Diverticulosis differential diagnosis: Difference between revisions

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*[[GI bleed]]
*[[GI bleed]]
*[[Ulcers]] (gastric or colonic)
*[[Ulcers]] (gastric or colonic)


{|
{|
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! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="5" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
| colspan="5" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
|-
|-
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-  
|-  
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bowel frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bowel frequency
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* Spiculated contour
* Spiculated contour
* Tapered margins
* Tapered margins
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |'''DRE'''
| style="background: #F5F5F5; padding: 5px;" |'''DRE'''
* [[Palpation|Palpable]] mass, tender if [[Thrombosis|thrombosed]]
* [[Palpation|Palpable]] mass, tender if [[Thrombosis|thrombosed]]
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |Clinical
| style="background: #F5F5F5; padding: 5px;" |Clinical
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |[[Anoscopy]]
| style="background: #F5F5F5; padding: 5px;" |[[Anoscopy]]
* Anal wall laceration
* Anal wall laceration
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
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* [[Leukocytosis]]
* [[Leukocytosis]]
'''Stool cultures'''
'''Stool cultures'''
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |[[Stool culture]]
| style="background: #F5F5F5; padding: 5px;" |[[Stool culture]]
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |'''Diagnosis of exclusion'''
| style="background: #F5F5F5; padding: 5px;" |'''Diagnosis of exclusion'''
* Fulfilment of [[Irritable bowel syndrome diagnostic criteria|Rome criteria]]
* Fulfilment of [[Irritable bowel syndrome diagnostic criteria|Rome criteria]]
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |Clinical diagnosis  [[Irritable bowel syndrome Diagnostic Study of Choice|(Rome criteria)]]
| style="background: #F5F5F5; padding: 5px;" |Clinical diagnosis  [[Irritable bowel syndrome Diagnostic Study of Choice|(Rome criteria)]]
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
* Hypoechoic mass suggesting dilated and edematous [[Intestine|intestinal segment]]
* Hypoechoic mass suggesting dilated and edematous [[Intestine|intestinal segment]]
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |[[Ultrasound]]
| style="background: #F5F5F5; padding: 5px;" |[[Ultrasound]]
|-
|-
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* Hyperintense [[hemorrhagic]]  
* Hyperintense [[hemorrhagic]]  
* Hyperintense [[Cavity|cavities]]  
* Hyperintense [[Cavity|cavities]]  
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |[[Gynecologic ultrasonography|Transvaginal ultrasound]]
| style="background: #F5F5F5; padding: 5px;" |[[Gynecologic ultrasonography|Transvaginal ultrasound]]
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]
|}
|}


==References==
==References==

Revision as of 19:24, 29 January 2019

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

Overview

Diverticulosis must be differentiated from other diseases that cause abdominal discomfort, bloating, and occasional bleeding, such as other diverticular diseases (diverticulitis and diverticular bleed), as well as other GI diseases, such as acute pancreatitis, colon cancer, colitis, inflammatory bowel disease, bowel obstruction, volvulus, and appendicitis.

Differential Diagnosis

Differential diagnosis of diverticulosis includes the following:[1]



Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms
Lab Findings Imaging Histopathology
Bowel frequency Blood in stool Abdominal pain Tenesmus Other symptoms Anemia Colonoscopy CT scan Other diagnostic study
Diverticular diseases[2][3][4] ↑ or ↓ +/- +

RLQ

- -
  • Not recommended
 Barium enema
  • Circumferential narrowing
  • Spiculated contour
  • Tapered margins
  • N/A
 CT scan
Hemorrhoids[5] ↓ + + -
  • Perianal Itching
  • Pain with defecation
  • Painful-hard lump in anus
 + Anoscopy
  • Protruding mass from the anus
  • N/A
 DRE
  • N/A
 Clinical
Anal fissure[6] - + + - +/- Anoscopy
  • Anal wall laceration
  • N/A
  • N/A
  • N/A
 Clinical
Infectious colitis[7] ↑ + + - -
  • N/A
 Stool analysis

Stool cultures

  • N/A
 Stool culture
Irritable bowel syndrome[8] ↑ ↓ + + + -
  • Not recommended
  • N/A
 Diagnosis of exclusion
  • N/A
 Clinical diagnosis (Rome criteria)
Strangulated hernia ↓ - +

RLQ

- -
  • N/A
 Ultrasound:
  • N/A
 Ultrasound
Bowel endometriosis[9] ↑ or ↓ + +

Pelvic

+ +
  • N/A
  • N/A
 Transvaginal ultrasound
  • Heterogeneous, hypoechoic, spiculated mass

T1-weighted or fat-suppression T1-weighted MRIs

  • N/A
 Transvaginal ultrasound
Appendicitis[10] ↑ - +

RLQ

- -
  • N/A

Ultrasound

  • Aperistaltic, noncompressible, dilated appendix (>6 mm)
  • Appendicolith
  • Echogenic prominent pericaecal fat
  • Periappendiceal fluid collection
 CT scan


References

  1. ↑ Strate LL (2005). "Lower GI bleeding: epidemiology and diagnosis". Gastroenterol. Clin. North Am. 34 (4): 643–64. doi:10.1016/j.gtc.2005.08.007. PMID 16303575.
  2. ↑ Shen SH, Chen JD, Tiu CM, Chou YH, Chiang JH, Chang CY, Lee CH (September 2005). "Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting". J Chin Med Assoc. 68 (9): 411–8. doi:10.1016/S1726-4901(09)70156-X. PMID 16187597.
  3. ↑ Shen, Shu-Huei; Chen, Jen-Dar; Tiu, Chui-Mei; Chou, Yi-Hong; Chiang, Jen-Huei; Chang, Cheng-Yen; Lee, Chen-Hsen (2005). "Differentiating Colonic Diverticulitis from Colon Cancer: The Value of Computed Tomography in the Emergency Setting". Journal of the Chinese Medical Association. 68 (9): 411–418. doi:10.1016/S1726-4901(09)70156-X. ISSN 1726-4901.
  4. ↑ Sheiman, Laura; Levine, Marc S.; Levin, Alicia A.; Hogan, Jonathan; Rubesin, Stephen E.; Furth, Emma E.; Laufer, Igor (2008). "Chronic Diverticulitis: Clinical, Radiographic, and Pathologic Findings". American Journal of Roentgenology. 191 (2): 522–528. doi:10.2214/AJR.07.3597. ISSN 0361-803X.
  5. ↑ Jacobs, Danny; Solomon, Caren G. (2014). "Hemorrhoids". New England Journal of Medicine. 371 (10): 944–951. doi:10.1056/NEJMcp1204188. ISSN 0028-4793.
  6. ↑ Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.
  7. ↑ DuPont HL (January 2012). "Approach to the patient with infectious colitis". Curr. Opin. Gastroenterol. 28 (1): 39–46. doi:10.1097/MOG.0b013e32834d3208. PMID 22080825.
  8. ↑ Iwańczak B, Iwańczak F (August 2017). "[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria]". Pol. Merkur. Lekarski (in Polish). 43 (254): 75–82. PMID 28875974.
  9. ↑ Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A (November 2014). "Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team". World J. Gastroenterol. 20 (42): 15616–23. doi:10.3748/wjg.v20.i42.15616. PMC 4229526. PMID 25400445.
  10. ↑ Choi D, Park H, Lee YR, Kook SH, Kim SK, Kwag HJ, Chung EC (2003). "The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT". Acta Radiol. 44 (6): 574–82. PMID 14616200.

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