Sandbox:Zahir

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zahir Ali Shaikh, MD[2]

Differentiating [Disease name] from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].

OR

As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].

Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].

Diseases	Clinical manifestations								Diagnosis							Gold standard	Additional findings	Others
	Symptoms				Physical examination
									Lab Findings			Imaging
	Abdominal pain	Bowel habits	Blood in stool	Weight loss	General appearance	Abdominal exam	Rectal exam	Genitourinary exam	CBC	Tumor markers	Stool test	Colonoscopy	Barium enema	Ultrasound	CT scan
Rectal carcinoma	LLQ	Constipation/diarrhea	+	+	lethargy pallor confusion emaciation	tendernes hepatomegaly ascites absent bowel sounds	rectal mass rectal bleeding	NL	Anmeia	↑ CEA ↑ CA19-9	FOBT+	mass/polyp	Apple core apearance	endoscopic/trnasrectal US detects tumor extent	determine tumor stage	colonoscopy with biopsy	DRE & proctoscopy detects tumor localization & extension	↓ serum iron ↓ vit: B12 & folate
Rectal polyp	+	mucous diarrhea	+	+	NL	NL	rectal mass/polyp	NL	NL/anemia	NL	FOBT+	Polyp	N/A	Polyp	N/A	colonoscopy with biopsy	hypoproteinemia hypoalbuminemia	N/A
Anal cancer	+/-	constipation/diarrhea	+	+/-	NL	NL	lump/mass at anal opening	NL	NL/anemia	N/A	FOBT+	N/A	N/A	determines anal cancer depth into sphincter	hypoattenuated necrotic mass on contrast CT	Biopsy	PET/CT detects localization of small anal tumors <2cm	sentinal lymph node biopsy detects lymph node metastases
Hemorrhoids	+/-	fecal incontinence/mucous discharge	+	-	NL/weakness,irritability	NL	palpable perianal lump bleeding PR	NL	iron deficiency anemia	N/A	blood on stool outer surface	done if colorectal cancer suspected	N/A	N/A	N/A	DRE + anoscopy	anoscopy shows bulging purplish hue veins or dark, pink, glistening mass	None
Rectal prolapse	Abdominal discomfort	constipation/diarrhea	+/-	-	NL	NL	intermittent rectum protrusion seen	NL	NL/anemia	N/A	mucous/blood in stool	may be used for screening	N/A	reveals asymmetry & any sphincter defect	N/A	history & physical examination	DRE shows patulous anus, attenuated sphincter tone & mass	anal manometry to assess sphincter function
Foreign body	Anorectal pain and abdominal pain	Constipation	+	-	Anxious Fever Tachycardia Hypotension	Palpable foreign body Absent bowel sounds Signs of peritonitis	Bleeding per rectum Laceration Mucosal tear Sphincter disruption	NL	Leucocytosis Metabolic acidosis	NL	FOBT+	Foreign body	Contraindicated	Foreign body	Foreign body	Plain radiographs show presence of foreign body	NL	NL
Diseases	Abdominal pain	Bowel habits	Blood in stool	Weight loss	General appearance	Abdominal exam	Rectal exam	Genitourinary exam	CBC	Tumor markers	Stool test	Colonoscopy	Barium enema	Ultrasound	CT scan	Gold standard	Additional findings	Others
Prostatitis	LLQ/groin pain	NL	N/A	-	NL	NL	NL	tender/enlarged prostate	leukocytosis	NL/↑ PSA	N/A	N/A	N/A	focal hypoechoic regoin in peripheral prostate fluid collection suggests abscess	edematous/enlarged prostate	N/A	prostate biopsy & thermograms may also be done	↑ CRP
Fecal impaction	+	constipation	-	+/-	agitation confusion worsening psychosis	abdominal distension with tympany difuse abdominal tenderness with palpable malleable tubular structure indicating stool filled rectosigmoid	DRE shows fecal impaction	NL	mild leukocytosis	N/A	N/A	N/A	used in softening of stool & stimulation of evacuation	N/A	presence of fecal matter in colon	DRE to detect fecal impaction	dehydration hyponatremia hypokalemic metabolic alkalosis	abdominal radiograph to detect fecal loading
Anal stenosis
Hypertrophied anal papillae
Endometriosis	+/- Dull pelvic pain	Constipation Diarrhea Dyschezia Bowel cramping	-	-	Fatigue	Mild tenderness	Nodules in posterior posterior fornix Adnexal masses Immobility Lateral placement of the cervix or uterus	Tenderness on vaginal exam	Anemia	-	-	N/A	N/A	Lesions can be detected on usg	Not required	N/A	N/A	N/A
Uterine malignancy	-	NL	-	+	Pallor Fatigue	NL	Pelvic mass	Vaginal bleeding Enlarged uteru Fixed uterus	Anemia	Hcg	-	N/A	N/A	Increased thickness of uterine wall >4mm	N/A	Endometrial biopsy	N/A	N/A
Diseases	Abdominal pain	Bowel habits	Blood in stool	Weight loss	General appearance	Abdominal exam	Rectal exam	Genitourinary exam	CBC	Tumor markers	Stool test	Colonoscopy	Barium enema	Ultrasound	CT scan	Gold standard	Additional findings	Others
Cervical malignancy	-	Normal	-	+	Pallor Fatigue	NL	Pelvic mass	Cervical growth Bleeding Cervical stenosis Fixed uterus	Anemia	N/A	FOBT -	N/A	N/A	Cervical thickening	detects metastasis	Cone biopsy	N/A	N/A
Metastases
Pelvic abscess	+	Nil	-	+/-	Fever Tachycardia	Gaurdening Generalized tenderness	Fluctuating mass	Vaginal discharge in females	leucocytosis	-	Fobt -	N/A	N/A	Location and consistency of abcess	Location and consistency of abcess	N/A	N/A	N/A
Pelvic sarcoma
Parasacral neurogenic tumor