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{{CMG}}; {{AE}} {{Anmol}}
{{CMG}}; {{AE}} {{Anmol}}
==Differential Oliguria==
 
==Tables==
{| class="wikitable"
{| class="wikitable"
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" |Classification by etiology
|+
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" |Etiology
!Diagnosis
! colspan="10" style="background:#4479BA; color: #FFFFFF;" |Clinical manifestations
!Lab findings
! colspan="11" style="background:#4479BA; color: #FFFFFF;" |Paraclinical findings
!
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" |Comments
!
|-
! colspan="10" style="background:#4479BA; color: #FFFFFF;" |Symptoms and signs
! colspan="6" style="background:#4479BA; color: #FFFFFF;" |Lab findings
! colspan="5" style="background:#4479BA; color: #FFFFFF;" |Imaging
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fatigue/Lethargy
! align="center" style="background:#4479BA; color: #FFFFFF;" |Thirst
! align="center" style="background:#4479BA; color: #FFFFFF;" |Dizziness/Confusion
! align="center" style="background:#4479BA; color: #FFFFFF;" |Muscle weakness/cramp
! align="center" style="background:#4479BA; color: #FFFFFF;" |Somatic/visceral pain
! align="center" style="background:#4479BA; color: #FFFFFF;" |Vomiting
! align="center" style="background:#4479BA; color: #FFFFFF;" |Diarrhea
! align="center" style="background:#4479BA; color: #FFFFFF;" |Tachypnea
! align="center" style="background:#4479BA; color: #FFFFFF;" |Haematuria/Proteinuria
! align="center" style="background:#4479BA; color: #FFFFFF;" |Edema
| align="center" style="background:#4479BA; color: #FFFFFF;" |CBC
| align="center" style="background:#4479BA; color: #FFFFFF;" |KFT
| align="center" style="background:#4479BA; color: #FFFFFF;" |Electrolytes
| align="center" style="background:#4479BA; color: #FFFFFF;" |Urine analysis
| align="center" style="background:#4479BA; color: #FFFFFF;" |ABG
| align="center" style="background:#4479BA; color: #FFFFFF;" |Other
| align="center" style="background:#4479BA; color: #FFFFFF;" |Ultrasound
| align="center" style="background:#4479BA; color: #FFFFFF;" |X-ray
| align="center" style="background:#4479BA; color: #FFFFFF;" |CT
| align="center" style="background:#4479BA; color: #FFFFFF;" |MRI
| align="center" style="background:#4479BA; color: #FFFFFF;" |Other
|-
! rowspan="23" style="background:#4479BA; color: #FFFFFF;" |Prerenal
|[[Alcohol poisoning]]<ref name="pmid15589492">{{cite journal |vauthors=Pletcher MJ, Maselli J, Gonzales R |title=Uncomplicated alcohol intoxication in the emergency department: an analysis of the National Hospital Ambulatory Medical Care Survey |journal=Am. J. Med. |volume=117 |issue=11 |pages=863–7 |date=December 2004 |pmid=15589492 |doi=10.1016/j.amjmed.2004.07.042 |url=}}</ref><ref name="pmid2927129">{{cite journal |vauthors=Cherpitel CJ |title=Breath analysis and self-reports as measures of alcohol-related emergency room admissions |journal=J. Stud. Alcohol |volume=50 |issue=2 |pages=155–61 |date=March 1989 |pmid=2927129 |doi= |url=}}</ref><ref name="pmid12510444">{{cite journal |vauthors=Yost DA |title=Acute care for alcohol intoxication. Be prepared to consider clinical dilemmas |journal=Postgrad Med |volume=112 |issue=6 |pages=14–6, 21–2, 25–6 |date=December 2002 |pmid=12510444 |doi= |url=}}</ref><ref name="pmid10452451">{{cite journal |vauthors=Boba A |title=Management of acute alcoholic intoxication |journal=Am J Emerg Med |volume=17 |issue=4 |pages=431 |date=July 1999 |pmid=10452451 |doi= |url=}}</ref>
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|Prolonged [[PT]]
|Elevated [[creatinine]] with normal [[BUN]] may indicate isopropyl [[alcohol]] poisoning
|
* Decreased serum [[sodium]]
|<nowiki>-</nowiki>
|
* Decreased [[bicarbonate]]
|<nowiki>-</nowiki>
* Serum [[glucose]] level
* Serum blood [[alcohol]] level
* Elevated hepatic [[transaminases]]
* Toxicology screen for [[acetaminophen]] and [[salicylates]]
|<nowiki>-</nowiki>
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|
* Serum [[osmolality]] should be calculated
* [[Thiamine]] must be given to avoid [[Wernicke's encephalopathy]]
|-
|[[Aspergillosis]]<ref name="pmid11880955">{{cite journal |vauthors=Marr KA, Carter RA, Crippa F, Wald A, Corey L |title=Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients |journal=Clin. Infect. Dis. |volume=34 |issue=7 |pages=909–17 |date=April 2002 |pmid=11880955 |doi=10.1086/339202 |url=}}</ref><ref name="pmid16886149">{{cite journal |vauthors=Cornillet A, Camus C, Nimubona S, Gandemer V, Tattevin P, Belleguic C, Chevrier S, Meunier C, Lebert C, Aupée M, Caulet-Maugendre S, Faucheux M, Lelong B, Leray E, Guiguen C, Gangneux JP |title=Comparison of epidemiological, clinical, and biological features of invasive aspergillosis in neutropenic and nonneutropenic patients: a 6-year survey |journal=Clin. Infect. Dis. |volume=43 |issue=5 |pages=577–84 |date=September 2006 |pmid=16886149 |doi=10.1086/505870 |url=}}</ref><ref name="pmid16129254">{{cite journal |vauthors=Horger M, Hebart H, Einsele H, Lengerke C, Claussen CD, Vonthein R, Pfannenberg C |title=Initial CT manifestations of invasive pulmonary aspergillosis in 45 non-HIV immunocompromised patients: association with patient outcome? |journal=Eur J Radiol |volume=55 |issue=3 |pages=437–44 |date=September 2005 |pmid=16129254 |doi=10.1016/j.ejrad.2005.01.001 |url=}}</ref>
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* [[Aspergillus]] precipitins [[allergy test]] is positive
* [[IgE]] is > 1000 IU/dl
* [[Fungi]] are identified via:
** Gomori methenamine silver stain
** Calcofluor
** Positive culture result from [[sputum]], [[needle biopsy]], or [[bronchoalveolar lavage]]
*** Hyphae are demonstrated
*** Elevated galactomannan level in bronchoalveolar fluid 
|<nowiki>-</nowiki>
|
* Pulmonary infiltrates
* Mucoid plugging
* Central [[bronchiectasis]]
* Mass in the upper lobe surrounded by a crescent of air
* Solitary or multiple cavities
|
* Halo sign (ground-glass appearance with nodules)
* Defines [[bronchiecstasis]]
* May show evidence of wedge-shaped pulmonary [[infarction]]
* Granulomata, tissue [[necrosis]], and blood vessel invasion may be noted
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Polymerase chain reaction]] (PCR) assays could be useful in diagnosis of invasive [[aspergillosis]]
|-
|-
|[[Cholera]]<ref name="pmid19842974">{{cite journal |vauthors=Weil AA, Khan AI, Chowdhury F, Larocque RC, Faruque AS, Ryan ET, Calderwood SB, Qadri F, Harris JB |title=Clinical outcomes in household contacts of patients with cholera in Bangladesh |journal=Clin. Infect. Dis. |volume=49 |issue=10 |pages=1473–9 |date=November 2009 |pmid=19842974 |pmc=2783773 |doi=10.1086/644779 |url=}}</ref><ref name="pmid4809112">{{cite journal |vauthors=Cash RA, Music SI, Libonati JP, Snyder MJ, Wenzel RP, Hornick RB |title=Response of man to infection with Vibrio cholerae. I. Clinical, serologic, and bacteriologic responses to a known inoculum |journal=J. Infect. Dis. |volume=129 |issue=1 |pages=45–52 |date=January 1974 |pmid=4809112 |doi= |url=}}</ref><ref name="pmid4809112">{{cite journal |vauthors=Cash RA, Music SI, Libonati JP, Snyder MJ, Wenzel RP, Hornick RB |title=Response of man to infection with Vibrio cholerae. I. Clinical, serologic, and bacteriologic responses to a known inoculum |journal=J. Infect. Dis. |volume=129 |issue=1 |pages=45–52 |date=January 1974 |pmid=4809112 |doi= |url=}}</ref><ref name="pmid21696312">{{cite journal |vauthors=Harris JB, Ivers LC, Ferraro MJ |title=Case records of the Massachusetts General Hospital. Case 19-2011. A 4-year-old Haitian boy with vomiting and diarrhea |journal=N. Engl. J. Med. |volume=364 |issue=25 |pages=2452–61 |date=June 2011 |pmid=21696312 |doi=10.1056/NEJMcpc1100927 |url=}}</ref>
!
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*[[Leukocytosis]] without left shift is noted
* Elevated [[hematocrit]]
|
* Elevated [[blood urea nitrogen]]
* Elevated [[creatinine]]
|
* Serum [[sodium]] < 135 mmol/l
* Elevated [[calcium]]
* Elevated [[magnesium]]
|<nowiki>-</nowiki>
|
* Elevated [[lactate]]
* Serum [[bicarbonate]] < 15 mmol/l
|
* Stool is used in dark field examination or PCR to visualize [[treponema pallidum]]
* Stool culture is carried out using thiosulfate-citrate-bile-sucrose-agar
* Serotyping may be performed using an anti-serum
* Elevated serum [[protein]] is noted
* Elevated serum-specific gravity is noted
* Elevated blood [[glucose]] may be detected
|<nowiki>-</nowiki>
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|
|-
|[[Congestive heart failure]] (CHF)<ref name="pmid17724259">{{cite journal |vauthors=Solomon SD, Dobson J, Pocock S, Skali H, McMurray JJ, Granger CB, Yusuf S, Swedberg K, Young JB, Michelson EL, Pfeffer MA |title=Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure |journal=Circulation |volume=116 |issue=13 |pages=1482–7 |date=September 2007 |pmid=17724259 |doi=10.1161/CIRCULATIONAHA.107.696906 |url=}}</ref><ref name="pmid15687312">{{cite journal |vauthors=Fonarow GC, Adams KF, Abraham WT, Yancy CW, Boscardin WJ |title=Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis |journal=JAMA |volume=293 |issue=5 |pages=572–80 |date=February 2005 |pmid=15687312 |doi=10.1001/jama.293.5.572 |url=}}</ref><ref name="pmid12798577">{{cite journal |vauthors=Kittleson M, Hurwitz S, Shah MR, Nohria A, Lewis E, Givertz M, Fang J, Jarcho J, Mudge G, Stevenson LW |title=Development of circulatory-renal limitations to angiotensin-converting enzyme inhibitors identifies patients with severe heart failure and early mortality |journal=J. Am. Coll. Cardiol. |volume=41 |issue=11 |pages=2029–35 |date=June 2003 |pmid=12798577 |doi= |url=}}</ref><ref name="pmid17602982">{{cite journal |vauthors=Filippatos G, Rossi J, Lloyd-Jones DM, Stough WG, Ouyang J, Shin DD, O'connor C, Adams KF, Orlandi C, Gheorghiade M |title=Prognostic value of blood urea nitrogen in patients hospitalized with worsening heart failure: insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) study |journal=J. Card. Fail. |volume=13 |issue=5 |pages=360–4 |date=June 2007 |pmid=17602982 |doi=10.1016/j.cardfail.2007.02.005 |url=}}</ref><ref name="pmid22554602">{{cite journal |vauthors=Zamora E, Lupón J, Vila J, Urrutia A, de Antonio M, Sanz H, Grau M, Ara J, Bayés-Genís A |title=Estimated glomerular filtration rate and prognosis in heart failure: value of the Modification of Diet in Renal Disease Study-4, chronic kidney disease epidemiology collaboration, and cockroft-gault formulas |journal=J. Am. Coll. Cardiol. |volume=59 |issue=19 |pages=1709–15 |date=May 2012 |pmid=22554602 |doi=10.1016/j.jacc.2011.11.066 |url=}}</ref><ref name="pmid22441773">{{cite journal |vauthors=McAlister FA, Ezekowitz J, Tarantini L, Squire I, Komajda M, Bayes-Genis A, Gotsman I, Whalley G, Earle N, Poppe KK, Doughty RN |title=Renal dysfunction in patients with heart failure with preserved versus reduced ejection fraction: impact of the new Chronic Kidney Disease-Epidemiology Collaboration Group formula |journal=Circ Heart Fail |volume=5 |issue=3 |pages=309–14 |date=May 2012 |pmid=22441773 |doi=10.1161/CIRCHEARTFAILURE.111.966242 |url=}}</ref>
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* May indicate [[anemia]]
* [[Leukocytosis]] may be detected
|
* Elevated [[BUN]]
* Elevated [[creatinine]]
|
* Serum [[sodium]] may be decreased
* Serum [[potassium]] may be elevated
|<nowiki>-</nowiki>
|
* Serum [[bicarbonate]] may be decreased
* Serum [[lactate]] may be elevated
* [[Metabolic acidosis]] may be present
|
* [[Brain natriuretic peptide]] (BNP) or N -terminal prohormone BNP may be elevated and indicate ventricular dilatation
* Cardiac [[troponin]]s may be elevated
* [[Pulse oximetry]] may indicate [[hypoxemia]]
|<nowiki>-</nowiki>
|
* May demonstrate:
** [[Cardiomegaly]]
** [[Pulmonary hypertension]]
** [[Pleural effusions]]
|
* More accurate visualization of [[pulmonary edema]]
|<nowiki>-</nowiki>
|
* Useful in detecting congenital cardiac abnormalities and assessment [[valvular heart disease]]
* Delayed enhancement cardiovascular [[magnetic resonance imaging]] is useful in identifying the etiology of acute [[chest pain]]
|
* [[Echocardiography]] demonstrates decreased [[ejection fraction]]
** Also demonstrates left and right ventricular function and filling pressures
* [[Electrocardiogram]] (ECG) may indicate a [[myocardial infarction]] or [[ischemia]], [[arrhythmia]] or atrioventricular block
* Nuclear imaging can be used to assess heart function and damage in CHF, such as:
** ECG-gated myocardial perfusion imaging
** ECG-gated single-photon emission CT
|
|-
|[[Dehydration]]<ref name="pmid15187057">{{cite journal |vauthors=Steiner MJ, DeWalt DA, Byerley JS |title=Is this child dehydrated? |journal=JAMA |volume=291 |issue=22 |pages=2746–54 |date=June 2004 |pmid=15187057 |doi=10.1001/jama.291.22.2746 |url=}}</ref><ref name="pmid9220501">{{cite journal |vauthors=Vega RM, Avner JR |title=A prospective study of the usefulness of clinical and laboratory parameters for predicting percentage of dehydration in children |journal=Pediatr Emerg Care |volume=13 |issue=3 |pages=179–82 |date=June 1997 |pmid=9220501 |doi= |url=}}</ref><ref name="pmid5928490">{{cite journal |vauthors=Dossetor JB |title=Creatininemia versus uremia. The relative significance of blood urea nitrogen and serum creatinine concentrations in azotemia |journal=Ann. Intern. Med. |volume=65 |issue=6 |pages=1287–99 |date=December 1966 |pmid=5928490 |doi= |url=}}</ref><ref name="pmid2198971">{{cite journal |vauthors=Baskett PJ |title=ABC of major trauma. Management of hypovolaemic shock |journal=BMJ |volume=300 |issue=6737 |pages=1453–7 |date=June 1990 |pmid=2198971 |pmc=1663124 |doi= |url=}}</ref>
- Burns
 
-Cutaneous loss e.g. sweating
 
- Inadequate water intake
 
- Salt-wasting nephropathy
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* Elevated [[BUN]]
* Elevated [[creatinine]]
|
* Serum [[sodium]] < 135 mmol/l
* Serum [[chloride]] is decreased
* Elevated [[potassium]]
|
* [[Ketone]]s and [[glucose]]] may be detected
* Urine specific gravity is elevated
|
* Serum [[bicarbonate]] is decreased
* Elevated [[lactate]]
|
* [[Hypoglycemia]] may be detected
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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|<nowiki>-</nowiki>
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* [[Oral rehydration therapy]] is the usual line of treatment
|-
|-
|[[Diarrhea]] and/or [[vomiting]]<ref name="pmid2178747">{{cite journal |vauthors=Carpenter DO |title=Neural mechanisms of emesis |journal=Can. J. Physiol. Pharmacol. |volume=68 |issue=2 |pages=230–6 |date=February 1990 |pmid=2178747 |doi= |url=}}</ref><ref name="pmid22454468">{{cite journal |vauthors=Bresee JS, Marcus R, Venezia RA, Keene WE, Morse D, Thanassi M, Brunett P, Bulens S, Beard RS, Dauphin LA, Slutsker L, Bopp C, Eberhard M, Hall A, Vinje J, Monroe SS, Glass RI |title=The etiology of severe acute gastroenteritis among adults visiting emergency departments in the United States |journal=J. Infect. Dis. |volume=205 |issue=9 |pages=1374–81 |date=May 2012 |pmid=22454468 |doi=10.1093/infdis/jis206 |url=}}</ref><ref name="pmid21801613">{{cite journal |vauthors=Hall AJ, Rosenthal M, Gregoricus N, Greene SA, Ferguson J, Henao OL, Vinjé J, Lopman BA, Parashar UD, Widdowson MA |title=Incidence of acute gastroenteritis and role of norovirus, Georgia, USA, 2004-2005 |journal=Emerging Infect. Dis. |volume=17 |issue=8 |pages=1381–8 |date=August 2011 |pmid=21801613 |pmc=3381564 |doi=10.3201/eid1708.101533 |url=}}</ref><ref name="pmid29053792">{{cite journal |vauthors=Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK |title=2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea |journal=Clin. Infect. Dis. |volume=65 |issue=12 |pages=e45–e80 |date=November 2017 |pmid=29053792 |doi=10.1093/cid/cix669 |url=}}</ref>
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|<nowiki>-</nowiki>
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* [[Leukocytosis]] with predominant [[neutrophilia]] may be detected
* Elevated [[ESR]] may be detected
|<nowiki>-</nowiki>
|
* Stool anion gap should be calculated
|
* [[Urine]] may be postive for:
** [[Ketones]]
** Organic acids
** Ester-to-free carnitine ratio
** [[Porphobilinogen]]
** [[Aminolevulinic acid]]
|<nowiki>-</nowiki>
|
* Stool pH < 5.5
* Stool culture may be positive for vibrio and plesiomonas species, [[]clostridium difficile]], [[salmonella]], [[shigella]], [[campylobacter]], and  yersinia enterocolitica
* Serotyping for E.coli O157:H7
* Enzyme immunoassay may be positive for [[rotavirus]] or [[adenovirus]]
* Elevated liver [[transaminases]] may be detected
* Elevated pancreatic [[amylase]] and [[lipase]] may be detected
|
* Abdominal [[ultrasound]] may be useful to detect cause
|
|
* Upper gastrointestinal radiography with follow-through may be useful to detect cause
|<nowiki>-</nowiki>
|
|
* Brain MRI may be useful to detect cause
|
|
* Esophagogastroduodenoscopy may be useful to detect cause
|
|
* Treatment must include volume replacement
|-
|-
|[[Drugs]]/[[Toxin|toxins]]<ref name="pmid1883120">{{cite journal |vauthors=Toto RD, Mitchell HC, Lee HC, Milam C, Pettinger WA |title=Reversible renal insufficiency due to angiotensin converting enzyme inhibitors in hypertensive nephrosclerosis |journal=Ann. Intern. Med. |volume=115 |issue=7 |pages=513–9 |date=October 1991 |pmid=1883120 |doi= |url=}}</ref><ref name="pmid4715199">{{cite journal |vauthors=Bismuth C, Gaultier M, Conso F, Efthymiou ML |title=Hyperkalemia in acute digitalis poisoning: prognostic significance and therapeutic implications |journal=Clin. Toxicol. |volume=6 |issue=2 |pages=153–62 |date=1973 |pmid=4715199 |doi=10.3109/15563657308990513 |url=}}</ref><ref name="pmid7579079">{{cite journal |vauthors=Sawaya BP, Briggs JP, Schnermann J |title=Amphotericin B nephrotoxicity: the adverse consequences of altered membrane properties |journal=J. Am. Soc. Nephrol. |volume=6 |issue=2 |pages=154–64 |date=August 1995 |pmid=7579079 |doi= |url=}}</ref><ref name="pmid10390124">{{cite journal |vauthors=Whelton A |title=Nephrotoxicity of nonsteroidal anti-inflammatory drugs: physiologic foundations and clinical implications |journal=Am. J. Med. |volume=106 |issue=5B |pages=13S–24S |date=May 1999 |pmid=10390124 |doi= |url=}}</ref>
- [[ACE inhibitor]]
- [[Aminoglycosides]]
- [[Amphotericin B]]
- [[Contrast medium|Contrast]] material
- [[Cyclosporin]]
- [[Diuretics]]
- [[Digitalis]]
- [[Heavy metals]]
- [[Indomethacin]]
- [[Tacrolimus]]
- [[NSAIDs]]
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
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|<nowiki>-</nowiki>
|
|
* Elevated [[BUN]]
* Elevated [[creatinine]]
* Elevated [[creatine kinase]]
|
|
* [[Potassium]] > 5.5 mEq/l with [[ACE inhibitors]]
* [[Hypomagnesemia]], [[hypokalemia]], [[hypocalcemia]], and [[hypophosphatemia]] with [[aminoglycosides]]
|
|
* [[Urine]] sample may detect drug
* [[Glucosuria]], [[aminoaciduria]], [[phosphaturia]], [[ketonuria]] and [[uricosuria]] may be detected
* Urine [[osmolality]] should be calculated
* Urine [[pH]] should be detected
* Bland [[urine]] sediment may be detected
* [[Hyaline cast]]s may be detected
* Granular casts may be detected
* Red blood cell casts may be detected
* Dysmorphic red blood cells may be present
* Red blood cell casts may be detected
* Absence of [[proteinuria]] differentiates between [[acute kidney injury]] and [[acute interstitial nephritis]]
|
* Serum osmolar gap should be calculated
* Elevated [[lactate]] may be detected
* [[Metabolic acidosis]] may be present
|
* Blood [[glucose]] should be measured
* Toxicology screening is crucial in aiding diagnosis
* Rapid immunoassay screens may also aid diagnosis
|
* Useful in drug-induced nephropathies
|
* Some radio-opaque substances may be visualized
* Ingested drug packets may also be visualized
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[ECG]] may be helpful in diagnosing [[arrhythmia]]s
|
|
|-
|-
|[[Esophageal varices|Esophageal varices bleeding]]<ref name="pmid6970703">{{cite journal |vauthors=Graham DY, Smith JL |title=The course of patients after variceal hemorrhage |journal=Gastroenterology |volume=80 |issue=4 |pages=800–9 |date=April 1981 |pmid=6970703 |doi= |url=}}</ref><ref name="pmid20638742">{{cite journal |vauthors=de Franchis R |title=Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension |journal=J. Hepatol. |volume=53 |issue=4 |pages=762–8 |date=October 2010 |pmid=20638742 |doi=10.1016/j.jhep.2010.06.004 |url=}}</ref>
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* May show [[normocytic normochromic anemia]]
* [[Hematocrit]] may be decreased
|
*In uncontrolled bleeding:
** Elevated [[BUN]]
** Elevated [[creatinine]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Duplex doppler ultrasonography can determine:
** Velocity and direction of portal flow
** Determine portal vein patency
* Endoscopic ultrasonography may also be useful
|
* Abnormal opacities representing paraesophageal varices  may be detected outside the esophageal wall
* The short or long segment of the descending [[aorta]] may be obliterated
* A posterior mediastinal or intraparenchymal mass may be noted
* A dilated [[azygous vein]] may be noted and is described as a "downhill varix"
* Dilated collaterals may lead to a widened [[superior mediastinum]]
* [[Barium swallow]] demonstrates snake-like filling defects
|
* Can visualize the entire portal venous system
|
* Can visualize the entire portal venous system
* Portrays [[esophageal varices]] as flow voids
|
* Positive emission tomography can determine portal hypertension and evaluate [[esophageal varices]]
* A flexible [[endoscope]] may also aid diagnosis
* Bleeding is stopped by [[vasopressin]], balloon tamponade, or [[transjugular intrahepatic portosystemic shunt]] to name a few.
|
|-
|[[Heart disease]]<ref name="pmid26644246">{{cite journal |vauthors=Sotos-Prieto M, Bhupathiraju SN, Mattei J, Fung TT, Li Y, Pan A, Willett WC, Rimm EB, Hu FB |title=Changes in Diet Quality Scores and Risk of Cardiovascular Disease Among US Men and Women |journal=Circulation |volume=132 |issue=23 |pages=2212–9 |date=December 2015 |pmid=26644246 |pmc=4673892 |doi=10.1161/CIRCULATIONAHA.115.017158 |url=}}</ref><ref name="pmid2030718">{{cite journal |vauthors=LaCroix AZ, Lang J, Scherr P, Wallace RB, Cornoni-Huntley J, Berkman L, Curb JD, Evans D, Hennekens CH |title=Smoking and mortality among older men and women in three communities |journal=N. Engl. J. Med. |volume=324 |issue=23 |pages=1619–25 |date=June 1991 |pmid=2030718 |doi=10.1056/NEJM199106063242303 |url=}}</ref><ref name="pmid19581259">{{cite journal |vauthors=Mahle WT, Newburger JW, Matherne GP, Smith FC, Hoke TR, Koppel R, Gidding SS, Beekman RH, Grosse SD |title=Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the AHA and AAP |journal=Pediatrics |volume=124 |issue=2 |pages=823–36 |date=August 2009 |pmid=19581259 |doi=10.1542/peds.2009-1397 |url=}}</ref>
-Congenital
-Acquired
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* [[ESR]] and [[CRP]] may be elevated
|
* [[BUN]] and [[creatinine]] may be elevated
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* For [[coronary heart disease]], cardiac stress testing may be performed:
* For [[rheumatic heart disease]], the following tests may be performed:
** Throat culture may be positive for group A beta hemolytic streptococcus
** Rapid antigen detection test may be positive for  group A streptococcal antigen
** Antistreptococcal antibodies may be detected
** Heart reactive antibodies may be detected against M protein
** Rapid detection test for D8/17 B cell markers
* Hyperoxia test can distinguish cardiac from non - cardiac causes of [[cyanosis]]
* [[Pulse oximetry]] is useful in congenital heart diseases
|
* [[Ultrasound]] visualizes anatomy of the heart and in particular, the chambers and chamber flow
|
* May visualize heart anatomy and vessels such as:
** [[Cardiomegaly]]
** [[Dextrocardia]]
** Abnormal cardiac silhouette
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|
* [[ECG]] may demonstrate:
** [[Arrhythmias]] such as:
*** [[Sinus tachycardia]]
*** Multifocal atrial [[tachycardia]]
*** Prolonged PR interval in [[atrioventricular block]]
*** [[Atrial fibrillation]]
*** [[Atrial flutter]]
** [[Pericarditis]] by ST segment elevation mostly in lead II, III, aVF, and V4 - V6
* [[Echocardiography]] may detect the following:
** Ventricular dysfunction
** Left and right ventricular [[hypertrophy]]
** Chronic mitral valve disease
** [[Mitral stenosis]]
** [[Mitral insufficiency]]
** Left atrial dilation
** Left atrial enlargement
** [[Aortic stenosis]]
** [[Aortic insufficiency]]
** [[Tricuspid insufficiency]]
** [[Pulmonary stenosis]]
** [[Pulmonary insufficiency]]
|
* History and physical examination (auscultation of the heart) are important for diagnosis
|-
|[[Hemorrhage]]<ref name="pmid21098468">{{cite journal |vauthors=Achneck HE, Sileshi B, Parikh A, Milano CA, Welsby IJ, Lawson JH |title=Pathophysiology of bleeding and clotting in the cardiac surgery patient: from vascular endothelium to circulatory assist device surface |journal=Circulation |volume=122 |issue=20 |pages=2068–77 |date=November 2010 |pmid=21098468 |doi=10.1161/CIRCULATIONAHA.110.936773 |url=}}</ref><ref name="pmid3487361">{{cite journal |vauthors=Gralnick HR, Rick ME, McKeown LP, Williams SB, Parker RI, Maisonneuve P, Jenneau C, Sultan Y |title=Platelet von Willebrand factor: an important determinant of the bleeding time in type I von Willebrand's disease |journal=Blood |volume=68 |issue=1 |pages=58–61 |date=July 1986 |pmid=3487361 |doi= |url=}}</ref><ref name="pmid3706933">{{cite journal |vauthors=Suchman AL, Griner PF |title=Diagnostic uses of the activated partial thromboplastin time and prothrombin time |journal=Ann. Intern. Med. |volume=104 |issue=6 |pages=810–6 |date=June 1986 |pmid=3706933 |doi= |url=}}</ref><ref name="pmid3541576">{{cite journal |vauthors=Greenberg CS, Devine DV, McCrae KM |title=Measurement of plasma fibrin D-dimer levels with the use of a monoclonal antibody coupled to latex beads |journal=Am. J. Clin. Pathol. |volume=87 |issue=1 |pages=94–100 |date=January 1987 |pmid=3541576 |doi= |url=}}</ref>
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* May indicate [[normocytic normochromic anemia]]
* [[Prothrombin time]], [[activated partial thromboplastin time]] and [[bleeding time]] may be elevated
|
* [[BUN]] and [[creatinine]] is elevated in severe [[hemorrhage]]
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|
* [[pH]] may be 7.30-7.35 with mild to severe [[metabolic acidosis]]
* Serum [[sodium]] and [[chloride]] may become elevated with high volume isotonic saline
* [[Hyperchloremia]] may cause a non–ion gap [[acidosis]]
* [[Hypocalemia]] may occur with rapid [[blood transfusion]]
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|
* Sensitive to [[bleeding]] within body cavities
* Focused abdominal sonographic technique (FAST) can detect peritoneal cavity fluid
|
* Chest x - ray may demonstrate bilateral opacities in the lung field and indicate [[hemothorax]]
* Abdominal x - ray may demonstrate [[hemoperitoneum]]
* Incomplete calcified margins of a dilated aorta may indicate a ruptured [[abdominal aortic aneurysm]]
* Absence of the psoas shadow may suggest retroperitoneal blood
|
* May visualize intrathoracic, intra-abdominal, and retroperitoneal [[bleeding]]
* However, [[ultrasound]] is more often used
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|
* Esophagogastroduodenoscopy is often used to visualize the source of [[bleeding]] in the upper GI
* [[Colonoscopy]] may be used in the lower GI
* [[Angiography]] and nuclear medicine scanning are also useful in diagnosing the source of [[bleeding]]
|
|-
|[[Hemolysis]]<ref name="pmid3814817">{{cite journal |vauthors=Liesveld JL, Rowe JM, Lichtman MA |title=Variability of the erythropoietic response in autoimmune hemolytic anemia: analysis of 109 cases |journal=Blood |volume=69 |issue=3 |pages=820–6 |date=March 1987 |pmid=3814817 |doi= |url=}}</ref><ref name="pmid7365971">{{cite journal |vauthors=Marchand A, Galen RS, Van Lente F |title=The predictive value of serum haptoglobin in hemolytic disease |journal=JAMA |volume=243 |issue=19 |pages=1909–11 |date=May 1980 |pmid=7365971 |doi= |url=}}</ref><ref name="pmid2436855">{{cite journal |vauthors=Stahl WM |title=Acute phase protein response to tissue injury |journal=Crit. Care Med. |volume=15 |issue=6 |pages=545–50 |date=June 1987 |pmid=2436855 |doi= |url=}}</ref><ref name="pmid7411826">{{cite journal |vauthors=Conley CL, Lippman SM, Ness P |title=Autoimmune hemolytic anemia with reticulocytopenia. A medical emergency |journal=JAMA |volume=244 |issue=15 |pages=1688–90 |date=October 1980 |pmid=7411826 |doi= |url=}}</ref>
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* Elevated or decreased [[mean corpuscular volume]] and [[mean corpuscular hemoglobin]]
* [[Thrombocytopenia]]
* [[Microcytic]] hypochromic [[anemia]]
* [[Macrocytic anemia]]
* Elevated [[red blood cell]] distribution width may indicate [[anisocytosis]]
* [[Reticulocyte]] count may be increased
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* Peripheral [[blood smear]] may demonstrate:
** Smudge cells
** Small [[lymphocytes]]
** Polychromasia
** [[Spherocyte]]s
** [[Schistocyte]]s
* Serum [[lactate dehydrogenase]] may be elevated
* Serum [[haptoglobin]] may be decreased
* Unconjugated or indirect [[bilirubin]]  may be elevated
* The following tests may also aid diagnosis:
** Direct antiglobulin test
** [[Urine]] free [[hemoglobin]] test
** [[Urine]] [[hemosiderin]] test
** [[Red blood cell]] survival test
** Cold agglutinin titer
** Glucose-6-phosphate dehydrogenase screen
** Sickle cell screen
|
** May visualize [[hepatomegaly]] or [[splenomegal]]y or [[hepatosplenomegaly]]
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|
|-
|[[Hepatorenal syndrome]]<ref name="pmid19776409">{{cite journal |vauthors=Ginès P, Schrier RW |title=Renal failure in cirrhosis |journal=N. Engl. J. Med. |volume=361 |issue=13 |pages=1279–90 |date=September 2009 |pmid=19776409 |doi=10.1056/NEJMra0809139 |url=}}</ref><ref name="pmid8550036">{{cite journal |vauthors=Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Schölmerich J |title=Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club |journal=Hepatology |volume=23 |issue=1 |pages=164–76 |date=January 1996 |pmid=8550036 |doi=10.1002/hep.510230122 |url=}}</ref><ref name="pmid17389705">{{cite journal |vauthors=Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V |title=Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis |journal=Gut |volume=56 |issue=9 |pages=1310–8 |date=September 2007 |pmid=17389705 |pmc=1954971 |doi=10.1136/gut.2006.107789 |url=}}</ref><ref name="pmid25638527">{{cite journal |vauthors=Angeli P, Ginès P, Wong F, Bernardi M, Boyer TD, Gerbes A, Moreau R, Jalan R, Sarin SK, Piano S, Moore K, Lee SS, Durand F, Salerno F, Caraceni P, Kim WR, Arroyo V, Garcia-Tsao G |title=Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites |journal=J. Hepatol. |volume=62 |issue=4 |pages=968–74 |date=April 2015 |pmid=25638527 |doi=10.1016/j.jhep.2014.12.029 |url=}}</ref>
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* [[Leukocytosis]] may indicate [[spontaneous bacterial peritonitis]]
|
* Reduced [[glomerular filtration rate]]
* Serum [[creatinine]]  > 1.5 mg/dL or 24 - hour [[creatinine]] clearance < 40 mL/min
|
* Serum [[sodium]] < 130 mEq/L
|
* [[Proteinuria]] < 500 mg/d
* Urine volume < 500 mL/d
* Urine [[sodium]] < 10 mEq/L
* [[Urine osmolality]] > [[plasma osmolality]]
* Urine [[red blood cell]] count < 50 per high-power field
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* Prolonged [[prothrombin time]]
* Alpha feto-protein may be positive
* [[Cryoglobulinemia]] may be seen
|
* Abdominal ultrasound to exclude [[hydronephrosis]] and intrinsic renal disease
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|
* [[Echocardiography]] is used to evaluate right ventricular preload, ventricular filling pressures, and cardiac function
|
|-
|[[Cardiomyopathy|Ischemic cardiomyopathy]]<ref name="pmid16567565">{{cite journal |vauthors=Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, Moss AJ, Seidman CE, Young JB |title=Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention |journal=Circulation |volume=113 |issue=14 |pages=1807–16 |date=April 2006 |pmid=16567565 |doi=10.1161/CIRCULATIONAHA.106.174287 |url=}}</ref><ref name="pmid15689345">{{cite journal |vauthors=Corrado D, Pelliccia A, Bjørnstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, van-Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom-Lundqvist C, McKenna WJ, Thiene G |title=Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology |journal=Eur. Heart J. |volume=26 |issue=5 |pages=516–24 |date=March 2005 |pmid=15689345 |doi=10.1093/eurheartj/ehi108 |url=}}</ref><ref name="pmid17916581">{{cite journal |vauthors=Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, Dubourg O, Kühl U, Maisch B, McKenna WJ, Monserrat L, Pankuweit S, Rapezzi C, Seferovic P, Tavazzi L, Keren A |title=Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases |journal=Eur. Heart J. |volume=29 |issue=2 |pages=270–6 |date=January 2008 |pmid=17916581 |doi=10.1093/eurheartj/ehm342 |url=}}</ref><ref name="pmid17468391">{{cite journal |vauthors=Thompson PD, Franklin BA, Balady GJ, Blair SN, Corrado D, Estes NA, Fulton JE, Gordon NF, Haskell WL, Link MS, Maron BJ, Mittleman MA, Pelliccia A, Wenger NK, Willich SN, Costa F |title=Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology |journal=Circulation |volume=115 |issue=17 |pages=2358–68 |date=May 2007 |pmid=17468391 |doi=10.1161/CIRCULATIONAHA.107.181485 |url=}}</ref>
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* In high [[cardiac output]], [[anemia]] may be detected
|
* Elevated [[creatinine]]
|
* Serum [[sodium]] may be decreased
* Serum [[postassium]] may be chronically low
* Serum [[magnesium]] may be decreased
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* [[Cardiac enzyme]]s may be elevated indicating a recent [[myocardial infarction]], and include:
** [[Troponin]]
** [[Creatine kinase]]
** [[Creatine kinase]] - MB
* B-type natriuretic peptide level reflects volume status
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* May detect abnormal cardiac silhouette
|
* CT with [[angiography]] can detect the following:
** Biventricular volume
** [[Ejection fraction]]
** Wall motion
** Myocardial perfusion
** [[Hypertrophic cardiomyopathy]]
** Left ventricular noncompaction
** Arrhythmogenic right ventricular dysplasia
** Congenital malformation
|
* MRI with gadolinium–diethylene-triamine pentaacetic acid (DTPA) can evaluate mid-wall fibrosis
|
* Echocardiography is the gold standard in diagnosis and indicates an [[ejection fraction]] ≤35%
* Echo may also diagnose [[pulmonary embolism]], right ventricular dilation or [[pericardial effusion]] with tamponade
* Electrocardiogram is useful in detecting;
** Left ventricular enlargement
** [[Atrial fibrillation]]
** Premature ventricular complexes
** Left ventricular [[hypertrophy]]
** Left bundle-branch block
** [[Atrioventricular block]]
* Right-sided heart catheterization can determine volume status
* Endomyocardial biopsy may also be helpful in diagnosis
|
|-
|[[ Liver cirrhosis]]<ref name="pmid24076364">{{cite journal |vauthors=Ge PS, Runyon BA |title=The changing role of beta-blocker therapy in patients with cirrhosis |journal=J. Hepatol. |volume=60 |issue=3 |pages=643–53 |date=March 2014 |pmid=24076364 |doi=10.1016/j.jhep.2013.09.016 |url=}}</ref><ref name="pmid3533689">{{cite journal |vauthors=Becker CD, Scheidegger J, Marincek B |title=Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography |journal=Gastrointest Radiol |volume=11 |issue=4 |pages=305–11 |date=1986 |pmid=3533689 |doi= |url=}}</ref><ref name="pmid3532188">{{cite journal |vauthors=Giorgio A, Amoroso P, Lettieri G, Fico P, de Stefano G, Finelli L, Scala V, Tarantino L, Pierri P, Pesce G |title=Cirrhosis: value of caudate to right lobe ratio in diagnosis with US |journal=Radiology |volume=161 |issue=2 |pages=443–5 |date=November 1986 |pmid=3532188 |doi=10.1148/radiology.161.2.3532188 |url=}}</ref>
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* Liver function testing is crucial for diagnosis
* The following serologic tests are used as indirect markers of [[fibrosis]]:
** [[Aspartate aminotransferase]] to [[platelet]] ratio
** FibroTest/FibroSure
** Hepascore
** FibroSpect
|
* Doppler ultrasound may demonstrate:
** Portal blood flow and flow velocity
** [[Hepatic artery]] enlargement
** Vascular resistance
** Multifocal or focal lesions or masses
** Hepatic contour
** Hepatic texture
** Portal collaterals
** [[Ascites]]
** [[Splenomegaly]]
** [[Portal vein thrombosis]]
|
* May demonstrate  the following:
** [[Ascites]]
** [[Bowel perforation]]
** [[Gynecomastia]] (enlargement of breast tissue)
** [[Azygos vein]] enlargement 
** Variceal hemorrhage
** [[Pleural effusion]]
|
* CT can detect the following:
** Morphologic changes in the liver
** Collaterals and shunts
** Lesions
** Hyperattenuating nodule of [[hepatocellular carcinoma]]
** [[Portal vein thrombosis]]
** [[Splenomegaly]] and gallbladder enlargement
|
* MRI can detect the following:
** Morphologic changes in the liver
** Vacular patency
** Lesions
** Tumor invasion
** [[Portal vein thrombosis]]
** [[Splenomegaly]] and gallbladder enlargement
** [[Steatosis]]
|
* Nuclear imaging can determine hepatic function and [[portal hypertension]]
* [[Angiography]] can determine hepatic perfusion and the development of [[shunt]]s and [[tumor]]s
|
* [[Liver cirrhosis]] is irreversible and a transplant is usually needed
|-
|[[Malignant hypertension]]<ref name="pmid23102030">{{cite journal |vauthors=Johnson W, Nguyen ML, Patel R |title=Hypertension crisis in the emergency department |journal=Cardiol Clin |volume=30 |issue=4 |pages=533–43 |date=November 2012 |pmid=23102030 |doi=10.1016/j.ccl.2012.07.011 |url=}}</ref><ref name="pmid16627047">{{cite journal |vauthors=Elliott WJ |title=Clinical features in the management of selected hypertensive emergencies |journal=Prog Cardiovasc Dis |volume=48 |issue=5 |pages=316–25 |date=2006 |pmid=16627047 |doi=10.1016/j.pcad.2006.02.004 |url=}}</ref>
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* May demonstrate [[microangiopathic hemolytic anemia]]
|
* Elevated [[BUN]]
* Elevated [[creatinine]]
* [[Azotemia]]
|
* [[Hypernatremia]]
* [[Hyperphosphatemia]]
* [[Hyperkalemia]] or [[hypokalemia]]
|
* [[Proteinuria]]
* [[Microscopic hematuria]]
* [[Red blood cell]] or [[hyaline cast]]s
|
* A[[cidosis]]
|
|
* It is useful to also test the following:
** [[Cardiac enzymes]]
** Urinary [[catecholamines]] and vanillylmandelic acid
** Thyroid-stimulating hormone level
* Elevated plasma [[renin]], [[angiotensin]] II, and [[aldosterone]] is often detected
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|
|
* May demonstrate the following:
** Cardiac enlargement
** [[Pulmonary edema]]
** Rib notching
** [[Aortic coarctation]]
** Mediastinal widening
** [[Aortic dissection]]
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|
|
* Electrocardiography may indicate the following:
** [[Ischemia]]
** Infarct
** Evidence of electrolyte abnormalities or drug overdose
* Echocardiography may indicate the following:
** Left atrial enlargement
** Left ventricular [[hypertrophy]]
|
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|}
|}

Latest revision as of 17:32, 14 January 2019


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

Tables

Diagnosis Lab findings

References

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