Familial adenomatous polyposis differential diagnosis: Difference between revisions
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** Hereditary mixed polyposis syndromes | ** Hereditary mixed polyposis syndromes | ||
** [[Hereditary nonpolyposis colorectal cancer|Lynch syndrome<br> ]] | ** [[Hereditary nonpolyposis colorectal cancer|Lynch syndrome<br> ]] | ||
Differential diagnosis according to polys: | |||
{| | |||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |||
! rowspan="2" |Diseases | |||
! colspan="4" |History and Symptoms | |||
! colspan="3" |Physical Examination | |||
! colspan="4" |Laboratory Findings | |||
! rowspan="2" |Other Findings | |||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |||
!Abdominal Pain | |||
!Rectal Bleeding | |||
!Hyperpigmentation | |||
!Fatigue | |||
!Abdominal Tenderness | |||
!Hyperpigmentation | |||
!Anemia | |||
!Gene(s) | |||
!Sertoli Cell Tumors | |||
!Gastrointestinal Tumors | |||
!Cancers | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Juvenile Polyposis Syndrome''' | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |SMAD4 | |||
[[BMPR1A]] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |[[Adenoma]]+ | |||
[[Hamartoma]]+++ | |||
| style="background: #F5F5F5; padding: 5px;" |[[Colon (anatomy)|Colon]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cowden syndrome|'''Cowden Syndrome''']] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |[[Axillary]]+ | |||
[[Inguinal region|Inguinal]]+ | |||
[[Facial]]+ | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |[[Axillary]]+ | |||
[[Inguinal region|Inguinal]]+ | |||
[[Facial]]+ | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |[[PTEN (gene)|PTEN]] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |[[Adenoma]]+ | |||
[[Hamartoma]]+++ | |||
| style="background: #F5F5F5; padding: 5px;" |[[Breast]], [[Thyroid]], [[Endometrium]] | |||
| style="background: #F5F5F5; padding: 5px;" |[[Trichilemmoma]], [[skin]] [[hamartoma]], [[Hyperplasia|hyperplastic]] [[Polyp|polyps]], [[macrocephaly]], [[breast]] [[fibrosis]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Carney syndrome|'''Carney Syndrome''']] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |[[Facial]]+ | |||
[[Mucous membrane|Mucosal]]+ | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |[[Facial]]+ | |||
[[Mucous membrane|Mucosal]]+ | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |[[PRKAR1A]] | |||
| style="background: #F5F5F5; padding: 5px;" | ++ | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" |[[Thyroid]] | |||
| style="background: #F5F5F5; padding: 5px;" |[[Myxoma|Myxomas]] of [[skin]] and [[heart]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Familial adenomatous polyposis|'''Familial Adenomatous Polyposis''']] | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | +/- | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" |[[APC]] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |[[Adenoma]]+++ | |||
| style="background: #F5F5F5; padding: 5px;" |[[Colon (anatomy)|Colon]], [[brain]] | |||
| style="background: #F5F5F5; padding: 5px;" |[[Desmoid tumor|Desmoid tumors]], [[Osteoma|osteomas]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hereditary nonpolyposis colorectal cancer|'''Hereditary Non-Polyposis Colon Cancer''']] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | +/- | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" |[[MLH1]] | |||
[[MSH2]] | |||
[[MSH3]] | |||
[[MSH6]] | |||
[[PMS1]] | |||
[[PMS2]] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |[[Adenoma]]+ | |||
| style="background: #F5F5F5; padding: 5px;" |[[Endometrium|Endometrial]], [[Stomach|gastric]], [[renal pelvis]], [[ureter]], and [[Ovary|ovarian]] | |||
| style="background: #F5F5F5; padding: 5px;" |[[Sebaceous gland|Sebaceous]] [[adenoma]] | |||
|} | |||
{| align="center" | |||
|+'''Differential of gastrointestinal bleeding''' | |||
|- | |||
| | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease | |||
| colspan="13" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestations''' | |||
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diagnosis | |||
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | |||
|- | |||
| colspan="9" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Symptoms''' | |||
! colspan="4" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Signs | |||
|- | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Fever | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss | |||
! 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 | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Peutz-Jeghers syndrome | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Depends on location of polyps it maybe present | |||
| 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" | | |||
* Rectal bleeding may be present due to polyp | |||
| 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" | | |||
* Hamartomatous polyps present on endoscopy | |||
* Iron deficiency anemia on CBC | |||
* STK11 mutation | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
* Intra-operative enteroscopy (laparatomy with endoscopy | |||
* Double balloon eneteroscopy | |||
* Colonoscopy | |||
* Barium Swallow | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
* Can lead to colon cancer, breast cancer, ovarian cancer, cervical cancer, and testicular cancer | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Peptic Ulcer Disease|Peptic ulcer 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" | <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" | | |||
* Gastric ulcer- [[melena]] and [[hematemesis]] | |||
* Duodenal ulcer- [[melena]] and [[hematochezia]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if perforated | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if perforated | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if perforated | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ascitic fluid | |||
** [[LDH]] > serum [[LDH]] | |||
** Glucose < 50mg/dl | |||
** Total protein > 1g/dl | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Air under [[diaphragm]] in upright [[CXR]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Upper GI [[endoscopy]] for diagnosis | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastritis|Gastritis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]] | |||
| 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" | Positive in chronic gastritis | |||
| 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" | | |||
* [[H.pylori infection diagnostic tests]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Endoscopy]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[H.pylori gastritis guideline recommendation]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastrointestinal perforation]] | |||
| 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" |<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" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive/hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* WBC> 10,000 | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Air under [[diaphragm]] in upright [[CXR]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Hamman's 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]] | |||
| 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" |[[Infective colitis]] | |||
| 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" | Positive in fulminant colitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| 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="padding: 5px 5px; background: #DCDCDC;" align="center" |Colon carcinoma | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse/localized | |||
| 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 if obstruction present | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* CBC | |||
* Carcinoembryonic antigen (CEA) | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Colonoscopy | |||
* Flexible sigmoidoscopy | |||
* Barium enema | |||
* CT colonography | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* PILLCAM 2: A colon capsule for CRC screening may be used in patients with an incomplete colonoscopy who lacks obstruction | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Budd-Chiari syndrome|Budd-Chiari syndrome]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]] | |||
| 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" | Positive in liver failure leading to varices | |||
| 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" | | |||
*Elevated [[Aspartate aminotransferase|serum aspartate aminotransferase]] and [[alanine aminotransferase]] levels may be more than five times the upper limit of the normal range. | |||
*Elevated serum [[alkaline phosphatase]] and [[Bilirubin|bilirubin levels]], decreased [[Albumin|serum albumin level]]. | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Findings on [[CT scan]] suggestive of Budd-Chiari syndrome include: | |||
*Early enhancement of the [[caudate lobe]] and [[central liver]] around the [[Inferior vena cavae|inferior vena cava]] | |||
*Delayed enhancement of the peripheral [[liver]] with accompanying central low density (flip-flop appearance) | |||
*Peripheral zones of the [[liver]] show reversed [[portal]] [[venous]] [[blood flow]] | |||
*In the [[chronic]] phase, there is [[caudate lobe]] enlargement and [[atrophy]] of the [[Liver|peripheral liver]] in affected areas | |||
|} | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ascitic tap|Ascitic fluid examination]] shows: | |||
*[[Total protein]] more than 2.5 g per deciliter | |||
*[[White blood cells]] are usually less than 500/μL. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hemochromatosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ | |||
| 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" | 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="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* >60% TS | |||
* >240 μg/L SF | |||
* Raised LFT <br>Hyperglycemia | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ultrasound shows evidence of cirrhosis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Extra intestinal findings: | |||
* Hyperpigmentation | |||
* Diabetes mellitus | |||
* Arthralgia | |||
* Impotence in males | |||
* Cardiomyopathy | |||
* Atherosclerosis | |||
* Hypopituitarism | |||
* Hypothyroidism | |||
* Extrahepatic cancer | |||
* Prone to specific infections | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cirrhosis|Cirrhosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]] | |||
| 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" | | |||
* [[Hypoalbuminemia]] | |||
* Prolonged PT | |||
* Abnormal LFTs | |||
* [[Hyponatremia]] | |||
* [[Thrombocytopenia]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |US | |||
* Nodular, shrunken liver | |||
* [[Ascites]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Stigmata of liver disease | |||
* Cruveilhier- Baumgarten murmur | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Periumbilical | |||
| 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="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;" align="center" |[[Ischemic colitis|Acute ischemic colitis]] | |||
| 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" |<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;" align="center" |[[Ruptured abdominal aortic aneurysm]] | |||
| 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" |<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" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Fibrinogen]] | |||
* [[D-dimer]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Focused Assessment with Sonography in Trauma (FAST) | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Unstable hemodynamics | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intra-abdominal or [[retroperitoneal hemorrhage]] | |||
| 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" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* ↓ Hb | |||
* ↓ Hct | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* CT scan | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* History of [[trauma]] | |||
|- | |||
|} | |||
|} | |||
==References== | ==References== |
Revision as of 15:18, 31 January 2018
Familial adenomatous polyposis Microchapters |
Differentiating Familial adenomatous polyposis from other Diseases |
---|
Diagnosis |
Treatment |
Case Studies |
Familial adenomatous polyposis differential diagnosis On the Web |
American Roentgen Ray Society Images of Familial adenomatous polyposis differential diagnosis |
FDA on Familial adenomatous polyposis differential diagnosis |
CDC on Familial adenomatous polyposis differential diagnosis |
Familial adenomatous polyposis differential diagnosis in the news |
Blogs on Familial adenomatous polyposis differential diagnosis |
Directions to Hospitals Treating Familial adenomatous polyposis |
Risk calculators and risk factors for Familial adenomatous polyposis differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]
Overview
Familial adenomatous polyposis must be differentiated from other diseases that cause multiple polyps, such as Peutz-Jeghers syndrome, familial juvenile polyps or hyperplastic polyposis, hereditary mixed polyposis syndromes, and Lynch syndrome.
Differentiating familial adenomatous polyposis from other Diseases
- Familial adenomatous polyposis must be differentiated from other diseases that cause multiple polyps including:
- Peutz-Jeghers syndrome
- Familial juvenile polyps or hyperplastic polyposis
- Hereditary mixed polyposis syndromes
- Lynch syndrome
Differential diagnosis according to polys:
Diseases | History and Symptoms | Physical Examination | Laboratory Findings | Other Findings | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Abdominal Pain | Rectal Bleeding | Hyperpigmentation | Fatigue | Abdominal Tenderness | Hyperpigmentation | Anemia | Gene(s) | Sertoli Cell Tumors | Gastrointestinal Tumors | Cancers | ||
Juvenile Polyposis Syndrome | + | - | + | - | - | - | SMAD4 | - | Adenoma+
Hamartoma+++ |
Colon | ||
Cowden Syndrome | - | - | Axillary+ | - | - | Axillary+ | - | PTEN | - | Adenoma+
Hamartoma+++ |
Breast, Thyroid, Endometrium | Trichilemmoma, skin hamartoma, hyperplastic polyps, macrocephaly, breast fibrosis |
Carney Syndrome | - | - | Facial+ | - | - | Facial+ | - | PRKAR1A | ++ | Thyroid | Myxomas of skin and heart | |
Familial Adenomatous Polyposis | + | + | - | + | +/- | - | + | APC | - | Adenoma+++ | Colon, brain | Desmoid tumors, osteomas |
Hereditary Non-Polyposis Colon Cancer | - | + | - | + | +/- | - | + | MLH1 | - | Adenoma+ | Endometrial, gastric, renal pelvis, ureter, and ovarian | Sebaceous adenoma |
|