Inflammatory bowel disease differential diagnosis: Difference between revisions

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{{Inflammatory bowel disease}}
{{Inflammatory bowel disease}}


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==Overview==
Inflammatory bowel disease must be differentiated from other diseases that cause [[Abdominal pain|lower abdominal pain]] and [[fever]] like [[appendicitis]], [[diverticulitis]], [[colon cancer]], [[cystitis]], and [[endometritis]].
 
==Differentiating inflammatory bowel disease from other diseases==
Inflammatory bowel disease must be differentiated from other diseases that cause [[Abdominal pain|lower abdominal pain]] and [[fever]] like [[appendicitis]], [[diverticulitis]], [[colon cancer]], [[cystitis]], and [[endometritis]].<ref name="pmid17573742">{{cite journal| author=Laurell H, Hansson LE, Gunnarsson U| title=Acute diverticulitis--clinical presentation and differential diagnostics. | journal=Colorectal Dis | year= 2007 | volume= 9 | issue= 6 | pages= 496-501; discussion 501-2 | pmid=17573742 | doi=10.1111/j.1463-1318.2006.01162.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17573742 }} </ref><ref>Hardin, M. Acute Appendicitis: Review and Update. ''Am Fam Physician".1999, Nov 1;60(7):2027-2034''</ref><ref name="pmid8596552">{{cite journal| author=Hanauer SB| title=Inflammatory bowel disease. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 13 | pages= 841-8 | pmid=8596552 | doi=10.1056/NEJM199603283341307 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8596552  }} </ref><ref name="hhh">Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016</ref><ref name="nlm">Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016</ref><ref name="pmid27107781">{{cite journal |vauthors=Ford GW, Decker CF |title=Pelvic inflammatory disease |journal=Dis Mon |volume=62 |issue=8 |pages=301–5 |year=2016 |pmid=27107781 |doi=10.1016/j.disamonth.2016.03.015 |url=}}</ref>
 
{| class="wikitable"
! colspan="2" rowspan="2" |Diseases
! colspan="2" |Symptoms
! colspan="3" |Signs
! colspan="2" |Diagnosis
! rowspan="2" |Comments
|-
!Abdominal pain
!Bowel habits
!Rebound tenderness
!Guarding
!Genitourinary signs
!Lab findings
!Imaging
|-
| rowspan="5" |GI diseases
|[[Inflammatory bowel disease]]
|LLQ
|Bloody diarrhea
|<nowiki>-</nowiki>
| -
| -
|
* Leukocytosis
|
|[[Colonoscopy]] and tissue sampling are recommended for differentiating between [[Crohn's disease]] and [[ulcerative colitis]].
|-
|[[Diverticulitis]]
|LLQ
|[[Constipation]]
Or
 
[[Diarrhea]]
| -
| +
|<nowiki>+ </nowiki>
|
* [[Leukocytosis]]
|CT scan shows evidence of [[inflammation]]
|
|-
|[[Appendicitis]]
|LLQ / RRQ
|Constipation
| +
| +
| -
|
* [[Leukocytosis]]
|Ultrasound shows evidence of [[inflammation]]
|[[Nausea and vomiting|Nausea & vomiting]],[[decreased appetite]]
|-
|[[Colon carcinoma]]
|LLQ
|Constipation
 
| -
| -
| -
|
* Serum [[carcino-embryogenic antigen]] 
* Low Vit b12
* [[Hypercalcemia]]
|CT scan, x-ray and MRI used to show [[metastasis]]
|
|-
|[[Strangulated hernia]]
|LLQ
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* No specific tests
|
* CT scan used to detect the [[hernia]] and to show if it is single or multiple
|
|-
| rowspan="3" |Gentiourinary diseases
|[[Cystitis]]
|LLQ
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* Suprapubic tenderness
|
* [[Pyuria]]  
* Presence of [[nitrites]] and leukocyte estrase
|
* X ray is done to probe the suspicion of emphysematous cystitis.
* CT scan shows gas in the [[Urinary bladder|bladder]] in cases of emphysematous cystitis.
|
|-
|[[Prostatitis]]
|LLQ
 
Groin pain
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Tender and enlarged
|
* Serum [[Prostate specific antigen|PSA]] elevated
* [[Leukocytosis]]
* Elevated [[C-reactive protein|CRP]]
|
* CT scan shows [[edema]] and enlarged [[prostate]]
* [[Abscess]] may be observed
|
|-
|[[Pelvic inflammatory disease]]
|Bilateral
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
| -
|
* Purulent vaginal discharge
|
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] is the best laboratory test for PID.
|[[Transvaginal ultrasound|Transvaginal utrasonography]]
|
|-
| rowspan="2" |Gynecological diseases
|[[Endometritis]]
|LLQ
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
* No specific tests
|
* Ultrasound is helpful to rule out other differential diagnosis such as pelvic abscess, thrombosis and masses
|
* Vaginal discharge
 
* Vaginal bleeding
|-
|[[Salpingitis]]
|LLQ/ RLQ
|
| +/-
| +/-
|
|
* Leukocytosis
|Pelvic ultrasound
|
* Vaginal discharge
|}


==References==
==References==

Latest revision as of 18:33, 31 July 2017

Inflammatory Bowel Disease Main page

Patient Information

Overview

Causes

Classification

Crohn's disease
Ulcerative colitis

Differential Diagnosis

Overview

Inflammatory bowel disease must be differentiated from other diseases that cause lower abdominal pain and fever like appendicitis, diverticulitis, colon cancer, cystitis, and endometritis.

Differentiating inflammatory bowel disease from other diseases

Inflammatory bowel disease must be differentiated from other diseases that cause lower abdominal pain and fever like appendicitis, diverticulitis, colon cancer, cystitis, and endometritis.[1][2][3][4][5][6]

Diseases Symptoms Signs Diagnosis Comments
Abdominal pain Bowel habits Rebound tenderness Guarding Genitourinary signs Lab findings Imaging
GI diseases Inflammatory bowel disease LLQ Bloody diarrhea - - -
  • Leukocytosis
 Colonoscopy and tissue sampling are recommended for differentiating between Crohn's disease and ulcerative colitis.
Diverticulitis LLQ Constipation

Or

Diarrhea

- + + CT scan shows evidence of inflammation
Appendicitis LLQ / RRQ Constipation + + - Ultrasound shows evidence of inflammation Nausea & vomiting,decreased appetite
Colon carcinoma LLQ Constipation - - - CT scan, x-ray and MRI used to show metastasis
Strangulated hernia LLQ - - - -
  • No specific tests
  • CT scan used to detect the hernia and to show if it is single or multiple
Gentiourinary diseases Cystitis LLQ - + -
  • Suprapubic tenderness
  • X ray is done to probe the suspicion of emphysematous cystitis.
  • CT scan shows gas in the bladder in cases of emphysematous cystitis.
Prostatitis LLQ

Groin pain

- - -
  • Tender and enlarged
Pelvic inflammatory disease Bilateral - + -
  • Purulent vaginal discharge
 Transvaginal utrasonography
Gynecological diseases Endometritis LLQ - + - +
  • No specific tests
  • Ultrasound is helpful to rule out other differential diagnosis such as pelvic abscess, thrombosis and masses
  • Vaginal discharge
  • Vaginal bleeding
Salpingitis LLQ/ RLQ +/- +/-
  • Leukocytosis
 Pelvic ultrasound
  • Vaginal discharge

References

  1. ↑ Laurell H, Hansson LE, Gunnarsson U (2007). "Acute diverticulitis--clinical presentation and differential diagnostics". Colorectal Dis. 9 (6): 496–501, discussion 501-2. doi:10.1111/j.1463-1318.2006.01162.x. PMID 17573742.
  2. ↑ Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
  3. ↑ Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.
  4. ↑ Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016
  5. ↑ Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016
  6. ↑ Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.
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