Colon polyps differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Colon polyps}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Colon_polyps]]
{{CMG}}; {{AE}} {{SSH}}
{{CMG}}; {{AE}} {{SSH}}
==Overview==
==Overview==
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Juvenile Polyposis Syndrome'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Juvenile Polyposis Syndrome'''
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |_
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
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| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" |SMAD4
| style="background: #F5F5F5; padding: 5px;" |
 
* SMAD4
[[BMPR1A]]
* [[BMPR1A]]
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" |[[Adenoma]]+ 
[[Hamartoma]]+++
| style="background: #F5F5F5; padding: 5px;" |[[Colon (anatomy)|Colon]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Adenoma]]+ 
* [[Hamartoma]]+++
| style="background: #F5F5F5; padding: 5px;" |
* [[Colon (anatomy)|Colon]]
| style="background: #F5F5F5; padding: 5px;" |_
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cowden syndrome|'''Cowden Syndrome''']]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cowden syndrome|'''Cowden Syndrome''']]
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" |[[Axillary]]+
| style="background: #F5F5F5; padding: 5px;" |
 
* [[Axillary]]+
[[Inguinal region|Inguinal]]+
* [[Inguinal region|Inguinal]]+
 
* [[Facial]]+
[[Facial]]+
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" |[[Axillary]]+
| style="background: #F5F5F5; padding: 5px;" |
 
* [[Axillary]]+
[[Inguinal region|Inguinal]]+
* [[Inguinal region|Inguinal]]+
 
* [[Facial]]+
[[Facial]]+
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" |[[PTEN (gene)|PTEN]]
| style="background: #F5F5F5; padding: 5px;" |
* [[PTEN (gene)|PTEN]]
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" |[[Adenoma]]+ 
| style="background: #F5F5F5; padding: 5px;" |
 
* [[Adenoma]]+ 
[[Hamartoma]]+++
* [[Hamartoma]]+++
| style="background: #F5F5F5; padding: 5px;" |[[Breast]], [[Thyroid]], [[Endometrium]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Trichilemmoma]], [[skin]] [[hamartoma]], [[Hyperplasia|hyperplastic]] [[Polyp|polyps]], [[macrocephaly]], [[breast]] [[fibrosis]]
* [[Breast]]
* [[Thyroid]]
* [[Endometrium]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Trichilemmoma]]
* [[skin]] [[hamartoma]]
* [[Hyperplasia|Hyperplastic]] [[Polyp|polyps]]
* [[macrocephaly]]
* [[breast]] [[fibrosis]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Carney syndrome|'''Carney Syndrome''']]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Carney syndrome|'''Carney Syndrome''']]
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" |[[Facial]]+
| style="background: #F5F5F5; padding: 5px;" |
 
* [[Facial]]+
[[Mucous membrane|Mucosal]]+
* [[Mucous membrane|Mucosal]]+
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" |[[Facial]]+
| style="background: #F5F5F5; padding: 5px;" |
 
* [[Facial]]+
[[Mucous membrane|Mucosal]]+
* [[Mucous membrane|Mucosal]]+
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" |[[PRKAR1A]]
| style="background: #F5F5F5; padding: 5px;" |
* [[PRKAR1A]]
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Thyroid]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Myxoma|Myxomas]] of [[skin]] and [[heart]]
* [[Thyroid]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Myxoma|Myxomas]] of [[skin]] and [[heart]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Familial adenomatous polyposis|'''Familial Adenomatous Polyposis''']]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Familial adenomatous polyposis|'''Familial Adenomatous Polyposis''']]
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| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[APC]]
| style="background: #F5F5F5; padding: 5px;" |
* [[APC]]
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" |[[Adenoma]]+++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Colon (anatomy)|Colon]], [[brain]]
* [[Adenoma]]+++
| style="background: #F5F5F5; padding: 5px;" |[[Desmoid tumor|Desmoid tumors]], [[Osteoma|osteomas]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Colon (anatomy)|Colon]]
* [[brain]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Desmoid tumor|Desmoid tumors]]
* [[Osteoma|Osteomas]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hereditary nonpolyposis colorectal cancer|'''Hereditary Non–Polyposis Colon Cancer''']]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hereditary nonpolyposis colorectal cancer|'''Hereditary Non–Polyposis Colon Cancer''']]
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| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[MLH1]]
| style="background: #F5F5F5; padding: 5px;" |
 
* [[MLH1]]
[[MSH2]]
* [[MSH2]]
 
* [[MSH3]]
[[MSH3]]
* [[MSH6]]
 
* [[PMS1]]
[[MSH6]]
* [[PMS2]]
 
[[PMS1]]
 
[[PMS2]]
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" | –
| style="background: #F5F5F5; padding: 5px;" |[[Adenoma]]+
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Endometrium|Endometrial]], [[Stomach|gastric]], [[renal pelvis]], [[ureter]], and [[Ovary|ovarian]]
* [[Adenoma]]+
| style="background: #F5F5F5; padding: 5px;" |[[Sebaceous gland|Sebaceous]] [[adenoma]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Endometrium|Endometrial]]
* [[Stomach|Gastric]]
* [[renal pelvis]]
* [[ureter]]
* [[Ovary|Ovarian]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Sebaceous gland|Sebaceous]] [[adenoma]]
|}
|}


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== References ==
== References ==
{{reflist|2}}
{{reflist|2}}
​​[[Category:Medicine]]
​​
 
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]​
[[Category:Up-To-Date]]
[[Category:Primary care]]

Latest revision as of 21:00, 29 July 2020

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

Overview

Colon polyps might present solitary or multiple. Solitary colon polyps usually have no symptoms. Colon polyps must be differentiated from other genetic diseases that cause multiple polyps, such as Peutz–Jeghers syndrome, Cowden syndrome, Bannayan–Riley–Ruvalcaba syndrome, juvenile polyposis, and McCune–Albright syndrome.

Differentiating Colon Polyps from other Diseases

Colon polyps must be differentiated from the following diseases:[1][2]

Differential diagnosis according to polys:

Diseases History and Symptoms Physical Examination Laboratory Findings Other Findings
Abdominal Pain Rectal Bleeding Hyperpigmentation Fatigue Abdominal Tenderness Hyperpigmentation Anemia Gene(s) Sertoli Cell Tumors Gastrointestinal Tumors Cancers
Juvenile Polyposis Syndrome + _ + _
Cowden Syndrome
Carney Syndrome ++
Familial Adenomatous Polyposis + + + +/– +
Hereditary Non–Polyposis Colon Cancer + + +/– +
Differential of gastrointestinal bleeding
Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo–

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Colon polyps + +
  • Colonoscopy
Peutz–Jeghers syndrome Depends on location of polyps it maybe present ± ± ± ± ±
  • Rectal bleeding may be present due to polyp
+
  • Hamartomatous polyps present on endoscopy
  • Iron deficiency anemia on CBC
  • STK11 mutation
  • Intra–operative enteroscopy (laparatomy with endoscopy
  • Double balloon eneteroscopy
  • Colonoscopy
  • Barium Swallow
  • Can lead to colon cancer, breast cancer, ovarian cancer, cervical cancer, and testicular cancer
Peptic ulcer disease Diffuse ± + + Positive if perforated Positive if perforated Positive if perforated N
  • Ascitic fluid
    • LDH > serum LDH
    • Glucose < 50mg/dl
    • Total protein > 1g/dl
Gastritis Epigastric ± + Positive in chronic gastritis + N
Gastrointestinal perforation Diffuse + ± ± + + + ± Hyperactive/hypoactive
  • WBC> 10,000
Acute diverticulitis LLQ + ± + + ± + Positive in perforated diverticulitis + + Hypoactive
  • CT scan
  • Ultrasound
Inflammatory bowel disease Diffuse ± ± + + + Normal or hyperactive

Extra intestinal findings:

Infective colitis Diffuse + ± + + Positive in fulminant colitis ± ± Hyperactive CT scan
  • Bowel wall thickening
  • Edema
Colon carcinoma Diffuse/localized ± ± + + ±
  • Normal or hyperactive if obstruction present
  • CBC
  • Carcinoembryonic antigen (CEA)
  • Colonoscopy
  • Flexible sigmoidoscopy
  • Barium enema
  • CT colonography 
  • PILLCAM 2: A colon capsule for CRC screening may be used in patients with an incomplete colonoscopy who lacks obstruction
Budd–Chiari syndrome RUQ ± ± Positive in liver failure leading to varices N
Findings on CT scan suggestive of Budd–Chiari syndrome include:
Ascitic fluid examination shows:
Hemochromatosis RUQ Positive in cirrhotic patients N
  • >60% TS
  • >240 μg/L SF
  • Raised LFT
    Hyperglycemia
  • Ultrasound shows evidence of cirrhosis
Extra intestinal findings:
  • Hyperpigmentation
  • Diabetes mellitus
  • Arthralgia
  • Impotence in males
  • Cardiomyopathy
  • Atherosclerosis
  • Hypopituitarism
  • Hypothyroidism
  • Extrahepatic cancer
  • Prone to specific infections
Cirrhosis RUQ + + + + N US
  • Stigmata of liver disease
  • Cruveilhier– Baumgarten murmur
Mesenteric ischemia Periumbilical Positive if bowel becomes gangrenous + + + + Positive if bowel becomes gangrenous Positive if bowel becomes gangrenous Hyperactive to absent CT angiography
  • SMA or SMV thrombosis
  • Also known as abdominal angina that worsens with eating
Acute ischemic colitis Diffuse + ± + + + + + + + Hyperactive then absent Abdominal x–ray
  • Distension and pneumatosis

CT scan

  • Double halo appearance, thumbprinting
  • Thickening of bowel
  • May lead to shock
Ruptured abdominal aortic aneurysm Diffuse ± + + + + N
  • Focused Assessment with Sonography in Trauma (FAST) 
  • Unstable hemodynamics
Intra–abdominal or retroperitoneal hemorrhage Diffuse ± ± + + N
  • ↓ Hb
  • ↓ Hct
  • CT scan

References

  1. Buck, J L; Harned, R K; Lichtenstein, J E; Sobin, L H (1992). "Peutz-Jeghers syndrome". RadioGraphics. 12 (2): 365–378. doi:10.1148/radiographics.12.2.1561426. ISSN 0271-5333.
  2. "Peutz-Jeghers Syndrome - GeneReviews® - NCBI Bookshelf".

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