Toxic megacolon differential diagnosis: Difference between revisions

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


==Differentiating X from other Diseases==
==Differentiating Toxic Megacolon 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].
*Toxic megacolon must be differentiated from other diseases that cause [[abdominal pain]], [[fever]],[[diarrhea]] such as [[acute appendicitis]], [[acute diverticulitis]], [[inflammatory bowel disease]], [[whipple's disease]], [[tropical sprue]], [[infective colitis]], [[viral hepatitis]] (hepatitis A and hepatitis E), [[liver abscess]], [[spontaneos bacterial peritonitis]], [[mesentric ischemia]], and [[acute ischemic colitis]].
*[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].


*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].
===Preferred Table===
<span style="font-size:85%">'''Abbreviations:'''
'''[[RUQ]]'''= Right upper quadrant of the abdomen, '''LUQ'''= Left upper quadrant, '''LLQ'''= Left lower quadrant, '''RLQ'''= Right lower quadrant, '''LFT'''= Liver function test, SIRS= [[Systemic inflammatory response syndrome]], '''[[ERCP]]'''= [[Endoscopic retrograde cholangiopancreatography]], '''IV'''= Intravenous, '''N'''= Normal, '''AMA'''= Anti mitochondrial antibodies, '''[[LDH]]'''= [[Lactate dehydrogenase]], '''GI'''= Gastrointestinal, '''CXR'''= Chest X ray, '''IgA'''= [[Immunoglobulin A]], '''IgG'''= [[Immunoglobulin G]], '''IgM'''= [[Immunoglobulin M]], '''CT'''= [[Computed tomography]], '''[[PMN]]'''= Polymorphonuclear cells, '''[[ESR]]'''= [[Erythrocyte sedimentation rate]], '''[[CRP]]'''= [[C-reactive protein]], TS= [[Transferrin saturation]], SF= Serum [[Ferritin]], SMA= [[Superior mesenteric artery]], SMV= [[Superior mesenteric vein]], ECG= [[Electrocardiogram]]</span>


===Preferred Table===
{| align="center"
{|
|-
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
|
! rowspan="2" |Diseases
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! colspan="4" |Laboratory Findings
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease
! colspan="4" |Physical Examination
| colspan="13" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestations'''
! colspan="4" |History and Symptoms
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diagnosis
! rowspan="2" |Other Findings
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Comments
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
|-
!Lab Test 1
| colspan="9" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Symptoms'''
!Lab Test 2
! colspan="4" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Signs
!Lab Test 3
|-
!Lab Test 4
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain
!Physical Finding 1
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Fever
!Physical Finding 2
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills
!Physical Finding 3
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting
!Physical Finding 4
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice
!Finding 1
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation
!Finding 2
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
!Finding 3
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
!Finding 4
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo-
tension
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Guarding
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Lab Findings
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Toxic megacolon|'''Toxic megacolon''']]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Anemia]]
*[[Leukocytosis]] especially in patients with [[Clostridium difficile infection|''Clostridium difficile'' infection]]
*[[Hypoalbuminemia]]
*[[Metabolic alkalosis]] associated with a poor [[prognosis]]
*[[Metabolic acidosis]] secondary to [[ischemic colitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT and [[Ultrasound]] shows:
*Loss of colonic haustration
*Hypoechoic and thickened bowel walls with irregular internal margins in the [[sigmoid]] and descending colon
*Prominent dilation of the transverse colon (>6 cm)
* Insignificant dilation of ileal bowel loops (diameter >18 mm) with increased intraluminal gas and fluid
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute appendicitis|'''Acute appendicitis''']]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Starts in [[epigastrium]], migrates to RLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in pyogenic appendicitis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in perforated appendicitis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ct scan
* Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Positive Rovsing sign
* Positive Obturator sign
* Positive Iliopsoas sign
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diverticulitis|'''Acute diverticulitis''']]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |LLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in perforated diverticulitis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* CT scan 
* Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* History of [[constipation]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Inflammatory bowel disease|'''Inflammatory bowel disease''']]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal or hyperactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Anti-neutrophil cytoplasmic antibody]] ([[P-ANCA]]) in [[Ulcerative colitis]]
* [[Anti saccharomyces cerevisiae antibodies]] (ASCA) in [[Crohn's disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[String sign]] on [[abdominal x-ray]] in [[Crohn's disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
Extra intestinal findings:
* [[Uveitis]]
* [[Arthritis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Whipple's disease|'''Whipple's disease''']]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Thrombocytopenia]]
* [[Hypoalbuminemia]]
* [[Small intestinal]] [[biopsy]] for [[Tropheryma whipplei]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Whipple's disease other diagnostic studies|Endoscopy]] is used to confirm diagnosis.
Images used to find complications
*[[Whipple's disease x ray|Chest and joint x-ray]]
*[[Whipple's disease CT|CT]]
*[[Whipple's disease MRI|MRI]]
*[[Whipple's disease ultrasound|Echocardiography]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Extra intestinal findings:
* [[Uveitis]]
* [[Endocarditis]]
* [[Encephalitis]]
* [[Dementia]]
* [[Hepatosplenomegaly]]
* [[Arthritis]]
* [[Ascites]]
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
! style="background:#4479BA; color: #FFFFFF;" align="center" |'''Disease'''
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
|style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo-
|style="background: #F5F5F5; padding: 5px;" |
tension
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Guarding
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds
! style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" |Comments
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tropical sprue|'''Tropical sprue''']]
|style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="background: #F5F5F5; padding: 5px;" |-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Fat soluble vitamin deficiency
* [[Hypoalbuminemia]]
* Fecal stool test
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Barium studies:
* Dilation and edema of mucosal folds
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Steatorrhea]]- 10-40 g/day (Normal=5 g/day)
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Infective colitis|'''Infective colitis''']]
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in fulminant colitis
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Stool culture]] and studies
* Shiga toxin in bloody diarrhea
* [[PCR]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
* Bowel wall thickening
* Edema
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
! style="background:#4479BA; color: #FFFFFF;" align="center" |'''Disease'''
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo-
|style="background: #F5F5F5; padding: 5px;" |
tension
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Guarding
|style="background: #F5F5F5; padding: 5px;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds
! style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" |Comments
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis|'''Viral hepatitis''']]
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in Hep A and E
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in fulminant hepatitis
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in acute
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="background: #F5F5F5; padding: 5px;" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|}
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 
* Abnormal LFTs
===Use if the above table can not be made===
* Viral serology
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align=center
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|valign=top|
* US
|+
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
* Hep A and E have fecal-oral route of transmission
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
* Hep B and C transmits via blood transfusion and sexual contact.
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 1
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver abscess|'''Liver abscess''']]
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal or hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* CBC
* Blood cultures
* Abnormal [[Liver function test|liver function tests]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* US
* CT
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 2
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Spontaneous bacterial peritonitis|'''Spontaneous bacterial peritonitis''']]
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in cirrhotic patients
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ascitic fluid [[PMN]]>250 cells/mm<small>³</small>
* Culture: Positive for single organism
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ultrasound for evaluation of liver cirrhosis
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 3
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia|'''Mesenteric ischemia''']]
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Periumbilical
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive if bowel becomes gangrenous
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if bowel becomes gangrenous
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if bowel becomes gangrenous
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive to absent
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Leukocytosis]] and [[lactic acidosis]]
* [[Amylase]] levels
* [[D-dimer]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT angiography
* SMA or SMV thrombosis
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Also known as abdominal angina  that worsens with eating
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 4
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ischemic colitis|'''Acute ischemic colitis''']]
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Diffuse
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Abdominal x-ray]]
* Distension and pneumatosis
CT scan
* Double halo appearance, thumbprinting
* Thickening of bowel
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* May lead to shock
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 5
|}
| style="padding: 5px 5px; background: #F5F5F5;"|
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;"|
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|}
|}



Revision as of 14:20, 12 December 2017

Toxic Megacolon Microchapters

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Overview

Historical Perspective

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Differentiating Toxic Megacolon from other Diseases

Epidemiology and Demographics

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Diagnosis

Diagnostic study of choice

History and Symptoms

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

Overview

[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].

Differentiating Toxic Megacolon from other Diseases

Preferred Table

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

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
Toxic megacolon Diffuse + + + ± + Hypoactive CT and Ultrasound shows:
  • Loss of colonic haustration
  • Hypoechoic and thickened bowel walls with irregular internal margins in the sigmoid and descending colon
  • Prominent dilation of the transverse colon (>6 cm)
  • Insignificant dilation of ileal bowel loops (diameter >18 mm) with increased intraluminal gas and fluid
Acute appendicitis Starts in epigastrium, migrates to RLQ + Positive in pyogenic appendicitis + ± Positive in perforated appendicitis + + Hypoactive
  • Ct scan
  • Ultrasound
  • Positive Rovsing sign
  • Positive Obturator sign
  • Positive Iliopsoas sign
Acute diverticulitis LLQ + ± + + ± + Positive in perforated diverticulitis + + Hypoactive
  • CT scan
  • Ultrasound
Inflammatory bowel disease Diffuse ± ± + + + Normal or hyperactive

Extra intestinal findings:

Whipple's disease Diffuse ± ± + + ± N Endoscopy is used to confirm diagnosis.

Images used to find complications

Extra intestinal findings:
Disease 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 Comments
Tropical sprue Diffuse + + + N Barium studies:
  • Dilation and edema of mucosal folds
Infective colitis Diffuse + ± + + Positive in fulminant colitis ± ± Hyperactive CT scan
  • Bowel wall thickening
  • Edema
Disease 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 Comments
Viral hepatitis RUQ + + + Positive in Hep A and E + Positive in fulminant hepatitis Positive in acute + N
  • Abnormal LFTs
  • Viral serology
  • US
  • Hep A and E have fecal-oral route of transmission
  • Hep B and C transmits via blood transfusion and sexual contact.
Liver abscess RUQ + + + + ± + + + ± Normal or hypoactive
  • US
  • CT
Spontaneous bacterial peritonitis Diffuse + Positive in cirrhotic patients + ± + + Hypoactive
  • Ascitic fluid PMN>250 cells/mm³
  • Culture: Positive for single organism
  • Ultrasound for evaluation of liver cirrhosis
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

References

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