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'''The following table outlines the major differential diagnoses of abdominal pain.''' | |||
<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]], US = [[Ultrasound]]</span> | |||
{| align="center" | |||
|- | |||
| | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease | |||
| colspan="13" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestations''' | |||
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diagnosis | |||
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | |||
|- | |||
| colspan="9" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Symptoms''' | |||
! colspan="4" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Signs | |||
|- | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Fever | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo- | |||
tension | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Guarding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Small bowel obstruction]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Leukocytosis]] with left shift indicates complications | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Abdominal X-ray|Abdominal X ray]] | |||
* Dilated loops of bowel with air fluid levels | |||
* Gasless abdomen | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* "Target sign"– , indicative of intussusception | |||
* Venous cut-off sign" – suggests thrombosis | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastric outlet obstruction|Gastric outlet obstruction]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | <nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Complete blood count]] | |||
* [[Basic metabolic panel]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Abdominal x-ray]]- air fluid level | |||
* Barium [[Upper GI series|upper GI studies]]- narrowed pylorus | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Succussion splash | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastroparesis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Hyperactive/hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
*[[Hemoglobin]] | |||
*Fasting plasma glucose | |||
*Serum total protein, albumin, [[thyrotropin]] ([[Thyroid-stimulating hormone|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 | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive/hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* 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="background:#4479BA; color: #FFFFFF;" align="center" |Disease | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Fever | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo- | |||
tension | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Guarding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute cholecystitis|Acute cholecystitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[RUQ]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Hyperbilirubinemia]] | |||
* [[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows: | |||
* Gallstone | |||
* Inflammation | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Murphy's sign|Murphy’s sign]] | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute pancreatitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[Epigastric]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Increased [[amylase]] / [[lipase]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ultrasound shows evidence of [[inflammation]] | |||
* CT scan shows severity of pancreatitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Pain radiation to back | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Chronic pancreatitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Increased [[amylase]] / [[lipase]] | |||
* Increased stool fat content | |||
* Pancreatic function test | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan | |||
* Calcification | |||
* Pseudocyst | |||
* Dilation of main pancreatic duct | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Predisposes to pancreatic cancer | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver abscess]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal or hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* CBC | |||
* Blood cultures | |||
* Abnormal [[Liver function test|liver function tests]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* US | |||
* CT | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Spontaneous bacterial peritonitis]] | |||
| 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" | 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" | | |||
|- | |||
|} | |||
|} | |||
{| | |||
|- | |||
| <figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Right_upper_quadrant.PNG|link=Right upper quadrant abdominal pain resident survival guide|339x339px]]</figure-inline></figure-inline></figure-inline>||<figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Epigastric_quadrant_pain.PNG|link=Epigastric pain resident survival guide|179x179px]]</figure-inline></figure-inline></figure-inline>||<figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Left_upper_quadrant.PNG|link=Left upper quadrant abdominal pain resident survival guide|329x329px]]</figure-inline></figure-inline></figure-inline> | |||
|- | |||
| <figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Right_flank_quadrant.PNG|link=Right flank pain resident survival guide|338x338px]]</figure-inline></figure-inline></figure-inline>||<figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Umbilical_pain.PNG|link=Umbilical region pain resident survival guide|165x165px]]</figure-inline></figure-inline></figure-inline>||<figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Left_flank_quadrant.PNG|link=Left flank quadrant abdominal pain resident survival guide|335x335px]]</figure-inline></figure-inline></figure-inline> | |||
|- | |||
| <figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Right_lower_quadrant.PNG|link=Right lower quadrant abdominal pain resident survival guide|338x338px]]</figure-inline></figure-inline></figure-inline>||<figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Hypogastric.PNG|link=Hypogastric pain resident survival guide|199x199px]]</figure-inline></figure-inline></figure-inline>||<figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Left_lower_quadrant.PNG|link=Left lower quadrant abdominal pain resident survival guide|335x335px]]</figure-inline></figure-inline></figure-inline> | |||
|} | |||
The following is a list of diseases that present with acute onset severe lower abdominal pain: | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
|+ | |||
! style="background: #4479BA; width: 180px;" | {{fontcolor|#000|Disease}} | |||
! style="background: #4479BA; width: 650px;" | {{fontcolor|#000|Findings}} | |||
|- | |||
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Ectopic pregnancy]]''' | |||
| style="padding: 7px 7px; background: #F5F5F5;" | History of missed menses, positive [[pregnancy test]], [[ultrasound]] reveals an empty [[uterus]] and may show a mass in the [[fallopian tubes]].<ref name="pmid27720100">{{cite journal |vauthors=Morin L, Cargill YM, Glanc P |title=Ultrasound Evaluation of First Trimester Complications of Pregnancy |journal=J Obstet Gynaecol Can |volume=38 |issue=10 |pages=982–988 |year=2016 |pmid=27720100 |doi=10.1016/j.jogc.2016.06.001 |url=}}</ref> | |||
|- | |||
| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Appendicitis]]''' | |||
| style="padding: 7px 7px; background: #F5F5F5;" |Pain localized to the [[right iliac fossa]], [[vomiting]], [[Ultrasound|abdominal ultrasound]] [[Sensitivity (tests)|sensitivity]] for diagnosis of [[acute appendicitis]] is 75% to 90%.<ref name="pmid8259423">{{cite journal |vauthors=Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C |title=Acute appendicitis: CT and US correlation in 100 patients |journal=Radiology |volume=190 |issue=1 |pages=31–5 |year=1994 |pmid=8259423 |doi=10.1148/radiology.190.1.8259423 |url=}}</ref> | |||
|- | |||
| style="padding: 7px 7px; background: #DCDCDC;" | '''Ruptured[[ ovarian cyst]]''' | |||
| style="padding: 7px 7px; background: #F5F5F5;" |Usually spontaneous, can follow history of trauma, mild chronic lower abdominal discomfort may suddenly intensify, [[ultrasound]] is diagnostic.<ref name="pmid19299205">{{cite journal |vauthors=Bottomley C, Bourne T |title=Diagnosis and management of ovarian cyst accidents |journal=Best Pract Res Clin Obstet Gynaecol |volume=23 |issue=5 |pages=711–24 |year=2009 |pmid=19299205 |doi=10.1016/j.bpobgyn.2009.02.001 |url=}}</ref> | |||
|- | |||
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Ovarian cyst ]]torsion''' | |||
| style="padding: 7px 7px; background: #F5F5F5;" |Presents with acute severe unilateral [[Lower abdominal pain|lower quadrant abdominal pain]], [[nausea and vomiting]], tender adnexal mass palpated in 90%, [[ultrasound]] is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref> | |||
|- | |||
| style="padding: 7px 7px; background: #DCDCDC;" | '''Hemorrhagic [[ovarian cyst]]''' | |||
| style="padding: 7px 7px; background: #F5F5F5;" |Presents with [[Abdominal pain|localized abdominal pain]], [[nausea and vomiting]]. [[Hypovolemic shock]] may be present, [[abdominal tenderness]] and guarding are physical exam findings, [[ultrasound]] is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref> | |||
|- | |||
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Endometriosis]]''' | |||
| style="padding: 7px 7px; background: #F5F5F5;" |Presents with cyclic pain that is exacerbated by onset of menses, [[dyspareunia]]. [[Laparoscopy|laparoscopic]] exploration is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref> | |||
|- | |||
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Acute cystitis]]''' | |||
| style="padding: 7px 7px; background: #F5F5F5;" |Presents with features of increased urinary [[frequency]], [[urgency]], [[dysuria]], and suprapubic pain.<ref>{{Cite journal | |||
<nowiki> </nowiki><nowiki>|</nowiki> author = [[W. E. Stamm]] | |||
| title = Etiology and management of the acute urethral syndrome | |||
| journal = [[Sexually transmitted diseases]] | |||
| volume = 8 | |||
| issue = 3 | |||
| pages = 235–238 | |||
| year = 1981 | |||
| month = July-September | |||
| pmid = 7292216 | |||
</ref><ref>{{Cite journal | |||
<nowiki> </nowiki><nowiki>|</nowiki> author = [[W. E. Stamm]], [[K. F. Wagner]], [[R. Amsel]], [[E. R. Alexander]], [[M. Turck]], [[G. W. Counts]] & [[K. K. Holmes]] | |||
| title = Causes of the acute urethral syndrome in women | |||
| journal = [[The New England journal of medicine]] | |||
| volume = 303 | |||
| issue = 8 | |||
| pages = 409–415 | |||
| year = 1980 | |||
| month = August | |||
| doi = 10.1056/NEJM198008213030801 | |||
| pmid = 6993946</ref> | |||
|} | |||
*Treatment should be initiated promptly once the diagnosis has been made. | |||
*The optimal duration of treatment is not known; controlled data are limited. | |||
*As a general rule, a prolonged course of treatment should be expected. | |||
*Folic acid should be given for at least 3 months and up to 1 year depending on clinical response. | |||
*Antibiotic treatment has been given for periods between 2 weeks and 1 year, but most experience shows good outcomes with 3 to 6 months of treatment. | |||
*Vitamin B12 supplementation is also recommended if symptoms last more than 4 months or in the presence of low vitamin B12 levels, regardless of symptom duration. | |||
Pathology | |||
*Tropical sprue (TS) causes mucosal changes throughout the digestive tract. | |||
*Histopathological analysis shows: | |||
**Marked villous atrophy of small bowel | |||
**Decrease in total absorptive surface area | |||
**Decreased absorption of long-chain fatty acids causes steatorrhea | |||
**Decreased protein absorption | |||
**Protein loss through the leaky mucosal membrane | |||
{{familytree/start |summary=Sample 1}} | |||
{{familytree | | | | | | | | | | | | | A01 |A01=Gastrointestinal stromal tumors}} | |||
{{familytree | | | | | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|.| }} | |||
{{familytree | | | | | | C01 | | | | | C02 | | | | | C03 |C01=KIT gene mutation|C02=PDGFRA mutation|C03=Wild type (absence of KIT/PDGFRA)}} | |||
{{familytree | | |,|-|-|-|^|-|-|-|.| | | | | | | | | |!| |}} | |||
{{familytree | | D01 | | | | | | D02 | | | | | | | | D03 |D01=Exon 9,13 & 17|D02=Exon 11|D03=Mutant succinate dehydrogenase}} | |||
{{familytree | | |!| | | | | | | |!| | | | | | | | | |!| |}} | |||
{{familytree | | E01 | | | | | | E02 | | | | | | | | E03 |E01=Uncontrolled KIT signalling|E02=KIT receptor mutation|E03=Dysfunction of electron transport mitochondria}} | |||
{{familytree | | | | | | | | | | | | | | | | | | | | |!| |}} | |||
{{familytree | | | | | | | | | | | | | | | | | | | | F01 |F01=Defective oxidative phosphorylation}} | |||
{{familytree | | | | | | | | | | | | | | | | | | | | |!| |}} | |||
{{familytree | | | | | | | | | | | | | | | | | | | | G01 |G01=Abnormal stabilization of HIF}} | |||
{{familytree/end}} | |||
{| align="center" | |||
|- | |||
| | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease | |||
| colspan="10" 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="6" 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" |Jaundice | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI Bleed | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo- | |||
tension | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Guarding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute cholecystitis|Acute cholecystitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[RUQ]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Hyperbilirubinemia]] | |||
* [[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows gallstone and evidence of inflammation | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]] | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute pancreatitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[Epigastric]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Increased [[amylase]] / [[lipase]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ultrasound shows evidence of [[inflammation]] | |||
* CT scan shows severity of pancreatitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Pain radiation to back | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Chronic pancreatitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| 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]] | |||
|- | |||
| 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 | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +, depends on site | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="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/hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* 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" |[[Hepatitis|Viral hepatitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in Hep A and 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 acute | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Abnormal LFTs | |||
* Viral serology | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |USG | |||
| 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. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver mass|Liver masses]] | |||
| 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" | + in [[Liver abscess]] | |||
| 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 [[Hepatocellular carcinoma]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in sepsis | |||
| 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="left" | | |||
* CBC | |||
* 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" |Normal/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;" 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="left" | | |||
* Normal | |||
* Hyperactive if obstruction present | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* High levels of [[Alpha-fetoprotein|AFP]] in serum | |||
* Abnormal [[Liver function test|liver function tests]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* US | |||
* CT | |||
* Liver biopsy | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
Other symptoms: | |||
* [[Splenomegaly]] | |||
* [[Variceal bleeding]] | |||
* [[Ascites]] | |||
* [[Spider nevi]] | |||
* [[Asterixis]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Budd-Chiari syndrome|Budd-Chiari syndrome]] | |||
| 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 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="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="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 | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Spontaneous bacterial peritonitis]] | |||
| 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" | + 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="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;" 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="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]] | |||
|- | |||
| 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 | |||
|- | |||
| 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]] | |||
|- | |||
| 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" |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]] | |||
|- | |||
|[[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]] | |||
|- | |||
|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" | | |||
|- | |||
!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" | | |||
|- | |||
|[[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 | |||
|- | |||
|} | |||
|} | |||
'''[[RUQ]]'''= Right upper quadrant of the abdomen, '''LFT'''= Liver function test, SIRS= [[Systemic inflammatory response syndrome]], '''[[ERCP]]'''= [[Endoscopic retrograde cholangiopancreatography]], '''N'''= Normal, '''AMA'''= Anti mitochondrial antibodies, '''[[LDH]]'''= [[Lactate dehydrogenase]], '''GI'''= Gastrointestinal, '''CT'''= [[Computed tomography]]<br> | |||
{| align="center" | |||
|- | |||
| | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
| rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease | |||
! colspan="3" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |History and clinical manifestations | |||
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis | |||
|- | |||
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab Findings | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Other blood tests | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Other diagnostic | |||
|- | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |AST | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |ALT | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |ALK | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Indirect | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Direct | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Viral serology | |||
|- | |||
| align="center" style="background:#4479BA; color: #FFFFFF;" |Type of jaundice | |||
| align="center" style="background:#4479BA; color: #FFFFFF;" |Pruritis | |||
| align="center" style="background:#4479BA; color: #FFFFFF;" |Family history | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Common bile duct stone | |||
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" | '''Cholestatic Jaundice''' | |||
| 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="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Dilated ducts on sono | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |CT/ERCP | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatitis A cholestatic type | |||
| 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="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |HAV- AB | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Abdominal ultrasound | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |EBV / CMV hepatitis | |||
| 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="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| 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 serology | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |PCR or ELISA | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary biliary cirrhosis | |||
| 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="center" |N/↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |AMA positive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary sclerosing cholangitis | |||
| 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="center" |N/↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Beading on MRCP | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Autoimmune hepatitis | |||
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Hepatocellular Jaundice''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| 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="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Anti-LKM antibody | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
|- | |||
|} | |||
|} | |||
{| align="center" | |||
|- | |||
| | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease | |||
! colspan="5" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |History and clinical manifestations | |||
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis | |||
|- | |||
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab Findings | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Other blood tests | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Other diagnostic | |||
|- | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |AST | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |ALT | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |ALK | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Indirect | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Direct | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Viral serology | |||
|- | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Type of jaundice | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pruritis | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |RUQ pain | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Family history | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Common bile duct stone | |||
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Cholestatic Jaundice | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| 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="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Dilated ducts on sono | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |CT/ERCP | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatitis A cholestatic type | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| 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="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |HAV- AB | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Abdominal ultrasound | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |EBV / CMV hepatitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| 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="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| 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 serology | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |PCR or ELISA | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary biliary cirrhosis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| 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="center" |N/↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |AMA positive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary sclerosing cholangitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| 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="center" |N/↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Beading on MRCP | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable" | {| class="wikitable" | ||
!Disease | ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease | ||
! colspan=" | ! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs and Symptoms | ||
! | ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Barium esophagogram | ||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Endoscopy | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Other imaging and laboratory findings | |||
!Endoscopy | ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Gold Standard | ||
!Other imaging findings | |- | ||
!Gold Standard | | rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ||
| colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Dysphagia | |||
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss | |||
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Heartburn | |||
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other findings | |||
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Mental status | |||
|- | |||
| align="center" style="background:#4479BA; color: #FFFFFF;" |Solids | |||
| align="center" style="background:#4479BA; color: #FFFFFF;" |Liquids | |||
| align="center" style="background:#4479BA; color: #FFFFFF;" |Type | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Plummer-Vinson syndrome | |||
| | |||
* Gradual | |||
| + | |||
| - | |||
|Non progressive | |||
| +/- | |||
| - | |||
| | |||
* [[Glossitis]] | |||
* [[Koilonychia]] | |||
|Normal | |||
| | |||
* Thin projections on the anterior [[esophageal]] wall | |||
* Multiple upper[[Esophageal stricture|esophageal constrictions]] | |||
| | |||
* Direct visualization of [[esophageal webs]] | |||
* Superior to [[esophagogram]] | |||
| | |||
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings | |||
| | |||
Triad of | |||
* [[Iron deficiency anemia]] | |||
* [[Esophageal webs]] | |||
* [[Glossitis]] | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal stricture]] | |||
| | | | ||
* Gradual | |||
| | |||
| | * Sudden onset | ||
| | | + | ||
| | | +/- | ||
| | |Progressive | ||
| +/- | |||
| +/- | |||
| | | | ||
* [[Odynophagia]] | |||
* [[Cough]] | |||
* [[Chest pain]] | |||
|Normal | |||
| | | | ||
*Sacculations | |||
*Fixed transverse folds | |||
*[[Esophageal]] intramural pseudodiverticula | |||
| | | | ||
* [[Mucosal]] edema | |||
* Circumferential thickening in [[Gastroesophageal reflux disease|GERD]] | |||
* Pale [[mucosa]] with white [[exudate]] in lymphocytic esophagitis | |||
* [[Swelling]] and [[hemorrhagic]] [[congestion]] in [[caustic]]<nowiki/>ingestion | |||
| | | | ||
* [[Manometry]] may show dysmotility | |||
* [[CT scan]] for staging [[malignant]] [[strictures]] | |||
| | | | ||
* No gold standard test | |||
* Diagnostic study based on history of [[dysphagia]], positive [[Esophagogram|barium esophagogram]] and [[endoscopy]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diffuse esophageal spasm]] | |||
| | | | ||
* Sudden | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+</nowiki> | |||
|Non progressive | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+</nowiki> | |||
| | |||
* [[Chest pain]] | |||
|Normal | |||
| | |||
* Nonperistaltic and nonpropulsive contractions | |||
* Corkscrew or rosary bead esophagus | |||
| | |||
* Inconclusive | |||
| | |||
*[[Manometry]] shows high-amplitude [[esophageal]] contractions | |||
*[[CT scan]] may show [[hypertrophy]] of esophageal muscles | |||
| | | | ||
* [[Manometry]] | |||
|- | |- | ||
| | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Achalasia]] | ||
|Gradual | | | ||
* Gradual | |||
| + | | + | ||
|<nowiki>+</nowiki> | |||
|Non progressive | |||
| +/- | | +/- | ||
| - | | - | ||
| | | | ||
* [[Regurgitation]] of undigested food | |||
* [[Chest pain]] | |||
|Normal | |Normal | ||
| | | | ||
* "Bird's beak" or "rat tail" appearance | |||
* Dilated esophageal body | |||
* Air fluid level (absent [[peristalsis]]) | |||
* Absence of an intragastric air bubble | |||
| | | | ||
* | * Dilated [[esophagus]] | ||
* | * Residual food fragments | ||
* Normal [[mucosa]] | |||
| | |||
* Residual pressure of [[Lower esophageal sphincter|LES]] > 10 mmHg | |||
* Incomplete relaxation of the [[Lower esophageal sphincter|LES]] | |||
* Increased resting tone of [[Lower esophageal sphincter|LES]] | |||
* Aperistalsis | |||
| | |||
* History of [[dysphagia]] with positive [[endoscopy]] and [[manometry]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic sclerosis]] | |||
| | |||
* Gradual | |||
| + | |||
|<nowiki>+</nowiki> | |||
|Progressive | |||
| +/- | |||
| + | |||
| | | | ||
* | * [[Muscle pain|Muscle]] and [[Arthralgia|joint pain]] | ||
* | |||
* [[Raynaud's phenomenon]] | |||
* [[Skin changes]] | |||
|Normal | |||
| | | | ||
* Dysmotility | |||
* | |||
* Patulous [[esophagus]] | |||
* | |||
| | | | ||
* [[Mucosal]] damage | |||
* [[Peptic]] stricture (advanced cases) | |||
|Positive serology for | |||
* [[Antinuclear antibodies]] | |||
* [[Rheumatoid factor]] | |||
* [[Creatine kinase]] | |||
* [[ESR]] | |||
| | | | ||
* [[Skin biopsy]] | |||
|- | |- | ||
| | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Zenker's diverticulum]] | ||
| | | | ||
* Gradual | * Gradual | ||
| + | | + | ||
|<nowiki>-</nowiki> | |||
| | |||
| +/- | | +/- | ||
| | | - | ||
| | | | ||
* Food [[regurgitation]] | |||
* [[Halitosis]] | |||
* [[Coughing|Cough]] | |||
* [[Hoarseness]] | |||
|Normal | |Normal | ||
| | | | ||
* Thin projections on [[esophageal]] wall over [[Killian's dehiscence|Killian's triangle]] | |||
| | |||
* Outpouching of posterior [[pharyngeal]] wall | |||
* Exclude the presence of [[Squamous cell carcinoma|SCC]] | |||
| | |||
* [[CT]] & [[MRI]] shows out-pouching over the posterior esophagus in the Killian's triangle | |||
| | |||
* Barium [[Esophagogram|esophagography]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal carcinoma]] | |||
| | | | ||
* | * Gradual | ||
|<nowiki>+</nowiki> | |||
|<nowiki>+</nowiki> | |||
|Progressive | |||
| + | |||
|<nowiki>+/-</nowiki> | |||
| | | | ||
* [[Lymphadenopathy]] | |||
* [[Cachexia]] | |||
|Normal | |||
| | | | ||
* Irregular [[Strictures|stricture]] | |||
* Pre-stricture [[dilatation]] | |||
| | | | ||
* [[Esophageal]] obstruction | |||
* Staging of disease | |||
| | | | ||
* [[CT]] and [[PET scan]] is an optional test for staging of the disease | |||
| | | | ||
* [[Biopsy]] | |||
|- | |- | ||
| | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Stroke]] | ||
| | ([[Cerebral hemorrhage]]) | ||
| | |||
* Sudden | |||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|Progressive | |||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |<nowiki>+/-</nowiki> | ||
| | |||
* [[Dysarthria]] | |||
* Limb [[weakness]] | |||
* [[Fatigue]] | |||
|Impaired | |||
| | |||
* Pooling of [[Contrast medium|contrast]] in the [[pharynx]] | |||
* [[Aspiration]] of [[barium]] [[Contrast medium|contrast]] into the [[airway]] | |||
| | |||
* Reduced opening of [[upper esophageal sphincter]] | |||
* Reduced [[larynx]] elevation | |||
| | |||
* [[CT]] without [[contrast]] shows acute [[hemorrhage]] as a hyperattenuating [[clot]] | |||
| | |||
* [[CT]] without [[Contrast medium|contrast]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Motor disorders | |||
([[Myasthenia gravis]]) | |||
| | |||
* Gradual | |||
| + | |||
| + | |||
|Progressive | |||
|<nowiki>+/-</nowiki> | |||
| | |||
| | |||
* [[Ptosis]] | |||
* [[Diplopia]] | |||
* [[Fatigue]] | |||
|Normal | |||
| | |||
* Stasis in [[pharynx]] and pooling in pharyngeal recesses | |||
| | |||
* [[Velopharyngeal insufficiency]] | |||
* Delayed [[swallowing]] function | |||
| | |||
* CT may show anterior [[mediastinal]] mass ([[thymoma]]) | |||
* Positive tensilon test | |||
| | |||
* Anti–acetylcholine receptor antibody test | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[GERD]] | |||
| | |||
* Gradual | |||
* Sudden onset | |||
| + | |||
| - | |||
|Progressive | |||
| +/- | |||
| + | |||
| | |||
* [[Cough]] | |||
* [[Hoarseness]] | |||
|Normal | |||
| | |||
* Free acid reflux | |||
* [[Esophagitis]] with scarring | |||
* [[Strictures]] | |||
* [[Barrett's oesophagus]] | |||
| | |||
* [[Erythema]], erosions and [[ulceration]] | |||
* [[Barrett's esophagus]] | |||
| | |||
* Esophageal [[manometry]] may show decreased tone of [[Lower esophageal sphincter|LES]] | |||
| | |||
* 24 hour [[esophageal]] pH monitoring | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal web]] | |||
| | |||
* Gradual | |||
| + | |||
| +/- | |||
|Progressive | |||
| - | |||
| +/- | |||
| | |||
* Findings of the underlying cause such as [[iron deficiency anemia]] or [[bullous pemphigoid]] | |||
|Normal | |Normal | ||
| | |||
* Symmetrical narrowing of the [[esophagus]] | |||
| | |||
* Smooth membrane not encircling the whole [[Lumen (anatomy)|lumen]] | |||
| | |||
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings | |||
| | |||
* Barium [[esophagogram]] | |||
|- | |||
|Eosinophilic esophagitis | |||
| | |||
| | |||
| | |||
| | |||
| | |||
| | |||
| | |||
| | | | ||
| | | | ||
| | | | ||
| | | | ||
| | | |
Latest revision as of 19:56, 24 January 2018
The following table outlines the major differential diagnoses of abdominal pain.
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, US = Ultrasound
|
The following is a list of diseases that present with acute onset severe lower abdominal pain:
Disease | Findings |
---|---|
Ectopic pregnancy | History of missed menses, positive pregnancy test, ultrasound reveals an empty uterus and may show a mass in the fallopian tubes.[1] |
Appendicitis | Pain localized to the right iliac fossa, vomiting, abdominal ultrasound sensitivity for diagnosis of acute appendicitis is 75% to 90%.[2] |
Rupturedovarian cyst | Usually spontaneous, can follow history of trauma, mild chronic lower abdominal discomfort may suddenly intensify, ultrasound is diagnostic.[3] |
Ovarian cyst torsion | Presents with acute severe unilateral lower quadrant abdominal pain, nausea and vomiting, tender adnexal mass palpated in 90%, ultrasound is diagnostic.[4] |
Hemorrhagic ovarian cyst | Presents with localized abdominal pain, nausea and vomiting. Hypovolemic shock may be present, abdominal tenderness and guarding are physical exam findings, ultrasound is diagnostic.[4] |
Endometriosis | Presents with cyclic pain that is exacerbated by onset of menses, dyspareunia. laparoscopic exploration is diagnostic.[4] |
Acute cystitis | Presents with features of increased urinary frequency, urgency, dysuria, and suprapubic pain.[5][6] |
- Treatment should be initiated promptly once the diagnosis has been made.
- The optimal duration of treatment is not known; controlled data are limited.
- As a general rule, a prolonged course of treatment should be expected.
- Folic acid should be given for at least 3 months and up to 1 year depending on clinical response.
- Antibiotic treatment has been given for periods between 2 weeks and 1 year, but most experience shows good outcomes with 3 to 6 months of treatment.
- Vitamin B12 supplementation is also recommended if symptoms last more than 4 months or in the presence of low vitamin B12 levels, regardless of symptom duration.
Pathology
- Tropical sprue (TS) causes mucosal changes throughout the digestive tract.
- Histopathological analysis shows:
- Marked villous atrophy of small bowel
- Decrease in total absorptive surface area
- Decreased absorption of long-chain fatty acids causes steatorrhea
- Decreased protein absorption
- Protein loss through the leaky mucosal membrane
Gastrointestinal stromal tumors | |||||||||||||||||||||||||||||||||||||||||||||
KIT gene mutation | PDGFRA mutation | Wild type (absence of KIT/PDGFRA) | |||||||||||||||||||||||||||||||||||||||||||
Exon 9,13 & 17 | Exon 11 | Mutant succinate dehydrogenase | |||||||||||||||||||||||||||||||||||||||||||
Uncontrolled KIT signalling | KIT receptor mutation | Dysfunction of electron transport mitochondria | |||||||||||||||||||||||||||||||||||||||||||
Defective oxidative phosphorylation | |||||||||||||||||||||||||||||||||||||||||||||
Abnormal stabilization of HIF | |||||||||||||||||||||||||||||||||||||||||||||
|
RUQ= Right upper quadrant of the abdomen, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CT= Computed tomography
|
|
Disease | Signs and Symptoms | Barium esophagogram | Endoscopy | Other imaging and laboratory findings | Gold Standard | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Onset | Dysphagia | Weight loss | Heartburn | Other findings | Mental status | |||||||
Solids | Liquids | Type | ||||||||||
Plummer-Vinson syndrome |
|
+ | - | Non progressive | +/- | - | Normal |
|
|
|
Triad of | |
Esophageal stricture |
|
+ | +/- | Progressive | +/- | +/- | Normal |
|
|
|
| |
Diffuse esophageal spasm |
|
+ | + | Non progressive | + | + | Normal |
|
|
|
||
Achalasia |
|
+ | + | Non progressive | +/- | - |
|
Normal |
|
|||
Systemic sclerosis |
|
+ | + | Progressive | +/- | + |
|
Normal |
|
|
Positive serology for | |
Zenker's diverticulum |
|
+ | - | +/- | - |
|
Normal |
|
|
| ||
Esophageal carcinoma |
|
+ | + | Progressive | + | +/- | Normal |
|
|
|||
Stroke |
|
+ | + | Progressive | + | +/- |
|
Impaired |
|
|
||
Motor disorders |
|
+ | + | Progressive | +/- | Normal |
|
|
|
| ||
GERD |
|
+ | - | Progressive | +/- | + | Normal |
|
|
| ||
Esophageal web |
|
+ | +/- | Progressive | - | +/- |
|
Normal |
|
|
|
|
Eosinophilic esophagitis |
polyglandular autoimmune syndrome polyendocrine autoimmune syndrome
tryptophan hydroxylase presenting with malabsorption
- Tyrosine hydroxylase presenting with alopecia areata
- Liver presenting with autoimmune liver disease and chronic active hepatitis
- Steroidal hormone–producing cell presenting with hypogonadism.
X linked polyendocrinopathy, immune dysfunction and diarrhea. This condition is very rare and generally presents in neonatal period with diabetes and malabsorption. Unlike type 1 and type 2 autoimmune polyglandular syndromes there is no association with HLA genotype. Mutation in FOXP3 gene is inherited as X linked and leads to loss of regulatory T cells and autoimmunity.
The term “polyendocrine” itself is a misnomer, in that not all patients have multiple endocrine disorders, and many have nonendocrine autoimmune diseases. Nevertheless, the recognition that patients in whom multiple autoimmune disorders are diagnosed may have a specific genetic syndrome, may be at increased risk for multiple autoimmune disorders, and may have relatives who have an increased risk should spur clinicians toward early diagnosis and treatment.
In the simplest hypothesis for understanding organ-specific autoimmunity, the initial step is the loss of immunologic tolerance to a peptide within a specific molecule found in the target organ. Clones of the CD4 T cells that recognize the peptide then expand, and the specific cytokines produced by the clonal CD4 T cells favor inflammation (as when type 1 helper T [Th1]–cell clones produce cytokines such as interferon-γ) or favor autoantibody-mediated disease (as is the case predominantly with type 2 helper T [Th2]–cell clones).9 The probability of T-cell autoreactivity is determined both in the thymus (the site of central tolerance) and in the periphery (the site of peripheral tolerance) and is strongly influenced by specific HLA alleles
TYPE 1 APS Mutations in the AIRE gene cause many autoimmune diseases, and affected patients are at risk for the development of multiple additional autoimmune diseases over time, including type 1A diabetes, hypothyroidism, pernicious anemia, alopecia, vitiligo, hepatitis, ovarian atrophy, and keratitis. Affected patients may also have diarrhea or obstipation that may be related to the destruction of gastrointestinal endocrine cells (enterochromaffin and enterochromaffin-like cells).39 Knockout of the AIRE gene in the mouse produces widespread autoimmunity, but the phenotype is relatively mild. SYMPTOMS TYPE1 Addison's disease develops in 80 percent of patients with autoimmune polyendocrine syndrome type I, and type 1A diabetes develops in 18 percent
PROGNOSISI TYPE 1 After diagnosis, patients with autoimmune polyendocrine syndrome type I require close monitoring. Monitoring can help prevent illness associated with delayed diagnosis of additional autoimmune diseases (e.g., Addison's disease and hypoparathyroidism, which can develop during adulthood) as well as oral cancer, which may develop if candidiasis is not treated aggressively, and infection due to asplenism, which is present in a subgroup of patients.
- In patients with autoimmune polyendocrine syndromes who have a single disorder such as Addison's disease or type 1A diabetes, the prevalence of additional autoimmune disorders is 30 to 50 times that in the general population.60,61 The concurrence of more than one endocrinopathy presumably results from shared genetic susceptibility leading to loss of tolerance to multiple tissues
TYPE 2
Autoimmune polyendocrine syndrome type II (also called Schmidt's syndrome with Addison's disease plus hypothyroidism) is much more common and more varied in its manifestations than autoimmune polyendocrine syndrome type I.
TYpe 3
X-Linked Polyendocrinopathy, Immune Dysfunction, and Diarrhea. The syndrome of X-linked polyendocrinopathy, immune dysfunction, and diarrhea (known as XPID) is an extremely rare disorder characterized by fulminant, widespread autoimmunity and type 1A diabetes, which usually develops in neonates; it is often fatal. The disorder is also known as XLAAD (X-linked autoimmunity and allergic dysregulation) and IPEX (immune dysfunction, polyendocrinopathy, and enteropathy, X-linked)
Aldosterone Deficiency: Hyporeninemic hypoaldosteronism - Commonly seen in patients with renal insufficiency (diabetic kidney disease, chronic tubulointerstitial disease, or glomerulonephritis) and those that take certain medications (non-steroidal anti-inflammatory drugs, calcineurin inhibitors).[1] Angiotensin inhibitors - angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), direct renin inhibitors Heparin therapy (including low molecular weight heparin) - Heparin has a direct toxic effect on the adrenal zona glomerulosa cells which leads to a reduction in plasma aldosterone concentration.[9] Primary adrenal insufficiency (Addison’s disease) - Associated with the lack of cortisol and aldosterone. This can result from autoimmune adrenalitis, infectious adrenalitis, and other disorders.[14] Critical illness - There is decreased adrenal production of aldosterone and stress-induced hypersecretion of ACTH which can diminish aldosterone synthesis by diverting substrate to the production of cortisol. Congenital isolated hypoaldosteronism - Deficiency of enzymes required for aldosterone synthesis.[14] Pseudohypoaldosteronism type 2 (Gordon’s syndrome or familial hyperkalemic hypertension) - Abnormalities in WNK kinases in the distal nephron increase chloride reabsorption leading to reduced renal potassium secretion. Characterized by hypertension, hyperkalemia, metabolic acidosis, normal renal function, and low or low-normal plasma renin activity and aldosterone concentrations.[14][2] Aldosterone Resistance: Inhibitors of the epithelial sodium channel - Most commonly associated with the administation of potassium-sparing diuretics (spironolactone, eplerenone, amiloride) and certain antibiotics (trimethoprim, pentamidine). Pseudohypoaldosteronism type 1 - Characterized by marked elevations of plasma aldosterone levels. There is an autosomal recessive form, and an autosomal dominant or sporadic form. The autosomal dominant form tends to be associated with milder symptoms
Type of
Adrenal insufficiency |
Skin Pigmentation | ACTH | Normal ACTH |
---|---|---|---|
Addison disease | + | >60 ng/mL | 5-30 ng/mL |
Secondary /
tertiary adrenal insufficiency |
- | <5 ng/mL |
Addison's disease must be differentiated from other diseases that cause hypotension, skin pigmentation, and abdominal pain such as myopathies, celiac disease, Peutz-Jeghers syndrome ,anorexia nervosa, syndrome of inappropriate anti-diuretic hormone (SIADH), neurofibromatosis, porphyria cutanea tarda, salt-depletion nephritis and bronchogenic carcinoma.[7][8]
Disease | Differentiating symptoms | Differentiating laboratory findings | Gold standard test | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Hypotension | Abdominal pain | Anorexia/
weight loss |
Muscle weakness | Hypoglycemia | Skin pigmentation | Other symptoms | Hyponatremia | Cortisol levels | Other labs | ||
Addison's disease | + | + | + | + | + | + | - | Low | ACTH stimulation test | ||
Myopathies
hereditary myopathies) |
- | - | - | + | - | Heliotrope rash and
Gottron's sign |
- | Normal | - | Muscle biopsy | |
Celiac disease | - | + | + | - | - | Dermatitis herpetiformis |
|
- | Normal | - | Abnormal small bowel biopsy |
Syndrome of inappropriate anti-diuretic hormone | - | - | - | - | - | - | - | + | Normal |
|
Water deprivation test |
Neurofibromatosis | - | - | + | + | - | Axillary- and inguinal-area freckling |
|
- | - | - | Biopsy of skin tissue |
Peutz-Jeghers syndrome | + | + |
|
- | Normal | Colonic imaging showing the small intestinal polyps | |||||
Porphyria cutanea tarda | - | + | - | - | - | Blisters on sun-exposed sites |
|
- | Normal or elevated | High level of porphyrins in the urine | |
Salt-depletion nephritis | + | Flank pain | - | - | - | - | + | Elevated | <15:1 BUN:CR | ||
Bronchogenic carcinoma | - | - | + | - | - | + | - | Elevated | Increased ACTH and | Cytological or histological evidence of lung cancer in sputum, pleural fluid, or tissue | |
Anorexia nervosa | + | - | + | + | + | - |
|
- | Elevated | - | Psychiatric condition |
- ↑ Morin L, Cargill YM, Glanc P (2016). "Ultrasound Evaluation of First Trimester Complications of Pregnancy". J Obstet Gynaecol Can. 38 (10): 982–988. doi:10.1016/j.jogc.2016.06.001. PMID 27720100.
- ↑ Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C (1994). "Acute appendicitis: CT and US correlation in 100 patients". Radiology. 190 (1): 31–5. doi:10.1148/radiology.190.1.8259423. PMID 8259423.
- ↑ Bottomley C, Bourne T (2009). "Diagnosis and management of ovarian cyst accidents". Best Pract Res Clin Obstet Gynaecol. 23 (5): 711–24. doi:10.1016/j.bpobgyn.2009.02.001. PMID 19299205.
- ↑ 4.0 4.1 4.2 Bhavsar AK, Gelner EJ, Shorma T (2016). "Common Questions About the Evaluation of Acute Pelvic Pain". Am Fam Physician. 93 (1): 41–8. PMID 26760839.
- ↑ {{Cite journal | author = W. E. Stamm | title = Etiology and management of the acute urethral syndrome | journal = Sexually transmitted diseases | volume = 8 | issue = 3 | pages = 235–238 | year = 1981 | month = July-September | pmid = 7292216
- ↑ {{Cite journal | author = W. E. Stamm, K. F. Wagner, R. Amsel, E. R. Alexander, M. Turck, G. W. Counts & K. K. Holmes | title = Causes of the acute urethral syndrome in women | journal = The New England journal of medicine | volume = 303 | issue = 8 | pages = 409–415 | year = 1980 | month = August | doi = 10.1056/NEJM198008213030801 | pmid = 6993946
- ↑ Selva-O'Callaghan A, Labrador-Horrillo M, Gallardo E, Herruzo A, Grau-Junyent JM, Vilardell-Tarres M (2006). "Muscle inflammation, autoimmune Addison's disease and sarcoidosis in a patient with dysferlin deficiency". Neuromuscul. Disord. 16 (3): 208–9. doi:10.1016/j.nmd.2006.01.005. PMID 16483775.
- ↑ Kumar V, Rajadhyaksha M, Wortsman J (2001). "Celiac disease-associated autoimmune endocrinopathies". Clin. Diagn. Lab. Immunol. 8 (4): 678–85. doi:10.1128/CDLI.8.4.678-685.2001. PMC 96126. PMID 11427410.