Budd-Chiari syndrome differential diagnosis: Difference between revisions

Latest revision as of 22:12, 8 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2] Amandeep Singh M.D.[3]

Overview

Differential diagnosis

Budd-Chiari syndrome should be differentiated from other causes of hepatic failure like viral hepatitis and liver cirrhosis, splenic vein thrombosis, portal vein thrombosis and inferior vena cava obstruction that may have similar presentation with right upper quadrant abdominal pain and ascites. The differential diagnosis is as follows:

Condition	Differentiating signs and symptoms	Differentiating Tests
Budd-Chiari Syndrome	Abdominal pain Diarrhea Ascites	Doppler ultrasound and CT of the abdomen shows absence of the hepatic vein filling Abdominal CT scan will show a rapid clearing of the caudate lobe of the liver
Cirrhosis	Abdominal pain and bloating Menstrual irregularities Symptoms of hypogonadism: Impotence Infertility Testicular atrophy Loss of libido Easy bruisability Decompensated cirrhosis may present with Jaundice Increase in abdominal girth due to ascites Pruritus Signs of upper gastrointestinal bleeding: Hematemesis Hematochezia Melena Symptoms due to hepatic encephalopathy: Altered mental status Confusion Sleep disturbances	Ultrasound findings in cirrhosis are as follows:^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8] Changes in liver contour: shrunken, irregular appearance Non homogeneous appearance of the hepatic tissue Increased surface nodularity Increase in echogenecity from focal fatty infiltration Atrophy of the right lobe and hypertrophy of the caudate or left lobe Splenomegaly Ascites Varices Hepatic or portal vein thrombosis Abdominal MRI may also be helpful in the diagnosis of portal hypertension. Findings on MRI suggestive of cirrhosis with portal hypertension include:^[9]^[10]^[11]^[12] Cirrhotic liver, as shrinkage and atrophy in liver Re-canalized umbilical vein--pathognomonic Dilated portal vein and/or splanchnic veins Esophageal varices Collaterals in any abdominal organ Splenomegaly Ascites Transient elastography and the Acoustic Radiation Force Impulse (ARFI) technique are well-established methods for the staging of fibrosis in various liver diseases: ^[13]^[14]^[15]^[16]^[17]^[18]^[19]^[20]^[21]^[22]^[23] The FibroScan (transient elastography) uses elastic waves to determine liver stiffness which theoretically may be converted into a liver score. The FibroScan produces an ultrasound image of the liver (from 20-80mm) along with a pressure reading (in kPa). Transient elastography is much faster than a biopsy (usually lasts 2.5-5 minutes) and is completely painless. Findings on transient elastography may show reasonable correlation with the severity of cirrhosis:^[24]^[25] Increasing scarring of the liver is associated with increasing "stiffness" of the tissue.
Splenic vein thrombosis	Signs and symptoms of: Upper abdominal pain radiating to the back Vomiting Hypoactive bowel sounds Fever Shock Cullen's sign Grey-Turner's sign	Ultrasound of the abdomen and CT scan will show evidence of a splenic vein thrombosis Normal hepatic venous pressure gradient is present
Portal vein thrombosis	Symptoms depend on the underlying cause: If pancreatitis is present, the patient may develop: Upper abdominal pain radiating to the back Vomiting Hypoactive bowel sounds fever shock Cullen's sign Grey-Turner's sign If the cause is ascending cholangitis, symptoms include: Fever Rigors Right upper quadrant pain Dark urine Pale stools If abdominal sepsis is the cause, symptoms include: Fever Abdominal pain Signs of peritonitis	Doppler ultrasound and abdominal CT scan show a portal vein filling defect and absence of flow in the portal vein. MR or direct angiography show a normal hepatic venous pressure gradient.
Schistosomiasis	Patients may have a history of travel to endemic areas Constitutional symptoms such as Malaise Rigors Anorexia Weight loss Vomiting Diarrhea Headache Muscular aches Weakness Abdominal pain Urticaria Fever Lymphadenopathy	MR or direct angiography shows a normal hepatic venous pressure gradient
Inferior vena cava obstruction	Signs and symptoms of renal cell carcinoma: Hematuria Flank pain Flank or abdominal mass Weight loss Hypertension	Ultrasound of the abdomen shows evidence of inferior vena cava obstruction
Nodular regenerative hyperplasia	None	Liver biopsy shows small regenerative nodules with little or no fibrosis on reticulin staining
Idiopathic portal hypertension (hepatoportal sclerosis)	None	Liver biopsy shows no evidence of cirrhosis

References

↑ Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM (2012). "Does this patient with liver disease have cirrhosis?". JAMA. 307 (8): 832–42. doi:10.1001/jama.2012.186. PMID 22357834.
↑ Becker CD, Scheidegger J, Marincek B (1986). "Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography". Gastrointest Radiol. 11 (4): 305–11. PMID 3533689.
↑ Di Lelio A, Cestari C, Lomazzi A, Beretta L (1989). "Cirrhosis: diagnosis with sonographic study of the liver surface". Radiology. 172 (2): 389–92. doi:10.1148/radiology.172.2.2526349. PMID 2526349.
↑ Sanford NL, Walsh P, Matis C, Baddeley H, Powell LW (1985). "Is ultrasonography useful in the assessment of diffuse parenchymal liver disease?". Gastroenterology. 89 (1): 186–91. PMID 3891495.
↑ Giorgio A, Amoroso P, Lettieri G, Fico P, de Stefano G, Finelli L, Scala V, Tarantino L, Pierri P, Pesce G (1986). "Cirrhosis: value of caudate to right lobe ratio in diagnosis with US". Radiology. 161 (2): 443–5. doi:10.1148/radiology.161.2.3532188. PMID 3532188.
↑ Simonovský V (1999). "The diagnosis of cirrhosis by high resolution ultrasound of the liver surface". Br J Radiol. 72 (853): 29–34. doi:10.1259/bjr.72.853.10341686. PMID 10341686.
↑ Trinchet JC, Chaffaut C, Bourcier V, Degos F, Henrion J, Fontaine H, Roulot D, Mallat A, Hillaire S, Cales P, Ollivier I, Vinel JP, Mathurin P, Bronowicki JP, Vilgrain V, N'Kontchou G, Beaugrand M, Chevret S (2011). "Ultrasonographic surveillance of hepatocellular carcinoma in cirrhosis: a randomized trial comparing 3- and 6-month periodicities". Hepatology. 54 (6): 1987–97. doi:10.1002/hep.24545. PMID 22144108.
↑ "EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma". J. Hepatol. 56 (4): 908–43. 2012. doi:10.1016/j.jhep.2011.12.001. PMID 22424438.
↑ Procopet, Bogdan; Berzigotti, Annalisa (2017). "Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy". Gastroenterology Report. 5 (2): 79–89. doi:10.1093/gastro/gox012. ISSN 2052-0034.
↑ Aagaard, J; Jensen, LI; Sorensen, TI; Christensen, U; Burcharth, F (1982). "Recanalized umbilical vein in portal hypertension". American Journal of Roentgenology. 139 (6): 1107–1110. doi:10.2214/ajr.139.6.1107. ISSN 0361-803X.
↑ Cho, K C; Patel, Y D; Wachsberg, R H; Seeff, J (1995). "Varices in portal hypertension: evaluation with CT". RadioGraphics. 15 (3): 609–622. doi:10.1148/radiographics.15.3.7624566. ISSN 0271-5333.
↑ Bandali, Murad Feroz; Mirakhur, Anirudh; Lee, Edward Wolfgang; Ferris, Mollie Clarke; Sadler, David James; Gray, Robin Ritchie; Wong, Jason Kam (2017). "Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy". World Journal of Gastroenterology. 23 (10): 1735. doi:10.3748/wjg.v23.i10.1735. ISSN 1007-9327.
↑ Castera L, Pinzani M (2010). "Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango?". Gut. 59 (7): 861–6. doi:10.1136/gut.2010.214650. PMID 20581229.
↑ Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D, Takahashi H, Yoneda M, Suda T, Zeuzem S, Herrmann E (2012). "Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis". J. Viral Hepat. 19 (2): e212–9. doi:10.1111/j.1365-2893.2011.01537.x. PMID 22239521.
↑ Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, Herrmann E (2008). "Performance of transient elastography for the staging of liver fibrosis: a meta-analysis". Gastroenterology. 134 (4): 960–74. doi:10.1053/j.gastro.2008.01.034. PMID 18395077.
↑ Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Lédinghen V, Marcellin P, Dhumeaux D, Trinchet JC, Beaugrand M (2005). "Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C". Hepatology. 41 (1): 48–54. doi:10.1002/hep.20506. PMID 15690481.
↑ Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, Beaugrand M, Palau R (2003). "Transient elastography: a new noninvasive method for assessment of hepatic fibrosis". Ultrasound Med Biol. 29 (12): 1705–13. PMID 14698338.
↑ Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Gilja OH, Havre RF, Jenssen C, Klauser AS, Ohlinger R, Saftoiu A, Schaefer F, Sporea I, Piscaglia F (2013). "EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology". Ultraschall Med. 34 (2): 169–84. doi:10.1055/s-0033-1335205. PMID 23558397.
↑ "EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis". J. Hepatol. 63 (1): 237–64. 2015. doi:10.1016/j.jhep.2015.04.006. PMID 25911335.
↑ Castera L, Bedossa P (2011). "How to assess liver fibrosis in chronic hepatitis C: serum markers or transient elastography vs. liver biopsy?". Liver Int. 31 Suppl 1: 13–7. doi:10.1111/j.1478-3231.2010.02380.x. PMID 21205132.
↑ Chou R, Wasson N (2013). "Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review". Ann. Intern. Med. 158 (11): 807–20. doi:10.7326/0003-4819-158-11-201306040-00005. PMID 23732714.
↑ Khallafi H, Qureshi K (2015). "Imaging Based Methods of Liver Fibrosis Assessment in Viral Hepatitis: A Practical Approach". Interdiscip Perspect Infect Dis. 2015: 809289. doi:10.1155/2015/809289. PMC 4686715. PMID 26779260.
↑ Singh S, Fujii LL, Murad MH, Wang Z, Asrani SK, Ehman RL, Kamath PS, Talwalkar JA (2013). "Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis". Clin. Gastroenterol. Hepatol. 11 (12): 1573–84.e1–2, quiz e88–9. doi:10.1016/j.cgh.2013.07.034. PMC 3900882. PMID 23954643.
↑ Foucher J, Chanteloup E, Vergniol J; et al. (2006). "Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study". Gut. 55 (3): 403–8. doi:10.1136/gut.2005.069153. PMID 16020491.
↑ Xie L, Chen X, Guo Q, Dong Y, Guang Y, Zhang X (2012). "Real-time elastography for diagnosis of liver fibrosis in chronic hepatitis B". Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 31 (7): 1053–60. PMID 22733854.

Template:WS Template:WH

[pmid22357834-1] Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM (2012). "Does this patient with liver disease have cirrhosis?". JAMA. 307 (8): 832–42. doi:10.1001/jama.2012.186. PMID 22357834.

[pmid3533689-2] Becker CD, Scheidegger J, Marincek B (1986). "Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography". Gastrointest Radiol. 11 (4): 305–11. PMID 3533689.

[pmid2526349-3] Di Lelio A, Cestari C, Lomazzi A, Beretta L (1989). "Cirrhosis: diagnosis with sonographic study of the liver surface". Radiology. 172 (2): 389–92. doi:10.1148/radiology.172.2.2526349. PMID 2526349.

[pmid3891495-4] Sanford NL, Walsh P, Matis C, Baddeley H, Powell LW (1985). "Is ultrasonography useful in the assessment of diffuse parenchymal liver disease?". Gastroenterology. 89 (1): 186–91. PMID 3891495.

[pmid3532188-5] Giorgio A, Amoroso P, Lettieri G, Fico P, de Stefano G, Finelli L, Scala V, Tarantino L, Pierri P, Pesce G (1986). "Cirrhosis: value of caudate to right lobe ratio in diagnosis with US". Radiology. 161 (2): 443–5. doi:10.1148/radiology.161.2.3532188. PMID 3532188.

[pmid10341686-6] Simonovský V (1999). "The diagnosis of cirrhosis by high resolution ultrasound of the liver surface". Br J Radiol. 72 (853): 29–34. doi:10.1259/bjr.72.853.10341686. PMID 10341686.

[pmid22144108-7] Trinchet JC, Chaffaut C, Bourcier V, Degos F, Henrion J, Fontaine H, Roulot D, Mallat A, Hillaire S, Cales P, Ollivier I, Vinel JP, Mathurin P, Bronowicki JP, Vilgrain V, N'Kontchou G, Beaugrand M, Chevret S (2011). "Ultrasonographic surveillance of hepatocellular carcinoma in cirrhosis: a randomized trial comparing 3- and 6-month periodicities". Hepatology. 54 (6): 1987–97. doi:10.1002/hep.24545. PMID 22144108.

[pmid22424438-8] "EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma". J. Hepatol. 56 (4): 908–43. 2012. doi:10.1016/j.jhep.2011.12.001. PMID 22424438.

[ProcopetBerzigotti2017-9] Procopet, Bogdan; Berzigotti, Annalisa (2017). "Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy". Gastroenterology Report. 5 (2): 79–89. doi:10.1093/gastro/gox012. ISSN 2052-0034.

[AagaardJensen1982-10] Aagaard, J; Jensen, LI; Sorensen, TI; Christensen, U; Burcharth, F (1982). "Recanalized umbilical vein in portal hypertension". American Journal of Roentgenology. 139 (6): 1107–1110. doi:10.2214/ajr.139.6.1107. ISSN 0361-803X.

[ChoPatel1995-11] Cho, K C; Patel, Y D; Wachsberg, R H; Seeff, J (1995). "Varices in portal hypertension: evaluation with CT". RadioGraphics. 15 (3): 609–622. doi:10.1148/radiographics.15.3.7624566. ISSN 0271-5333.

[BandaliMirakhur2017-12] Bandali, Murad Feroz; Mirakhur, Anirudh; Lee, Edward Wolfgang; Ferris, Mollie Clarke; Sadler, David James; Gray, Robin Ritchie; Wong, Jason Kam (2017). "Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy". World Journal of Gastroenterology. 23 (10): 1735. doi:10.3748/wjg.v23.i10.1735. ISSN 1007-9327.

[pmid20581229-13] Castera L, Pinzani M (2010). "Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango?". Gut. 59 (7): 861–6. doi:10.1136/gut.2010.214650. PMID 20581229.

[pmid22239521-14] Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D, Takahashi H, Yoneda M, Suda T, Zeuzem S, Herrmann E (2012). "Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis". J. Viral Hepat. 19 (2): e212–9. doi:10.1111/j.1365-2893.2011.01537.x. PMID 22239521.

[pmid18395077-15] Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, Herrmann E (2008). "Performance of transient elastography for the staging of liver fibrosis: a meta-analysis". Gastroenterology. 134 (4): 960–74. doi:10.1053/j.gastro.2008.01.034. PMID 18395077.

[pmid15690481-16] Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Lédinghen V, Marcellin P, Dhumeaux D, Trinchet JC, Beaugrand M (2005). "Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C". Hepatology. 41 (1): 48–54. doi:10.1002/hep.20506. PMID 15690481.

[pmid14698338-17] Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, Beaugrand M, Palau R (2003). "Transient elastography: a new noninvasive method for assessment of hepatic fibrosis". Ultrasound Med Biol. 29 (12): 1705–13. PMID 14698338.

[pmid23558397-18] Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Gilja OH, Havre RF, Jenssen C, Klauser AS, Ohlinger R, Saftoiu A, Schaefer F, Sporea I, Piscaglia F (2013). "EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology". Ultraschall Med. 34 (2): 169–84. doi:10.1055/s-0033-1335205. PMID 23558397.

[pmid25911335-19] "EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis". J. Hepatol. 63 (1): 237–64. 2015. doi:10.1016/j.jhep.2015.04.006. PMID 25911335.

[pmid21205132-20] Castera L, Bedossa P (2011). "How to assess liver fibrosis in chronic hepatitis C: serum markers or transient elastography vs. liver biopsy?". Liver Int. 31 Suppl 1: 13–7. doi:10.1111/j.1478-3231.2010.02380.x. PMID 21205132.

[pmid23732714-21] Chou R, Wasson N (2013). "Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review". Ann. Intern. Med. 158 (11): 807–20. doi:10.7326/0003-4819-158-11-201306040-00005. PMID 23732714.

[pmid26779260-22] Khallafi H, Qureshi K (2015). "Imaging Based Methods of Liver Fibrosis Assessment in Viral Hepatitis: A Practical Approach". Interdiscip Perspect Infect Dis. 2015: 809289. doi:10.1155/2015/809289. PMC 4686715. PMID 26779260.

[pmid23954643-23] Singh S, Fujii LL, Murad MH, Wang Z, Asrani SK, Ehman RL, Kamath PS, Talwalkar JA (2013). "Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis". Clin. Gastroenterol. Hepatol. 11 (12): 1573–84.e1–2, quiz e88–9. doi:10.1016/j.cgh.2013.07.034. PMC 3900882. PMID 23954643.

[24] Foucher J, Chanteloup E, Vergniol J; et al. (2006). "Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study". Gut. 55 (3): 403–8. doi:10.1136/gut.2005.069153. PMID 16020491.

[pmid22733854-25] Xie L, Chen X, Guo Q, Dong Y, Guang Y, Zhang X (2012). "Real-time elastography for diagnosis of liver fibrosis in chronic hepatitis B". Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 31 (7): 1053–60. PMID 22733854.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Budd-Chiari syndrome}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Budd-Chiari_syndrome]]
-{{CMG}}; {{AE}}
+{{CMG}}; {{AE}}{{Mazia}} {{ADS}}
-{{PleaseHelp}}
 ==Overview==
-==Differential Diagnosis==
 ==Differential diagnosis==
-<span style="font-size:85%">'''Abbreviations:'''
+Budd-Chiari syndrome should be differentiated from other causes of [[hepatic failure]] like [[viral hepatitis]] and [[liver cirrhosis]], [[splenic vein thrombosis]], [[portal vein thrombosis]] and [[inferior vena cava obstruction]] that may have similar presentation with right upper quadrant abdominal pain and [[ascites]]. The differential diagnosis is as follows:
-'''[[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]]
-</span>
-<br>
-{| align="center"
+{| class="wikitable"
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Condition
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Differentiating signs and symptoms
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Differentiating Tests
 |-
+| style="background:#DCDCDC; + " | '''Budd-Chiari Syndrome'''
 |
-{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
+* [[Abdominal pain]]
-! colspan="3" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of acute abdomen based on etiology
+* [[Diarrhea]]
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
-! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical manifestations
-! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments
-|-
-! colspan="4" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Symptoms
-! colspan="4" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Signs
-|-
-! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Fever
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and chills
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal Pain
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Hypo-
-tension
-! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Guarding
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Rebound Tenderness
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel sounds
-! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Lab Findings
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
-|-
-! rowspan="38" align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal causes
-! colspan="1" rowspan="26" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Inflammatory causes
-! rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pancreato-biliary disorders
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Acute suppurative cholangitis
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| 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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Abnormal [[LFT]]
-* WBC >10,000
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[biliary]] dilatation/stents/tumor
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Septic shock occurs with features of [[SIRS]]
-|-
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Cholangitis|Acute 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" | [[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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Abnormal [[LFT]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[biliary]] dilatation/stents/tumor
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Biliary drainage ([[Endoscopic retrograde cholangiopancreatography|ERCP]]) + IV antibiotics
-|-
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute cholecystitis|Acute cholecystitis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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="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" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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="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]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Pain radiation to back
-|-
-| 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" |[[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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased AMA level, abnormal [[LFTs]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Primary sclerosing cholangitis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Increased liver enzymes
-* Increased [[IgM]], [[IgG]]4
-* [[Anti-neutrophil cytoplasmic antibody]] ([[p-ANCA]])
-* [[Anti-nuclear antibody]] ([[ANA]])
-* [[Anti-smooth muscle antibody]] (Anti-Sm)
-* Anti-endothelial antibody
-* Anti-cardiolipin antibody
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cholelithiasis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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="left" |N to hyperactive for dislodged stone
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[gallstone]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]]
-|-
-! colspan="1" rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Gastric causes
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Peptic Ulcer Disease|Peptic ulcer disease]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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" | + in perforated
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Ascitic fluid
-** [[LDH]] > serum [[LDH]]
-** Glucose < 50mg/dl
-** Total protein > 1g/dl
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Air under [[diaphragm]] in upright [[CXR]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Upper GI [[endoscopy]] for diagnosis
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastritis|Gastritis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
-| 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="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastroesophageal reflux disease|Gastroesophageal reflux disease]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
-| 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="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastric outlet obstruction|Gastric outlet obstruction]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
-| 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="left" |Hyperactive
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastrointestinal perforation]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-| 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="left" |
-| 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" |
-|-
-! rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intestinal causes
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute appendicitis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +in pyogenic appendicitis
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Starts in [[epigastrium]], migrates to RLQ
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in perforated appendicitis
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], [[decreased appetite]]
-|-
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diverticulitis|Acute diverticulitis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |LLQ
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound shows evidence of inflammation
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Inflammatory bowel disease]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Irritable bowel syndrome]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Tests done to exclude other diseases as it diagnosis of exclusion
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Tests done to exclude other diseases as it diagnosis of exclusion
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Symptomatic treatment
-* High [[dietary fiber]]
-* [[Osmotic]] [[laxatives]]
-* [[Antispasmodic]] drugs
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Whipple's disease]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* [[Thrombocytopenia]]
-* [[Hypoalbuminemia]]
-* [[Small intestinal]] [[biopsy]] for [[Tropheryma whipplei]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |*[[Whipple's disease other diagnostic studies|Endoscopy]] is used to confirm diagnosis.
-Images used to find complications
-*[[Whipple's disease x ray|Chest and joint x-ray]]
-*[[Whipple's disease CT|CT]]
-*[[Whipple's disease MRI|MRI]]
-*[[Whipple's disease ultrasound|Echocardiography]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Extra intestinal findings:
-* [[Uveitis]]
-* [[Endocarditis]]
-* [[Encephalitis]]
-* [[Dementia]]
-* [[Hepatosplenomegaly]]
-* [[Arthritis]]
 * [[Ascites]]
+|
+* [[Doppler ultrasound]] and [[CT]] of the [[abdomen]] shows absence of the [[hepatic vein]] filling
+* [[Abdominal]] [[Computed tomography|CT scan]] will show a rapid clearing of the [[Caudate lobe of liver|caudate lobe]] of the [[liver]]
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Toxic megacolon]]
+| style="background:#DCDCDC; + " |'''Cirrhosis'''
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+|
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
+* [[Abdominal pain]] and [[bloating]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
+* [[Menstrual disorder|Menstrual irregularities]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
+* [[Symptoms]] of [[hypogonadism]]:
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+** [[Erectile dysfunction|Impotence]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+** [[Infertility]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
+** [[Testicular atrophy]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
+** Loss of [[libido]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+** Easy bruisability
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tropical sprue]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Celiac disease]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±, also [[dermatitis herpetiformis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="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 (increased sounds)
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* [[IgA]] endomysial antibody
-* [[IgA]] [[tissue transglutaminase]] antibody
-* [[Anti-gliadin antibodies|Anti-gliadin antibody]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatic causes
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis|Viral hepatitis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
-| 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="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver mass|Liver masses]]
-| 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" |[[RUQ]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in sepsis
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Budd-Chiari syndrome|Budd-Chiari syndrome]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
-| 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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Laboratory findings consistent with the [[diagnosis]] of [[acute]] and [[fulminant]] BCS include:
-*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" |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)
-*inhomogeneous mottled [[liver]] ([[nutmeg liver]])
-*Peripheral zones of the [[liver]] may appear hypoattenuating because of reversed [[portal]] [[venous]] [[blood flow]]
-*Inability to identify [[hepatic veins]]
-*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" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Dull / aching
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in cirrhotic patients
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |may be in cardicmyopathy
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |>60% TS<br> >240 μg/L SF <br>Raised LFT <br>Hyperglycemia
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Ultrasound shows evidence of cirrhosis
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |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" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
-| 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="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-! style="padding: 5px 5px; background: #DCDCDC;" align="center" | Peritoneal causes
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Spontaneous bacterial peritonitis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
-| 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="left" |Hypoactive
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Ascitic fluid [[PMN]]>250 cells/mm<small>³</small>
-* Culture: Positive for single organism
+* Decompensated [[cirrhosis]] may present with
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound for evaluation of liver cirrhosis
+** [[Jaundice]]
-! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+** Increase in [[abdominal]] girth due to [[ascites]]
+** [[Itch|Pruritus]]
+* Signs of [[upper gastrointestinal bleeding]]:
+** [[Hematemesis]]
+** [[Hematochezia]]
+** [[Melena]]
+** [[Symptoms]] due to [[hepatic encephalopathy]]:
+** [[Altered mental status]]
+** [[Confusion]]
+** [[Sleep]] disturbances
+|
+[[Ultrasound]] findings in cirrhosis are as follows:<ref name="pmid22357834">{{cite journal |vauthors=Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM |title=Does this patient with liver disease have cirrhosis? |journal=JAMA |volume=307 |issue=8 |pages=832–42 |year=2012 |pmid=22357834 |doi=10.1001/jama.2012.186 |url=}}</ref><ref name="pmid3533689">{{cite journal |vauthors=Becker CD, Scheidegger J, Marincek B |title=Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography |journal=Gastrointest Radiol |volume=11 |issue=4 |pages=305–11 |year=1986 |pmid=3533689 |doi= |url=}}</ref><ref name="pmid2526349">{{cite journal |vauthors=Di Lelio A, Cestari C, Lomazzi A, Beretta L |title=Cirrhosis: diagnosis with sonographic study of the liver surface |journal=Radiology |volume=172 |issue=2 |pages=389–92 |year=1989 |pmid=2526349 |doi=10.1148/radiology.172.2.2526349 |url=}}</ref><ref name="pmid3891495">{{cite journal |vauthors=Sanford NL, Walsh P, Matis C, Baddeley H, Powell LW |title=Is ultrasonography useful in the assessment of diffuse parenchymal liver disease? |journal=Gastroenterology |volume=89 |issue=1 |pages=186–91 |year=1985 |pmid=3891495 |doi= |url=}}</ref><ref name="pmid3532188">{{cite journal |vauthors=Giorgio A, Amoroso P, Lettieri G, Fico P, de Stefano G, Finelli L, Scala V, Tarantino L, Pierri P, Pesce G |title=Cirrhosis: value of caudate to right lobe ratio in diagnosis with US |journal=Radiology |volume=161 |issue=2 |pages=443–5 |year=1986 |pmid=3532188 |doi=10.1148/radiology.161.2.3532188 |url=}}</ref><ref name="pmid10341686">{{cite journal |vauthors=Simonovský V |title=The diagnosis of cirrhosis by high resolution ultrasound of the liver surface |journal=Br J Radiol |volume=72 |issue=853 |pages=29–34 |year=1999 |pmid=10341686 |doi=10.1259/bjr.72.853.10341686 |url=}}</ref><ref name="pmid22144108">{{cite journal |vauthors=Trinchet JC, Chaffaut C, Bourcier V, Degos F, Henrion J, Fontaine H, Roulot D, Mallat A, Hillaire S, Cales P, Ollivier I, Vinel JP, Mathurin P, Bronowicki JP, Vilgrain V, N'Kontchou G, Beaugrand M, Chevret S |title=Ultrasonographic surveillance of hepatocellular carcinoma in cirrhosis: a randomized trial comparing 3- and 6-month periodicities |journal=Hepatology |volume=54 |issue=6 |pages=1987–97 |year=2011 |pmid=22144108 |doi=10.1002/hep.24545 |url=}}</ref><ref name="pmid22424438">{{cite journal |vauthors= |title=EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma |journal=J. Hepatol. |volume=56 |issue=4 |pages=908–43 |year=2012 |pmid=22424438 |doi=10.1016/j.jhep.2011.12.001 |url=}}</ref>
+*Changes in [[liver]] contour: shrunken, irregular appearance
+*Non [[Homogenization|homogeneous]] appearance of the [[Liver|hepatic]] tissue
+*Increased [[Liver|surface]] [[Nodule (medicine)|nodularity]]
+*Increase in echogenecity from focal fatty [[Infiltration (medical)|infiltration]]
+*[[Atrophy]] of the right lobe and [[Hypertrophy (medical)|hypertrophy]] of the [[Caudate lobe of liver|caudate]] or left lobe
+*[[Splenomegaly]]
+*[[Ascites]]
+*[[Varices]]
+*[[Hepatic vein|Hepatic]] or [[portal vein]] [[thrombosis]]
+Abdominal [[MRI]] may also be helpful in the [[diagnosis]] of [[portal hypertension]]. Findings on [[MRI]] suggestive of cirrhosis with [[portal hypertension]] include:<ref name="ProcopetBerzigotti2017">{{cite journal|last1=Procopet|first1=Bogdan|last2=Berzigotti|first2=Annalisa|title=Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy|journal=Gastroenterology Report|volume=5|issue=2|year=2017|pages=79–89|issn=2052-0034|doi=10.1093/gastro/gox012}}</ref><ref name="AagaardJensen1982">{{cite journal|last1=Aagaard|first1=J|last2=Jensen|first2=LI|last3=Sorensen|first3=TI|last4=Christensen|first4=U|last5=Burcharth|first5=F|title=Recanalized umbilical vein in portal hypertension|journal=American Journal of Roentgenology|volume=139|issue=6|year=1982|pages=1107–1110|issn=0361-803X|doi=10.2214/ajr.139.6.1107}}</ref><ref name="ChoPatel1995">{{cite journal|last1=Cho|first1=K C|last2=Patel|first2=Y D|last3=Wachsberg|first3=R H|last4=Seeff|first4=J|title=Varices in portal hypertension: evaluation with CT.|journal=RadioGraphics|volume=15|issue=3|year=1995|pages=609–622|issn=0271-5333|doi=10.1148/radiographics.15.3.7624566}}</ref><ref name="BandaliMirakhur2017">{{cite journal|last1=Bandali|first1=Murad Feroz|last2=Mirakhur|first2=Anirudh|last3=Lee|first3=Edward Wolfgang|last4=Ferris|first4=Mollie Clarke|last5=Sadler|first5=David James|last6=Gray|first6=Robin Ritchie|last7=Wong|first7=Jason Kam|title=Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy|journal=World Journal of Gastroenterology|volume=23|issue=10|year=2017|pages=1735|issn=1007-9327|doi=10.3748/wjg.v23.i10.1735}}</ref>
+*[[Cirrhosis|Cirrhotic liver]], as shrinkage and [[atrophy]] in [[liver]]
+*Re-canalized [[umbilical vein]]--[[pathognomonic]]
+*Dilated [[portal vein]] and/or [[splanchnic]] veins
+*[[Esophageal varices]]
+*[[Collaterals]] in any [[Abdominal organs|abdominal organ]]
+*[[Splenomegaly]]
+*[[Ascites]]
+Transient [[elastography]] and the Acoustic Radiation Force Impulse (ARFI) technique are well-established methods for the staging of [[fibrosis]] in various [[liver]] diseases: <ref name="pmid20581229">{{cite journal |vauthors=Castera L, Pinzani M |title=Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango? |journal=Gut |volume=59 |issue=7 |pages=861–6 |year=2010 |pmid=20581229 |doi=10.1136/gut.2010.214650 |url=}}</ref><ref name="pmid22239521">{{cite journal |vauthors=Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D, Takahashi H, Yoneda M, Suda T, Zeuzem S, Herrmann E |title=Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis |journal=J. Viral Hepat. |volume=19 |issue=2 |pages=e212–9 |year=2012 |pmid=22239521 |doi=10.1111/j.1365-2893.2011.01537.x |url=}}</ref><ref name="pmid18395077">{{cite journal |vauthors=Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, Herrmann E |title=Performance of transient elastography for the staging of liver fibrosis: a meta-analysis |journal=Gastroenterology |volume=134 |issue=4 |pages=960–74 |year=2008 |pmid=18395077 |doi=10.1053/j.gastro.2008.01.034 |url=}}</ref><ref name="pmid15690481">{{cite journal |vauthors=Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Lédinghen V, Marcellin P, Dhumeaux D, Trinchet JC, Beaugrand M |title=Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C |journal=Hepatology |volume=41 |issue=1 |pages=48–54 |year=2005 |pmid=15690481 |doi=10.1002/hep.20506 |url=}}</ref><ref name="pmid14698338">{{cite journal |vauthors=Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, Beaugrand M, Palau R |title=Transient elastography: a new noninvasive method for assessment of hepatic fibrosis |journal=Ultrasound Med Biol |volume=29 |issue=12 |pages=1705–13 |year=2003 |pmid=14698338 |doi= |url=}}</ref><ref name="pmid23558397">{{cite journal |vauthors=Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Gilja OH, Havre RF, Jenssen C, Klauser AS, Ohlinger R, Saftoiu A, Schaefer F, Sporea I, Piscaglia F |title=EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology |journal=Ultraschall Med |volume=34 |issue=2 |pages=169–84 |year=2013 |pmid=23558397 |doi=10.1055/s-0033-1335205 |url=}}</ref><ref name="pmid25911335">{{cite journal |vauthors= |title=EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis |journal=J. Hepatol. |volume=63 |issue=1 |pages=237–64 |year=2015 |pmid=25911335 |doi=10.1016/j.jhep.2015.04.006 |url=}}</ref><ref name="pmid21205132">{{cite journal |vauthors=Castera L, Bedossa P |title=How to assess liver fibrosis in chronic hepatitis C: serum markers or transient elastography vs. liver biopsy? |journal=Liver Int. |volume=31 Suppl 1 |issue= |pages=13–7 |year=2011 |pmid=21205132 |doi=10.1111/j.1478-3231.2010.02380.x |url=}}</ref><ref name="pmid23732714">{{cite journal |vauthors=Chou R, Wasson N |title=Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review |journal=Ann. Intern. Med. |volume=158 |issue=11 |pages=807–20 |year=2013 |pmid=23732714 |doi=10.7326/0003-4819-158-11-201306040-00005 |url=}}</ref><ref name="pmid26779260">{{cite journal |vauthors=Khallafi H, Qureshi K |title=Imaging Based Methods of Liver Fibrosis Assessment in Viral Hepatitis: A Practical Approach |journal=Interdiscip Perspect Infect Dis |volume=2015 |issue= |pages=809289 |year=2015 |pmid=26779260 |pmc=4686715 |doi=10.1155/2015/809289 |url=}}</ref><ref name="pmid23954643">{{cite journal |vauthors=Singh S, Fujii LL, Murad MH, Wang Z, Asrani SK, Ehman RL, Kamath PS, Talwalkar JA |title=Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis |journal=Clin. Gastroenterol. Hepatol. |volume=11 |issue=12 |pages=1573–84.e1–2; quiz e88–9 |year=2013 |pmid=23954643 |pmc=3900882 |doi=10.1016/j.cgh.2013.07.034 |url=}}</ref>
+*The FibroScan (transient elastography) uses elastic waves to determine [[liver]] stiffness which theoretically may be converted into a liver score.
+*The FibroScan produces an [[ultrasound]] image of the [[liver]] (from 20-80mm) along with a pressure reading (in kPa).
+*Transient [[elastography]] is much faster than a [[biopsy]] (usually lasts 2.5-5 minutes) and is completely painless.
+*Findings on transient [[elastography]] may show reasonable correlation with the severity of cirrhosis:<ref>{{cite journal |author=Foucher J, Chanteloup E, Vergniol J, ''et al'' |title=Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study |journal=Gut |volume=55|issue=3 |pages=403-8 |year=2006 |pmid=16020491 |doi=10.1136/gut.2005.069153}}</ref><ref name="pmid22733854">{{cite journal |author=Xie L, Chen X, Guo Q, Dong Y, Guang Y, Zhang X |title=Real-time elastography for diagnosis of liver fibrosis in chronic hepatitis B |journal=[[Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine]] |volume=31 |issue=7 |pages=1053–60 |year=2012|pmid=22733854 |doi= |url=}}</ref>
+**Increasing [[Scar|scarring]] of the [[liver]] is associated with increasing "stiffness" of the [[Tissue (biology)|tissue]].
 |-
-! colspan="2" rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Hollow Viscous Obstruction
+| style="background:#DCDCDC; + " | '''Splenic vein thrombosis'''
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Small intestine obstruction
+|[[Signs]] and [[Symptom|symptoms]] of:
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
+* Upper [[abdominal pain]] radiating to the back
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
+* [[Vomiting]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
+* Hypoactive [[bowel sounds]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
+* [[Fever]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
+* [[Shock]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+* [[Cullen's sign]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+* [[Grey-Turner's sign]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent
+|
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
+* [[Ultrasound]] of the [[abdomen]] and [[Computed tomography|CT scan]] will show evidence of a [[splenic vein thrombosis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Abdominal X-ray|Abdominal X ray]]
+* Normal [[Hepatic vein|hepatic venous]] pressure gradient is present
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]]
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Volvulus]]
+| style="background:#DCDCDC; + " | '''Portal vein thrombosis'''
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
+|
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
+* [[Symptoms]] depend on the underlying cause:
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
+* If [[pancreatitis]] is present, the patient may develop:
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
+** Upper [[abdominal pain]] radiating to the back
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
+** Vomiting
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
+** Hypoactive [[bowel sounds]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
+** [[fever]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
+** [[shock]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
+** [[Cullen's sign]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and [[Abdominal x-ray|abdominal X ray]]
+** [[Grey-Turner's sign]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]]
+* If the cause is [[ascending cholangitis]], [[symptoms]] include:
+** [[Fever]]
+** [[Rigors]]
+** [[Right upper quadrant (abdomen)|Right upper quadrant]] [[pain]]
+** Dark [[urine]]
+** Pale [[stools]]
+* If [[abdominal]] [[sepsis]] is the cause, [[symptoms]] include:
+* [[Fever]]
+* [[Abdominal pain]]
+* [[Medical sign|Signs]] of [[peritonitis]]
+|
+* [[Doppler ultrasound]] and [[abdominal]] [[Computed tomography|CT scan]] show a [[portal vein]] filling defect and absence of flow in the [[portal vein]].
+* MR or direct [[Angiogram|angiography]] show a normal [[Hepatic vein|hepatic venous]] pressure gradient.
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Biliary colic]]
+| style="background:#DCDCDC; + " | '''Schistosomiasis'''
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
+|
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
+* Patients may have a history of travel to [[endemic]] areas
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ
+* Constitutional [[symptoms]] such as
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+** [[Malaise]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
+** [[Rigors]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
+** [[Anorexia]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
+** [[Weight loss]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
+** [[Vomiting]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[bilirubin]] and [[alkaline phosphatase]]
+** [[diarrhea|Diarrhea]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
+** [[Headache]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
+** [[Muscular aches]]
+** [[Weakness]]
+** [[Abdominal pain]]
+** [[Urticaria]]
+** [[Fever]]
+** [[Lymphadenopathy]]
+|
+* MR or direct [[Angiogram|angiography]] shows a normal [[Hepatic vein|hepatic venous]] pressure gradient
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Renal colic]]
+| style="background:#DCDCDC; + " | '''Inferior vena cava obstruction'''
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
+|
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
+* Signs and symptoms of [[renal cell carcinoma]]:
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Flank pain]]
+* [[Hematuria]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
+* [[Flank pain]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
+* [[Flank]] or [[abdominal]] mass
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
+* [[Weight loss]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
+* [[Hypertension]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
+|
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Hematuria]]
+* [[Ultrasound]] of the abdomen shows evidence of [[inferior vena cava]] obstruction
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Colicky [[abdominal pain]] associated with [[Nausea and vomiting|nausea & vomiting]]
 |-
-! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Vascular Disorders
+| style="background:#DCDCDC; + " | '''Nodular regenerative hyperplasia'''
-! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ischemic causes
+|None
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia]]
+|
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+* [[Liver biopsy]] shows small regenerative [[Nodule (medicine)|nodules]] with little or no [[fibrosis]] on reticulin staining
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Periumbilical
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="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" |[[Leukocytosis]] and [[lactic acidosis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], normal physical examination
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ischemic colitis|Acute ischemic colitis]]
+| style="background:#DCDCDC; + " | '''Idiopathic portal hypertension (hepatoportal sclerosis)'''
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+|None
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+|
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
+* [[Liver biopsy]] shows no evidence of 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" |<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" |CT scan
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
-|-
-! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hemorrhagic causes
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ruptured abdominal aortic aneurysm]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
-| 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" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Anemia]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of [[trauma]]
-|-
-! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gynaecological Causes
-! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Tubal causes
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Torsion of the cyst
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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="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" |[[Salpingitis|Acute salpingitis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-| 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="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" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]]
-|-
-! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pregnancy
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ruptured [[ectopic pregnancy]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Positive [[pregnancy test]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of missed period and [[vaginal bleeding]]
-|-
-! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Extra-abdominal causes
-! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pulmonary disorders
-| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pleural empyema]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-| 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="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cardiovascular disorders
-| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Myocardial Infarction]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
-| 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" | + 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" |
-! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-|}
 |}
-{|
-|-
-{|
-|-
-| [[Image:Right_upper_quadrant.PNG|link=Right upper quadrant abdominal pain resident survival guide]]||[[Image:Epigastric_quadrant_pain.PNG|link=Epigastric pain resident survival guide]]||[[Image:Left_upper_quadrant.PNG|link=Left upper quadrant abdominal pain resident survival guide]]
-|-
-| [[Image:Right_flank_quadrant.PNG|link=Right flank pain resident survival guide]]||[[Image:Umbilical_pain.PNG|link=Umbilical region pain resident survival guide]]||[[Image:Left_flank_quadrant.PNG|link=Left flank quadrant abdominal pain resident survival guide]]
-|-
-| [[Image:Right_lower_quadrant.PNG|link=Right lower quadrant abdominal pain resident survival guide]]||[[Image:Hypogastric.PNG|link=Hypogastric pain resident survival guide]]||[[Image:Left_lower_quadrant.PNG|link=Left lower quadrant abdominal pain resident survival guide]]
-|}
 ==References==

Budd-Chiari syndrome differential diagnosis: Difference between revisions

Latest revision as of 22:12, 8 February 2019

Overview

Differential diagnosis

References

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