Gallbladder cancer differential diagnosis

Gallbladder cancer Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Epidemiology and Demographics
Risk Factors
Screening
Differentiating Gallbladder cancer from other Diseases
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
CT
MRI
Echocardiography and Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Palliative Treatment
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Gallbladder cancer differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Gallbladder cancer differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Gallbladder cancer differential diagnosis
CDC on Gallbladder cancer differential diagnosis
Gallbladder cancer differential diagnosis in the news
Blogs on Gallbladder cancer differential diagnosis
Directions to Hospitals Treating Gallbladder cancer
Risk calculators and risk factors for Gallbladder cancer differential diagnosis

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

Overview

Gallbladder cancer must be differentiated from Hepatocellular carcinoma Liver hemangioma, Liver abscess, Cirrhosis, Inflammatory lesions, Cholangiocarcinoma, Pancreatic carcinoma,Focal nodular hyperplasia.

Differentiatiating Gallbladder cancer from other Diseases

• Gallbladder cancer must be differentiated from other diseases that causes right upper quadrent pain
  • Hepatocellular carcinoma 
  • Liver hemangioma
  • Liver abscess
  • Cirrhosis
  • Inflammatory lesions
  • Cholangiocarcinoma
  • Pancreatic carcinoma
  • Focal nodular hyperplasia

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
Hepatocellular carcinoma/Metastasis	RUQ	+	−	−	+	−	−	+	−	−	−	−	Normal Hyperactive if obstruction present	High levels of AFP in serum Abnormal liver function tests	US CT Liver biopsy	Other symptoms: Splenomegaly Variceal bleeding Ascites Spider nevi Asterixis
Cholangiocarcinoma	Epigastric	−	−	±	±	−	+	+	−	−	−	−	N	Increased amylase / lipase Increased stool fat content Pancreatic function test	CT scan Calcification Pseudocyst Dilation of main pancreatic duct	Predisposes to pancreatic cancer
Pancreatic carcinoma	Epigastric	−	−	+	+	−	+	+	−	−	−	−	N	↑ Alkaline phosphatase ↑ serum bilirubin ↑ gamma-glutamyl transpeptidase ↑ CA 19-9	MDCT with  PET/CT MRI	Skin manifestations may include: Bullous pemphigoid Cicatricial pemphigoid Migratory superficial thrombophlebitis (classic Trousseau's syndrome) Pancreatic panniculitis
Focal nodular hyperplasia	Diffuse	±	−	−	±	−	+	+	+	−	−	−	Normal or hyperactive	Anti-neutrophil cytoplasmic antibody (P-ANCA) in Ulcerative colitis Anti saccharomyces cerevisiae antibodies (ASCA) in Crohn's disease	String sign on abdominal x-ray in Crohn's disease	Extra intestinal findings: Uveitis Arthritis
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
Gallbladder cancer	Diffuse	±	−	−	±	−	+	+	−	±	−	−	N	Thrombocytopenia Hypoalbuminemia Small intestinal biopsy for Tropheryma whipplei	Endoscopy is used to confirm diagnosis. Images used to find complications Chest and joint x-ray CT MRI Echocardiography	Extra intestinal findings: Uveitis Endocarditis Encephalitis Dementia Hepatosplenomegaly Arthritis Ascites
Liver hemangioma	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	CBC Blood cultures Abnormal liver function tests	US CT
Cirrhosis	RUQ	−	−	−	+	−	−	+	+	+	−	−	N	Hypoalbuminemia Prolonged PT Abnormal LFTs Hyponatremia Thrombocytopenia	US Nodular, shrunken liver Ascites	Stigmata of liver disease Cruveilhier- Baumgarten murmur
Inflammatory lesions	RUQ	−	−	−	+	−	−	+	+	+	−	−	N	Hypoalbuminemia Prolonged PT Abnormal LFTs Hyponatremia Thrombocytopenia	US Nodular, shrunken liver Ascites	Stigmata of liver disease Cruveilhier- Baumgarten murmur

References

Template:WikiDoc Sources