic antibody]] ([[P-ANCA]]) in [[Ulcerative colitis]] | |||
* [[Anti saccharomyces cerevisiae antibodies]] (ASCA) in [[Crohn's disease]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[String sign]] on [[abdominal x-ray]] in [[Crohn's disease]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
Extra intestinal findings: | |||
* [[Uveitis]] | |||
* [[Arthritis]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Whipple's disease|'''Whipple's disease''']] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Thrombocytopenia]] | |||
* [[Hypoalbuminemia]] | |||
* [[Small intestinal]] [[biopsy]] for [[Tropheryma whipplei]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Whipple's disease other diagnostic studies|Endoscopy]] is used to confirm diagnosis. | |||
Images used to find complications | |||
*[[Whipple's disease x ray|Chest and joint x-ray]] | |||
*[[Whipple's disease CT|CT]] | |||
*[[Whipple's disease MRI|MRI]] | |||
*[[Whipple's disease ultrasound|Echocardiography]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Extra intestinal findings: | |||
* [[Uveitis]] | |||
* [[Endocarditis]] | |||
* [[Encephalitis]] | |||
* [[Dementia]] | |||
* [[Hepatosplenomegaly]] | |||
* [[Arthritis]] | |||
* [[Ascites]] | |||
|- | |- | ||
|style="background: # | ! style="background:#4479BA; color: #FFFFFF;" align="center" |'''Disease''' | ||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Fever | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo- | |||
tension | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Guarding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | |||
|- | |- | ||
|style="background: #DCDCDC; padding: 5px; | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tropical sprue|'''Tropical sprue''']] | ||
|style="background: #F5F5F5; padding: 5px;" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse | ||
|style="background: #F5F5F5; padding: 5px;" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
| style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
|style="background: #F5F5F5; | | 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: | |||
* Dilation and edema of mucosal folds | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Steatorrhea]]- 10-40 g/day (Normal=5 g/day) | |||
|- | |- | ||
|style="background: #DCDCDC; padding: 5px; | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Infective colitis|'''Infective colitis''']] | ||
|style="background: #F5F5F5; padding: 5px;" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse | ||
|style="background: #F5F5F5; padding: 5px;" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in fulminant colitis | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | ||
|style="background: #F5F5F5; | | 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="background: # | ! style="background:#4479BA; color: #FFFFFF;" align="center" |'''Disease''' | ||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Fever | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo- | |||
tension | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Guarding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | |||
|- | |- | ||
|style="background: #DCDCDC; | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis|'''Viral hepatitis''']] | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]] | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in Hep A and E | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in fulminant hepatitis | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in acute | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
|style="background: #F5F5F5; | | style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Abnormal LFTs | |||
* Viral serology | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* US | |||
| | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* Hep A and E have fecal-oral route of transmission | |||
* Hep B and C transmits via blood transfusion and sexual contact. | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver abscess|'''Liver abscess''']] | ||
| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal or hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* CBC | |||
* Blood cultures | |||
* Abnormal [[Liver function test|liver function tests]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* US | |||
* CT | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Spontaneous bacterial peritonitis|'''Spontaneous bacterial peritonitis''']] | ||
| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in cirrhotic patients | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="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" | | |||
* 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" | | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia|'''Mesenteric ischemia''']] | ||
| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Periumbilical | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive if bowel becomes gangrenous | |||
| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | ||
* | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if bowel becomes gangrenous | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if bowel becomes gangrenous | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive to absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Leukocytosis]] and [[lactic acidosis]] | |||
* [[Amylase]] levels | |||
* [[D-dimer]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT angiography | |||
* SMA or SMV thrombosis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Also known as abdominal angina that worsens with eating | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ischemic colitis|'''Acute ischemic colitis''']] | ||
| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Diffuse | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Abdominal x-ray]] | |||
* Distension and pneumatosis | |||
CT scan | |||
* Double halo appearance, thumbprinting | |||
* Thickening of bowel | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* May lead to shock | |||
|- | |- | ||
|} | |} | ||
|} | |||
Latest revision as of 04:12, 14 July 2021
Differentiating Toxic Megacolon from other Diseases
- Toxic megacolon must be differentiated from other diseases that cause abdominal pain, fever,diarrhea such as acute appendicitis, acute diverticulitis, inflammatory bowel disease, whipple's disease, tropical sprue, infective colitis, viral hepatitis (hepatitis A and hepatitis E), liver abscess, spontaneous bacterial peritonitis, mesenteric ischemia, and acute ischemic colitis.
Preferred Table
Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram
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