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*Irritable bowel syndrome (IBS)
*Irritable bowel syndrome (IBS)


===Differential Diagnosis of Dumping Syndrome based on Early Dumping Syndrome symptoms:===
===Differential Diagnosis of Dumping Syndrome based on Postvagotomy complications symptoms:===
The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline.They are as follows: <ref name="urlShort-Bowel Syndrome Workup: Laboratory Studies, Imaging Studies, Other Tests">{{cite web |url=https://emedicine.medscape.com/article/193391-workup#c8 |title=Short-Bowel Syndrome Workup: Laboratory Studies, Imaging Studies, Other Tests |format= |work= |accessdate=}}</ref><ref name="urlThe Dictionary of Modern Medicine - J.C. Segen - Google Books">{{cite web |url=https://books.google.com/books?id=FbSlyyshjOoC&pg=PA183&lpg=PA183&dq=small+capacity+syndrome+dumping+-gut&source=bl&ots=jxTdlNDcwC&sig=opIV9WoEa6yCIY6udkil_Mq3rYE&hl=en&sa=X&ved=0ahUKEwjrz72gn-LXAhUK7YMKHTOXCZMQ6AEIYjAN#v=onepage&q=small%20capacity%20syndrome%20dumping%20-gut&f=false |title=The Dictionary of Modern Medicine - J.C. Segen - Google Books |format= |work= |accessdate=}}</ref><ref name="urlMastery of Surgery - Google Books">{{cite web |url=https://books.google.com/books?id=PgUFJg_-f4YC&pg=PA952&lpg=PA952&dq=small+capacity+syndrome&source=bl&ots=f0TebFuKK1&sig=CVIB44xCURFPi0CctG9-MWCsMnU&hl=en&sa=X&ved=0ahUKEwiU7IC0l-LXAhUB2oMKHQ4HBEEQ6AEIMjAC#v=onepage&q=small%20capacity%20syndrome&f=false |title=Mastery of Surgery - Google Books |format= |work= |accessdate=}}</ref>
The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline.They are the following:<ref name="urlShort-Bowel Syndrome Workup: Laboratory Studies, Imaging Studies, Other Tests">{{cite web |url=https://emedicine.medscape.com/article/193391-workup#c8 |title=Short-Bowel Syndrome Workup: Laboratory Studies, Imaging Studies, Other Tests |format= |work= |accessdate=}}</ref><ref name="urlThe Dictionary of Modern Medicine - J.C. Segen - Google Books">{{cite web |url=https://books.google.com/books?id=FbSlyyshjOoC&pg=PA183&lpg=PA183&dq=small+capacity+syndrome+dumping+-gut&source=bl&ots=jxTdlNDcwC&sig=opIV9WoEa6yCIY6udkil_Mq3rYE&hl=en&sa=X&ved=0ahUKEwjrz72gn-LXAhUK7YMKHTOXCZMQ6AEIYjAN#v=onepage&q=small%20capacity%20syndrome%20dumping%20-gut&f=false |title=The Dictionary of Modern Medicine - J.C. Segen - Google Books |format= |work= |accessdate=}}</ref><ref name="urlMastery of Surgery - Google Books">{{cite web |url=https://books.google.com/books?id=PgUFJg_-f4YC&pg=PA952&lpg=PA952&dq=small+capacity+syndrome&source=bl&ots=f0TebFuKK1&sig=CVIB44xCURFPi0CctG9-MWCsMnU&hl=en&sa=X&ved=0ahUKEwiU7IC0l-LXAhUB2oMKHQ4HBEEQ6AEIMjAC#v=onepage&q=small%20capacity%20syndrome&f=false |title=Mastery of Surgery - Google Books |format= |work= |accessdate=}}</ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
| valign="top" |
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|}
|}


===Differential Diagnosis of Dumping Syndrome based on Early Dumping Syndrome symptoms:===
The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline. They are as follows:
=== '''Differential Diagnosis of Dumping Syndrome based on Late Dumping Syndrome symptoms:''' ===
=== '''Differential Diagnosis of Dumping Syndrome based on Late Dumping Syndrome symptoms:''' ===
The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline.They are as follows:
The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline.They are as follows:
Line 142: Line 144:


The diffrentials of chronic watery diarrhea are as follows:
The diffrentials of chronic watery diarrhea are as follows:
{| class="wikitable"
! colspan="3" rowspan="2" |Cause
! colspan="2" |Osmotic gap
! rowspan="2" |History
! rowspan="2" |Physical exam
! rowspan="2" |Gold standard
! rowspan="2" |Treatment
|-
!< 50 mOsm per kg
!> 50 mOsm per kg*
|-
| rowspan="7" |Watery
| rowspan="4" |Secretory
|[[Crohns disease|Crohns]]
| +
| -
|
* [[Abdominal pain]] followed by [[diarrhea]]
|
* [[Abdominal]] [[Tenderness|tenderness when]]<nowiki/> palpated in severe [[disease]]
* Blood seen on [[rectal exam]]
* [[Fever]]
* [[Tachycardia]]
* [[Hypotension]]
|
* [[Colonoscopy]] with [[biopsy]]
|
* Topical mucosamine and [[corticosteroids]]<nowiki/> are preferred
* [[Mesalamine]]<nowiki/>and [[sulfasalazine]]<nowiki/> are used for remission
|-
|[[Zollinger-Ellison syndrome]]
| +
| -
|
* [[Abdominal pain]] and [[diarrhea]]
* Dyspepsia
* Upper or lower GI bleeding
|
* [[Abdominal]][[Tenderness|tenderness when]]<nowiki/>palpated in severe [[disease]]
* Blood seen on [[rectal exam]], Hematochezia
* Hematemesis
* [[Tachycardia]]
* [[Hypotension]]
|
* Gastrin levels
|
* Proton pump inhibitors
* Octreotide
|-
|[[Hyperthyroidism]]
| +
| -
|
* [[Abdominal pain]] and [[diarrhea]]
* Dyspepsia
* Upper or lower GI bleeding
|
* Lump in the neck
* [[Proptosis]]
* [[Tremors]]
* Increased DTR
|
* [[TSH]] with [[T3]] and [[T4]]
|
* [[Carbimazole]]<nowiki/> and [[methimazole]]
* [[Beta blockers]]<nowiki/> like [[propylthiouracil]]
* [[Iodine-131]]
|-
|[[VIPoma]]
| +
| -
|
* Watery [[diarrhea]]
* [[Dehydration]]([[thirst]], [[dry skin]], [[dry mouth]], [[tiredness]], [[headaches]], and [[dizziness]])
* [[Lethargy]], [[muscle weakness]]
* [[Nausea]], [[vomiting]]
* Crampy [[abdominal pain]]
* [[Weight loss]]
* [[Flushing]]
|
* Lump in the neck
* [[Proptosis]]
* [[Tremors]]
* Increased DTR
|
* Elevated [[VIP]]<nowiki/>levels
* Followed by imaging
|
* [[Sandostatin]] or [[chemotherapy]] for [[malignant tumors]]
* Surgical removal of the [[tumor]]
|-
| rowspan="2" |Osmotic
|Lactose intolerance
| -
| +
|
* [[Abdominal pain]]
* [[Bloating]]
* [[Diarrhea]]
* [[Flatulence]]
|
* [[Abdominal tenderness]]
|
* Intestinal [[biopsy]]
|
* Avoidance of dietary [[lactose]]
* Substitution to maintain nutrient intake
* Regulation of [[calcium]] intake
* Use of [[enzyme]][[lactase]]
|-
|[[Celiac disease (patient information)|Celiac disease]]
| -
| +
|
* May be asymptomatic
* Vague [[abdominal pain]]
* [[Diarrhea]]
* [[Weight loss]]
* [[Malabsorption]]/ [[steatorrhea]]
* Bloatedness
|
** [[Abdominal pain]] and [[cramping]]
** [[Abdominal distention]]
** [[Tetany]]
** [[Mouth ulcers]]
** [[Dermatitis herpetiformis]]
** Signs of the fat-soluble [[Vitamin A|vitamins A]], D, E, and K deficiency
|
* [[IgA]] tissue [[transglutaminase]]Ab
|
* [[Gluten-free diet]]
|-
|Functional
|[[Irritable bowel syndrome]]
| -
| -
|[[Abdominal pain]] or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following:
* Improves with [[defecation]]
* Onset associated with change in frequency of [[stool]]
* Onset associated with change in appearance of stool
* 25% of [[Bowel movement|bowel movements]] are loose stools
History of straining is also common
|
* [[Abdominal tenderness]]
* Hard stool in the rectal vault
|[[Diagnosis|Clinical diagnosis]]
* ROME III criteria
* [[Pharmacological|Pharmacologic]]<nowiki/>studies based criteria
|
* High [[dietary fiber]]
* [[Osmotic]] [[laxatives]] such as [[polyethylene glycol]], [[sorbitol]], and [[lactulose]]
* [[Antispasmodic]]<nowiki/>drugs (e.g. [[Anticholinergic|anticholinergics]]<nowiki/> such as [[hyoscyamine]]<nowiki/> or [[dicyclomine]])
|}


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==Differential diagnosis of abdominal pain==
==Differential diagnosis of abdominal pain==

Revision as of 22:33, 28 November 2017

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

Overview

Dumping syndrome may often be confused with other similar diseases that cause upper abdominal pain, nausea, and fatigue.

Differentiating from other Diseases

Diseases with similar symptoms

  • Postgastrectomy complications:[1]
    • Postvagatomy diarrhea[2]
    • Small capacity syndrome[3]
    • Short bowel syndrome[4]
    • Afferent loop syndrome
    • Efferent loop syndrome
  • Peptic ulcer disease
  • Fistula
  • Adhesion
  • Stenosis
  • Ischemia
  • Gastritis
  • Hernia
  • Insulinoma
  • Glucose-lowering medication abuse
  • Symptomatic gallstone disease
  • Postprandial Hypotension[5]
  • Short bowel syndrome
  • Irritable bowel syndrome (IBS)

Differential Diagnosis of Dumping Syndrome based on Postvagotomy complications symptoms:

The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline.They are the following:[6][7][3]

Differential Diagnosis for Postgastrectomy complications Clinical features Diagnosis
Small-capacity syndrome
  • Early satiety, malnutrition, weight loss
Afferent loop syndrome
Efferent loop syndrome
Postvagotomy diarrhea
  • Clinical diagnosis with a history of surgery.
Short bowel syndrome

Differential Diagnosis of Dumping Syndrome based on Early Dumping Syndrome symptoms:

The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline. They are as follows:

Differential Diagnosis of Dumping Syndrome based on Late Dumping Syndrome symptoms:

The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline.They are as follows:

Differential Diagnosis for Diarrhea predominant symptoms Clinical features Diagnosis
Crohn's disease
Ulcerative colitis
Microscopic colitis
Celiac disease
Neuroendocrine tumor
Hyperthyroidism
  • Serum TSH levels
Lactose intolerance
Infectious causes
  • Abdominal discomfort, diarrhea especially in the setting of recent travel
Small bowel bacterial overgrowth
Clostridium difficile infection(Psuedomembranous colitis)

The diffrentials of chronic watery diarrhea are as follows:

Template:WikiDoc Sources

Differential diagnosis of abdominal pain

The differential diagnosis based on abdominal pain are as follows:

Classification of acute abdomen based

on etiology

Presentation Clinical findings Diagnosis Comments
Fever Rigors and Chills Abdominal Pain Jaundice Hypotension Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Common causes of

Peritonitis

Spontaneous bacterial peritonitis + Diffuse − − − − Hypoactive
  • Ascitic fluid PMN>250 cells/mm³
  • Culture: Positive for single organism
 Ultrasound for evaluation of liver cirrhosis -
Perforated gastric and duodenal ulcer + Diffuse − + + + N
  • Ascitic fluid
    • LDH > serum LDH
    • Glucose < 50mg/dl
    • Total protein > 1g/dl
 Air under diaphragm in upright CXR Upper GI endoscopy for diagnosis
Acute suppurative cholangitis + + RUQ + + + + ±
Acute cholangitis + − RUQ + − − − N Abnormal LFT Ultrasound shows biliary dilatation Biliary drainage (ERCP) + IV antibiotics
Acute cholecystitis + RUQ + − − Hypoactive Ultrasound shows gallstone and evidence of inflammation Murphy’s sign
Acute pancreatitis + Epigastric ± − − N Increased amylase / lipase Ultrasound shows evidence of inflammation Pain radiation to back
Acute appendicitis + RLQ − + + Hypoactive Leukocytosis Ultrasound shows evidence of inflammation Nausea & vomiting, decreased appetite
Acute diverticulitis + LLQ ± + − Hypoactive Leukocytosis CT scan and ultrasound shows evidence of inflammation
Hollow Viscous Obstruction Small intestine obstruction − Diffuse − + ± Hyperactive then absent Leukocytosis Abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Gall stone disease/Cholelithiasis ± −
Volvulus - Diffuse - + - Hypoactive Leukocytosis CT scan and abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Biliary colic - RUQ + - - N Increased bilirubin and alkaline phosphatase Ultrasound Nausea & vomiting
Renal colic - Flank pain - - - N Hematuria CT scan and ultrasound Colicky abdominal pain associated with nausea & vomiting
Vascular Disorders Ischemic causes Mesenteric ischemia ± Periumbilical - - - Hyperactive Leukocytosis and lactic acidosis CT scan Nausea & vomiting, normal physical examination
Acute ischemic colitis ± Diffuse - + + Hyperactive then absent Leukocytosis CT scan Nausea & vomiting
Hemorrhagic causes Ruptured abdominal aortic aneurysm - Diffuse - - - N Normal CT scan Unstable hemodynamics
Intra-abdominal or retroperitoneal hemorrhage - Diffuse - - - N Anemia CT scan History of trauma
Gynaecological Causes Fallopian tube Acute salpingitis + LLQ/ RLQ − ± ± N Leukocytosis Pelvic ultrasound Vaginal discharge
Ovarian cyst complications and endometrial disease Torsion of the cyst - RLQ / LLQ - ± ± N Increased ESR and CRP Ultrasound Sudden onset severe pain with nausea and vomiting
Endometriosis - RLQ/LLQ - +/- +/- N Normal Laproscopy Menstrual-associated symptoms, pelvic

symptoms

Cyst rupture - RLQ / LLQ - +/- +/- N Increased ESR and CRP Ultrasound Sudden onset severe pain with nausea and vomiting
Pregnancy Ruptured ectopic pregnancy - RLQ / LLQ - - - N Positive pregnancy test Ultrasound History of missed period and vaginal bleeding
Functional Irritable Bowel Syndrome - Diffuse - - - - N

Clinical diagnosis

-

The following is a list of diseases that present with acute onset severe lower abdominal pain:

Disease Findings
Ectopic pregnancy History of missed menses, positive pregnancy test, ultrasound reveals an empty uterus and may show a mass in the fallopian tubes.[8]
Appendicitis Pain localized to the right iliac fossa, vomiting, abdominal ultrasound sensitivity for diagnosis of acute appendicitis is 75% to 90%.[9]
Ruptured ovarian cyst Usually spontaneous, can follow history of trauma, mild chronic lower abdominal discomfort may suddenly intensify, ultrasound is diagnostic.[10]
Ovarian cyst torsion Presents with acute severe unilateral lower quadrant abdominal pain, nausea and vomiting, tender adnexal mass palpated in 90%, ultrasound is diagnostic.[11]
Hemorrhagic ovarian cyst Presents with localized abdominal pain, nausea and vomiting. Hypovolemic shock may be present, abdominal tenderness and guarding are physical exam findings, ultrasound is diagnostic.[11]
Endometriosis Presents with cyclic pain that is exacerbated by onset of menses, dyspareunia. laparoscopic exploration is diagnostic.[11]
Acute cystitis Presents with features of increased urinary frequency, urgency, dysuria, and suprapubic pain.[12][13]

References

  1. ↑ "Postgastrectomy complications".
  2. ↑ "Explaining Diarrhea After Vagotomy". JAMA: The Journal of the American Medical Association. 195 (13): 37. 1966. doi:10.1001/jama.1966.03100130023009. ISSN 0098-7484.
  3. ↑ 3.0 3.1 "Mastery of Surgery - Google Books".
  4. ↑ Farthing MJ (1993). "Octreotide in dumping and short bowel syndromes". Digestion. 54 Suppl 1: 47–52. PMID 8359568.
  5. ↑ van Beek, A. P.; Emous, M.; Laville, M.; Tack, J. (2017). "Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management". Obesity Reviews. 18 (1): 68–85. doi:10.1111/obr.12467. ISSN 1467-7881.
  6. ↑ "Short-Bowel Syndrome Workup: Laboratory Studies, Imaging Studies, Other Tests".
  7. ↑ "The Dictionary of Modern Medicine - J.C. Segen - Google Books".
  8. ↑ Morin L, Cargill YM, Glanc P (2016). "Ultrasound Evaluation of First Trimester Complications of Pregnancy". J Obstet Gynaecol Can. 38 (10): 982–988. doi:10.1016/j.jogc.2016.06.001. PMID 27720100.
  9. ↑ Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C (1994). "Acute appendicitis: CT and US correlation in 100 patients". Radiology. 190 (1): 31–5. doi:10.1148/radiology.190.1.8259423. PMID 8259423.
  10. ↑ Bottomley C, Bourne T (2009). "Diagnosis and management of ovarian cyst accidents". Best Pract Res Clin Obstet Gynaecol. 23 (5): 711–24. doi:10.1016/j.bpobgyn.2009.02.001. PMID 19299205.
  11. ↑ 11.0 11.1 11.2 Bhavsar AK, Gelner EJ, Shorma T (2016). "Common Questions About the Evaluation of Acute Pelvic Pain". Am Fam Physician. 93 (1): 41–8. PMID 26760839.
  12. ↑ {{Cite journal | author = W. E. Stamm | title = Etiology and management of the acute urethral syndrome | journal = Sexually transmitted diseases | volume = 8 | issue = 3 | pages = 235–238 | year = 1981 | month = July-September | pmid = 7292216
  13. ↑ {{Cite journal | author = W. E. Stamm, K. F. Wagner, R. Amsel, E. R. Alexander, M. Turck, G. W. Counts & K. K. Holmes | title = Causes of the acute urethral syndrome in women | journal = The New England journal of medicine | volume = 303 | issue = 8 | pages = 409–415 | year = 1980 | month = August | doi = 10.1056/NEJM198008213030801 | pmid = 6993946

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