Colorectal cancer differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Colon cancer}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Colorectal_cancer]]
To view the differential diagnosis of familial adenomatous polyposis (FAP), click [[Familial adenomatous polyposis differential diagnosis|'''here''']]<br>
To view the differential diagnosis of familial adenomatous polyposis (FAP), click [[Familial adenomatous polyposis differential diagnosis|'''here''']]<br>
To view the differential diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC), click [[Hereditary nonpolyposis colorectal cancer differential diagnosis|'''here''']]<br><br>
To view the differential diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC), click [[Hereditary nonpolyposis colorectal cancer differential diagnosis|'''here''']]<br><br>
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'''Other conditions that can be mistaken for colorectal cancer include the following:'''
'''Other conditions that can be mistaken for colorectal cancer include the following:'''
*Benign colon polyps
*Benign colon polyps
*[[Ischemic colitis]]
*[[Infectious colitis]]
*[[Infectious colitis]]
*[[Arteriovenous malformation]] ([[AVM]])
*[[Arteriovenous malformation]] ([[AVM]])
Line 19: Line 18:
*[[Small intestine]] carcinomas
*[[Small intestine]] carcinomas
*Gastrointestinal lymphoma
*Gastrointestinal lymphoma
*[[Ileus]]
*[[Pregnancy]]
*[[Pregnancy]]
*[[Appendicitis]]
*[[Appendicitis]]
Line 28: Line 26:
*[[Cholecystitis]]
*[[Cholecystitis]]


{| class="wikitable"
<small>
<div style="width: 80%;">
{|
| colspan="12" |'''<small>ABBREVIATIONS''':'''N/A''': Not available , '''N/V''': Nausea/vomiting, '''M/C''': Most common, '''DRE''': Digital rectal exam, '''RLQ''': Right lower quadrant, '''LLQ''': Left lower quadrant </small><small><nowiki/></small><small><nowiki/></small>
|-
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="4" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
| colspan="5" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
|-
|-
| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
| colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
Line 41: Line 43:
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-  
|-  
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Constipation/<br>Diarrhea
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bowel frequency
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenesmus
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
Line 50: Line 53:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other diagnostic study
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other diagnostic study
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenocarcinoma]]<ref name="pmid8265100">{{cite journal |vauthors=Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C |title=Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum |journal=Oncology |volume=51 |issue=1 |pages=30–4 |date=1994 |pmid=8265100 |doi=10.1159/000227306 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Colorectal carcinoma ([[Adenocarcinoma]])<ref name="pmid8265100">{{cite journal |vauthors=Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C |title=Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum |journal=Oncology |volume=51 |issue=1 |pages=30–4 |date=1994 |pmid=8265100 |doi=10.1159/000227306 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |or
* [[Constipation]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
and/or
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
* [[Diarrhea]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Diffuse abdominal pain +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Tenesmus]]
*[[Weight loss]]
*Diminished caliber of stools
*[[Fatigue]]
*Low caliber of stools
*[[Mucus]] in stools
*[[Mucus]] in stools
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Polyp|Polyps]] (villous, tubular, tubulo-villous)
*[[Polyp|Polyps]] (villous, tubular, tubulo-villous)
*[[Ulcer|Ulcerating polyps]]
*[[Ulcer|Ulcerating polyps]]
*[[cancerous]] [[lesions]]
*[[Cancerous]] [[lesions]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*Luminal narrowing and [[bowel obstruction]]
*Luminal narrowing
*Circumferential thickening of the bowel wall
*[[Bowel obstruction]]
*[[Enlarged lymph nodes]]
*Thickening of the bowel wall
*Pulmonary [[metastases]]
*[[Lymphadenopathy]]
*Peritoneal metastases
*[[Metastases]]
*[[Metastases|Hepatic metastases]]
| style="background: #F5F5F5; padding: 5px;" |'''PET scans'''
| style="background: #F5F5F5; padding: 5px;" |
*[[Metastasis]]
*[[PET scan|PET scans]]
'''Barium enema'''
**Detailed images and metastasis
*[[Cancer]] or [[Premalignant condition|precancerous]] [[polyp]]
*[[Barium enema]]
**Cancer or a precancerous polyp
*[[Genetic testing]]
**[[Hereditary nonpolyposis colorectal cancer case study one|Hereditary nonpolyposis colorectal cancer]] (HNPCC)
**[[Familial adenomatous polyposis]] (FAP)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Different grades of differentiation of glandular structures
* Different grades of differentiation of [[glandular]] structures
** Sheets or cords of malignant cells,
** Sheets or cords of [[malignant]] cells
**Cellular atypia, pleomorphism
**[[Cellular]] [[atypia]] and [[pleomorphism]]
**High mitotic rate
**High [[Mitosis|mitotic]] rate
* Necrotic debris in glandular lumina
* [[Necrosis|Necrotic]] debris in [[Glandular tissue|glandular lumina]]
* Desmoplastic reaction (sign of invasion)
* [[Desmoplastic|Desmoplastic reaction (sign of invasion)]]
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]] and [[histopathological]] analysis
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]], [[genetic testing]], and [[histopathological]] analysis
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Peutz-Jeghers syndrome]]<br><ref name="pmid27298573">{{cite journal |vauthors=Zhong ME, Niu BZ, Ji WY, Wu B |title=Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer |journal=World J. Gastroenterol. |volume=22 |issue=22 |pages=5293–6 |date=June 2016 |pmid=27298573 |doi=10.3748/wjg.v22.i22.5293 |url=}}</ref><ref name="KopacovaTacheci20092">{{cite journal|last1=Kopacova|first1=Marcela|last2=Tacheci|first2=Ilja|last3=Rejchrt|first3=Stanislav|last4=Bures|first4=Jan|title=Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach|journal=World Journal of Gastroenterology|volume=15|issue=43|year=2009|pages=5397|issn=1007-9327|doi=10.3748/wjg.15.5397}}</ref><ref name="GiardielloTrimbath2006">{{cite journal|last1=Giardiello|first1=F|last2=Trimbath|first2=J|title=Peutz-Jeghers Syndrome and Management Recommendations|journal=Clinical Gastroenterology and Hepatology|volume=4|issue=4|year=2006|pages=408–415|issn=15423565|doi=10.1016/j.cgh.2005.11.005}}</ref><ref name="BeggsLatchford2010">{{cite journal|last1=Beggs|first1=A. D.|last2=Latchford|first2=A. R.|last3=Vasen|first3=H. F. A.|last4=Moslein|first4=G.|last5=Alonso|first5=A.|last6=Aretz|first6=S.|last7=Bertario|first7=L.|last8=Blanco|first8=I.|last9=Bulow|first9=S.|last10=Burn|first10=J.|last11=Capella|first11=G.|last12=Colas|first12=C.|last13=Friedl|first13=W.|last14=Moller|first14=P.|last15=Hes|first15=F. J.|last16=Jarvinen|first16=H.|last17=Mecklin|first17=J.-P.|last18=Nagengast|first18=F. M.|last19=Parc|first19=Y.|last20=Phillips|first20=R. K. S.|last21=Hyer|first21=W.|last22=Ponz de Leon|first22=M.|last23=Renkonen-Sinisalo|first23=L.|last24=Sampson|first24=J. R.|last25=Stormorken|first25=A.|last26=Tejpar|first26=S.|last27=Thomas|first27=H. J. W.|last28=Wijnen|first28=J. T.|last29=Clark|first29=S. K.|last30=Hodgson|first30=S. V.|title=Peutz-Jeghers syndrome: a systematic review and recommendations for management|journal=Gut|volume=59|issue=7|year=2010|pages=975–986|issn=0017-5749|doi=10.1136/gut.2009.198499}}</ref><ref name="KopacovaTacheci20093">{{cite journal|last1=Kopacova|first1=Marcela|last2=Tacheci|first2=Ilja|last3=Rejchrt|first3=Stanislav|last4=Bures|first4=Jan|title=Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach|journal=World Journal of Gastroenterology|volume=15|issue=43|year=2009|pages=5397|issn=1007-9327|doi=10.3748/wjg.15.5397}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Peutz-Jeghers syndrome]]<br><ref name="pmid27298573">{{cite journal |vauthors=Zhong ME, Niu BZ, Ji WY, Wu B |title=Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer |journal=World J. Gastroenterol. |volume=22 |issue=22 |pages=5293–6 |date=June 2016 |pmid=27298573 |doi=10.3748/wjg.v22.i22.5293 |url=}}</ref><ref name="KopacovaTacheci20092">{{cite journal|last1=Kopacova|first1=Marcela|last2=Tacheci|first2=Ilja|last3=Rejchrt|first3=Stanislav|last4=Bures|first4=Jan|title=Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach|journal=World Journal of Gastroenterology|volume=15|issue=43|year=2009|pages=5397|issn=1007-9327|doi=10.3748/wjg.15.5397}}</ref><ref name="GiardielloTrimbath2006">{{cite journal|last1=Giardiello|first1=F|last2=Trimbath|first2=J|title=Peutz-Jeghers Syndrome and Management Recommendations|journal=Clinical Gastroenterology and Hepatology|volume=4|issue=4|year=2006|pages=408–415|issn=15423565|doi=10.1016/j.cgh.2005.11.005}}</ref><ref name="BeggsLatchford2010">{{cite journal|last1=Beggs|first1=A. D.|last2=Latchford|first2=A. R.|last3=Vasen|first3=H. F. A.|last4=Moslein|first4=G.|last5=Alonso|first5=A.|last6=Aretz|first6=S.|last7=Bertario|first7=L.|last8=Blanco|first8=I.|last9=Bulow|first9=S.|last10=Burn|first10=J.|last11=Capella|first11=G.|last12=Colas|first12=C.|last13=Friedl|first13=W.|last14=Moller|first14=P.|last15=Hes|first15=F. J.|last16=Jarvinen|first16=H.|last17=Mecklin|first17=J.-P.|last18=Nagengast|first18=F. M.|last19=Parc|first19=Y.|last20=Phillips|first20=R. K. S.|last21=Hyer|first21=W.|last22=Ponz de Leon|first22=M.|last23=Renkonen-Sinisalo|first23=L.|last24=Sampson|first24=J. R.|last25=Stormorken|first25=A.|last26=Tejpar|first26=S.|last27=Thomas|first27=H. J. W.|last28=Wijnen|first28=J. T.|last29=Clark|first29=S. K.|last30=Hodgson|first30=S. V.|title=Peutz-Jeghers syndrome: a systematic review and recommendations for management|journal=Gut|volume=59|issue=7|year=2010|pages=975–986|issn=0017-5749|doi=10.1136/gut.2009.198499}}</ref><ref name="KopacovaTacheci20093">{{cite journal|last1=Kopacova|first1=Marcela|last2=Tacheci|first2=Ilja|last3=Rejchrt|first3=Stanislav|last4=Bures|first4=Jan|title=Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach|journal=World Journal of Gastroenterology|volume=15|issue=43|year=2009|pages=5397|issn=1007-9327|doi=10.3748/wjg.15.5397}}</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |↑ or ↓
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Constipation]]
* [[Weight loss]]
and/or
* [[Diarrhea]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Abdominal pain
| style="background: #F5F5F5; padding: 5px;" |
* [[Mucocutaneous]]  [[hyperpigmentation]] (mouth, hands, and feet)
* [[Fatigue]]
* [[Fatigue]]
* [[Weight loss]]
* [[Hyperpigmentation|Mucocutaneous  hyperpigmentation]]
* [[Rectal prolapse]]
* [[Rectal prolapse]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Hamartomatous intestinal polyposis|Multiple polyps]]  
* [[Hamartomatous intestinal polyposis|Multiple polyps]]  
* [[mucocutaneous]] [[pigmentation]]
* [[Mucocutaneous]] [[pigmentation]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Polyps|Multiple polyps]]
*[[Polyps|Multiple polyps]]
*[[Intussusception]]
*[[Intussusception]]
*[[Bowel obstruction]]
*[[Bowel obstruction]]
| style="background: #F5F5F5; padding: 5px;" |'''Barium enema'''
* Multiple [[Polyp|polyps]]
'''MRI'''
* Multiple [[Hamartoma|hamartomatous]] [[Polyp|polyps]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Barium enema]]
* [[Hamartoma|Hamartomatous]] [[Polyps|mucosal polyps]] with core of [[smooth muscle]] associated with [[Mucous membrane|mucosa]]
** Multiple [[Polyp|polyps]].
* Smaller [[Polyp|polyps]] lack the prominent arborizing [[smooth muscle]]
* [[MRI]]
** Multiple [[Hamartoma|hamartomatous]] polyps
| style="background: #F5F5F5; padding: 5px;" |
* [[Hamartoma|Hamartomatous]] [[Polyps|mucosal polyps]] with central core of branching smooth muscle associated with mucosa
* Smaller [[Polyp|polyps]] may lack the prominent arborizing smooth muscle
| style="background: #F5F5F5; padding: 5px;" |[[Genetic testing]] for [[STK11]] and [[colonoscopy]]
| style="background: #F5F5F5; padding: 5px;" |[[Genetic testing]] for [[STK11]] and [[colonoscopy]]
|-
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Carcinoid|Carcinoids]]<br><ref name="pmid20011309">{{cite journal |vauthors=Chung TP, Hunt SR |title=Carcinoid and neuroendocrine tumors of the colon and rectum |journal=Clin Colon Rectal Surg |volume=19 |issue=2 |pages=45–8 |date=May 2006 |pmid=20011309 |pmc=2780103 |doi=10.1055/s-2006-942343 |url=}}</ref><ref name="diagnostics">Diagnostics: Biochemical Markers, Imaging, and Approach. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq</ref><ref name="pmid22525418">{{cite journal |vauthors=Rindi G, Falconi M, Klersy C, Albarello L, Boninsegna L, Buchler MW, Capella C, Caplin M, Couvelard A, Doglioni C, Delle Fave G, Fischer L, Fusai G, de Herder WW, Jann H, Komminoth P, de Krijger RR, La Rosa S, Luong TV, Pape U, Perren A, Ruszniewski P, Scarpa A, Schmitt A, Solcia E, Wiedenmann B |title=TNM staging of neoplasms of the endocrine pancreas: results from a large international cohort study |journal=J. Natl. Cancer Inst. |volume=104 |issue=10 |pages=764–77 |date=May 2012 |pmid=22525418 |doi=10.1093/jnci/djs208 |url=}}</ref><ref name="pmid28637502">{{cite journal |vauthors=Fang C, Wang W, Zhang Y, Feng X, Sun J, Zeng Y, Chen Y, Li Y, Chen M, Zhou Z, Chen J |title=Clinicopathologic characteristics and prognosis of gastroenteropancreatic neuroendocrine neoplasms: a multicenter study in South China |journal=Chin J Cancer |volume=36 |issue=1 |pages=51 |date=June 2017 |pmid=28637502 |pmc=5480192 |doi=10.1186/s40880-017-0218-3 |url=}}</ref><ref name="symptoms">Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Carcinoid|Carcinoids]]<br><ref name="pmid20011309">{{cite journal |vauthors=Chung TP, Hunt SR |title=Carcinoid and neuroendocrine tumors of the colon and rectum |journal=Clin Colon Rectal Surg |volume=19 |issue=2 |pages=45–8 |date=May 2006 |pmid=20011309 |pmc=2780103 |doi=10.1055/s-2006-942343 |url=}}</ref><ref name="diagnostics">Diagnostics: Biochemical Markers, Imaging, and Approach. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq</ref><ref name="pmid22525418">{{cite journal |vauthors=Rindi G, Falconi M, Klersy C, Albarello L, Boninsegna L, Buchler MW, Capella C, Caplin M, Couvelard A, Doglioni C, Delle Fave G, Fischer L, Fusai G, de Herder WW, Jann H, Komminoth P, de Krijger RR, La Rosa S, Luong TV, Pape U, Perren A, Ruszniewski P, Scarpa A, Schmitt A, Solcia E, Wiedenmann B |title=TNM staging of neoplasms of the endocrine pancreas: results from a large international cohort study |journal=J. Natl. Cancer Inst. |volume=104 |issue=10 |pages=764–77 |date=May 2012 |pmid=22525418 |doi=10.1093/jnci/djs208 |url=}}</ref><ref name="pmid28637502">{{cite journal |vauthors=Fang C, Wang W, Zhang Y, Feng X, Sun J, Zeng Y, Chen Y, Li Y, Chen M, Zhou Z, Chen J |title=Clinicopathologic characteristics and prognosis of gastroenteropancreatic neuroendocrine neoplasms: a multicenter study in South China |journal=Chin J Cancer |volume=36 |issue=1 |pages=51 |date=June 2017 |pmid=28637502 |pmc=5480192 |doi=10.1186/s40880-017-0218-3 |url=}}</ref><ref name="symptoms">Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |↑
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Diarrhea]]
*[[Weight gain|Weight loss]]
| style="background: #F5F5F5; padding: 5px;" | +/-
*[[Weakness]]
| style="background: #F5F5F5; padding: 5px;" |
* Abdominal pain
| style="background: #F5F5F5; padding: 5px;" |
*[[Flushing (physiology)|Flushing]]
*[[Flushing (physiology)|Flushing]]
*[[Wheezing]]
*[[Wheezing]]
*[[Shortness of breath]]
*[[Shortness of breath]]
*[[Palpitations]]
*[[Palpitations]]
*[[Weight gain]]
*[[Hirsutism]]
*[[Weakness]]
*[[Leg edema]]
*[[Leg edema]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Infiltrating, ulcerating or fungating lesions in the wall of colon
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Well-defined single or multiple lesions
* [[Infiltration (medical)|Infiltrating]], [[Ulceration|ulcerating]] or fungating lesions in the [[Colon (anatomy)|wall of colon]]
* Round or ovoid in shape
* Variable in size ranges between 2-5 cm
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[PET scan]] (11C-5-hydroxytryptophan, 11C-5-HTP)
* Well-defined single/multiple lesions
** Detects metastasis
* Round/ovoid in shape
* [[MRI]]
* Variable in size between 2-5 cm
** Nodular mass originating from the bowel wall or regional uniform bowel wall thickening with moderate intense enhancement on post gadolinium T1-weighted fat-suppressed images
| style="background: #F5F5F5; padding: 5px;" |'''PET scan''' (11C-5-hydroxytryptophan, 11C-5-HTP)
** Mesenteric metastases presents as nodular masses with [[mesenteric]] stranding
* Detects [[metastasis]]
** [[Liver]] metastases may show hypointense precontrast T1- and hyperintense T2-weighted images
'''MRI'''
** [[Liver]] metastases are commonly hypervascular
* Nodular mass  
* Ki-67 index
* Wall thickening
* [[Metastasis]]
'''Ki-67 index'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Solid or spongy nests of cells accentuated by neatly outlined luminal spaces  
* Solid/spongy nests of cells accentuated by neatly outlined luminal spaces  


* Peripheral nuclear palisading  
* Peripheral nuclear palisading  
* Granular eosinophilic cytoplasm.
* [[Granule cell|Granular]] [[eosinophilic]] [[cytoplasm]]
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]] and [[Histopathology|histopathological analysis]]
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]] and [[Histopathology|histopathological analysis]]
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bowel frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenesmus
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Colonoscopy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other diagnostic study
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Juvenile polyposis syndrome|Juvenile Polyposis Coli]]<ref name="pmid7054044">{{cite journal |vauthors=Grotsky HW, Rickert RR, Smith WD, Newsome JF |title=Familial juvenile polyposis coli. A clinical and pathologic study of a large kindred |journal=Gastroenterology |volume=82 |issue=3 |pages=494–501 |date=March 1982 |pmid=7054044 |doi= |url=}}</ref><ref name="pmid22171123">{{cite journal |vauthors=Brosens LA, Langeveld D, van Hattem WA, Giardiello FM, Offerhaus GJ |title=Juvenile polyposis syndrome |journal=World J. Gastroenterol. |volume=17 |issue=44 |pages=4839–44 |date=November 2011 |pmid=22171123 |pmc=3235625 |doi=10.3748/wjg.v17.i44.4839 |url=}}</ref><ref name="pmid22965402">{{cite journal |vauthors=Latchford AR, Neale K, Phillips RK, Clark SK |title=Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome |journal=Dis. Colon Rectum |volume=55 |issue=10 |pages=1038–43 |date=October 2012 |pmid=22965402 |doi=10.1097/DCR.0b013e31826278b3 |url=}}</ref><ref name="pmid229654023">{{cite journal |vauthors=Latchford AR, Neale K, Phillips RK, Clark SK |title=Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome |journal=Dis. Colon Rectum |volume=55 |issue=10 |pages=1038–43 |date=October 2012 |pmid=22965402 |doi=10.1097/DCR.0b013e31826278b3 |url=}}</ref><ref name="pmid229654022">{{cite journal |vauthors=Latchford AR, Neale K, Phillips RK, Clark SK |title=Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome |journal=Dis. Colon Rectum |volume=55 |issue=10 |pages=1038–43 |date=October 2012 |pmid=22965402 |doi=10.1097/DCR.0b013e31826278b3 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Juvenile polyposis syndrome|Juvenile Polyposis Coli]]<ref name="pmid7054044">{{cite journal |vauthors=Grotsky HW, Rickert RR, Smith WD, Newsome JF |title=Familial juvenile polyposis coli. A clinical and pathologic study of a large kindred |journal=Gastroenterology |volume=82 |issue=3 |pages=494–501 |date=March 1982 |pmid=7054044 |doi= |url=}}</ref><ref name="pmid22171123">{{cite journal |vauthors=Brosens LA, Langeveld D, van Hattem WA, Giardiello FM, Offerhaus GJ |title=Juvenile polyposis syndrome |journal=World J. Gastroenterol. |volume=17 |issue=44 |pages=4839–44 |date=November 2011 |pmid=22171123 |pmc=3235625 |doi=10.3748/wjg.v17.i44.4839 |url=}}</ref><ref name="pmid22965402">{{cite journal |vauthors=Latchford AR, Neale K, Phillips RK, Clark SK |title=Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome |journal=Dis. Colon Rectum |volume=55 |issue=10 |pages=1038–43 |date=October 2012 |pmid=22965402 |doi=10.1097/DCR.0b013e31826278b3 |url=}}</ref><ref name="pmid229654023">{{cite journal |vauthors=Latchford AR, Neale K, Phillips RK, Clark SK |title=Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome |journal=Dis. Colon Rectum |volume=55 |issue=10 |pages=1038–43 |date=October 2012 |pmid=22965402 |doi=10.1097/DCR.0b013e31826278b3 |url=}}</ref><ref name="pmid229654022">{{cite journal |vauthors=Latchford AR, Neale K, Phillips RK, Clark SK |title=Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome |journal=Dis. Colon Rectum |volume=55 |issue=10 |pages=1038–43 |date=October 2012 |pmid=22965402 |doi=10.1097/DCR.0b013e31826278b3 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* [[Diarrhea]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
* Diffuse abdominal pain
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Prolapsing [[polyp]]
* Prolapsing [[polyp]]
Line 173: Line 172:
* [[Hypotonia]]
* [[Hypotonia]]
* [[Intestinal obstruction|Bowel obstruction]]
* [[Intestinal obstruction|Bowel obstruction]]
* Heart or brain abnormalities
* [[Heart]] or [[brain]] abnormalities
* Cleft palate
* [[Cleft lip and palate|Cleft palate]]
* Polydactyly
* [[Polydactyly]]
* Abnormalities of the genitalia or urinary tract.
* Genitalia or urinary abnormalities
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* >5 juvenile [[Polyp|polyps]] in the [[colon]] and [[rectum]]
* >5 juvenile [[Polyp|polyps]] in the [[colon]] and [[rectum]]
* Multiple [[Polyps|juvenile polyps]] in [[gastrointestinal tract]]
* Multiple [[Polyps|juvenile polyps]] in [[gastrointestinal tract]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* M[[Polyps|ultiple polyps]] in [[gastrointestinal tract]]
* [[Polyp|Multiple polyps]] in [[gastrointestinal tract|GI tract]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''Barium study'''
* Barium study
* Multiple polyps in [[Gastrointestinal tract|GI tract]]
** Multiple polyps in GI tract
'''Stool DNA test'''
* Stool DNA test
* ''[[SMAD4]]'' or ''[[BMPR1A]]''
** ''SMAD4'' or ''BMPR1A''
'''Diagnose if any of the following positive:'''
* Diagnose if any of the following positive:
* More than five juvenile [[Polyp|polyps]] of the colorectum
** More than five juvenile polyps of the colorectum
* Multiple juvenile [[Polyp|polyps]] throughout the [[Gastrointestinal tract|GI tract]]
** Multiple juvenile polyps throughout the GI tract
* Any number of juvenile [[Polyp|polyps]] and a family history of juvenile [[polyposis]]
** Any number of juvenile polyps and a family history of juvenile polyposis
* [[Heterozygous]] pathogenic variant in ''[[Mothers against decapentaplegic homolog 4|SMAD4]]'' or ''[[BMPR1A]]''
** Heterozygous pathogenic variant in ''SMAD4'' or ''BMPR1A''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Numerous cystic and dilated crypts or glands with inspissated mucin and intraluminal neutrophils
* [[Cyst|Cystic]] and dilated [[Crypt (anatomy)|crypts]] or [[Gland|glands]] with inspissated [[mucin]] and [[Lumen (anatomy)|intraluminal]] [[Neutrophil|neutrophils]]
* Lamina propria edematous with associated lymphocytes, plasma cells, eosinophils and neutrophils
* [[Lamina propria]] [[Edema|edematous]] with associated [[Lymphocyte|lymphocytes]], [[Plasma cell|plasma cells]], [[Eosinophil granulocyte|eosinophils]], and [[Neutrophil|neutrophils]]
* Filiform, multilobated forms with increased glandular-to-stroma ratio in nonclassic or atypical polyps
* [[Filiform papilla|Filiform]], multilobed forms with increased [[Glandular tissue|glandular]]-to-[[Stroma (animal tissue)|stroma]] ratio in nonclassic or [[Polyps|atypical polyps]]
* Areas of conventional dysplasia
* Areas of conventional [[dysplasia]]
| style="background: #F5F5F5; padding: 5px;" |Diagnostic criteria on the basis of history, colonoscopy, and genetics
| style="background: #F5F5F5; padding: 5px;" |Diagnostic criteria fulfilment
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Gastrointestinal stromal tumor|Gastrointestinal Stromal Tumors (GIST)]]<ref name="pmid24778074">{{cite journal |vauthors=Niazi AK, Kaley K, Saif MW |title=Gastrointestinal stromal tumor of colon: a case report and review of literature |journal=Anticancer Res. |volume=34 |issue=5 |pages=2547–50 |date=May 2014 |pmid=24778074 |doi= |url=}}</ref><ref name="pmid247780742">{{cite journal |vauthors=Niazi AK, Kaley K, Saif MW |title=Gastrointestinal stromal tumor of colon: a case report and review of literature |journal=Anticancer Res. |volume=34 |issue=5 |pages=2547–50 |date=May 2014 |pmid=24778074 |doi= |url=}}</ref><ref name="pmid15223958">{{cite journal |vauthors=Medeiros F, Corless CL, Duensing A, Hornick JL, Oliveira AM, Heinrich MC, Fletcher JA, Fletcher CD |title=KIT-negative gastrointestinal stromal tumors: proof of concept and therapeutic implications |journal=Am. J. Surg. Pathol. |volume=28 |issue=7 |pages=889–94 |date=July 2004 |pmid=15223958 |doi= |url=}}</ref><ref name="pmid16222452">{{cite journal |vauthors=Kamiyama Y, Aihara R, Nakabayashi T, Mochiki E, Asao T, Kuwano H, Oriuchi N, Endo K |title=18F-fluorodeoxyglucose positron emission tomography: useful technique for predicting malignant potential of gastrointestinal stromal tumors |journal=World J Surg |volume=29 |issue=11 |pages=1429–35 |date=November 2005 |pmid=16222452 |doi=10.1007/s00268-005-0045-6 |url=}}</ref><ref name="pmid15613856">{{cite journal |vauthors=Miettinen M, Sobin LH, Lasota J |title=Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up |journal=Am. J. Surg. Pathol. |volume=29 |issue=1 |pages=52–68 |date=January 2005 |pmid=15613856 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Gastrointestinal stromal tumor|Gastrointestinal Stromal Tumors (GIST)]]<ref name="pmid24778074">{{cite journal |vauthors=Niazi AK, Kaley K, Saif MW |title=Gastrointestinal stromal tumor of colon: a case report and review of literature |journal=Anticancer Res. |volume=34 |issue=5 |pages=2547–50 |date=May 2014 |pmid=24778074 |doi= |url=}}</ref><ref name="pmid247780742">{{cite journal |vauthors=Niazi AK, Kaley K, Saif MW |title=Gastrointestinal stromal tumor of colon: a case report and review of literature |journal=Anticancer Res. |volume=34 |issue=5 |pages=2547–50 |date=May 2014 |pmid=24778074 |doi= |url=}}</ref><ref name="pmid15223958">{{cite journal |vauthors=Medeiros F, Corless CL, Duensing A, Hornick JL, Oliveira AM, Heinrich MC, Fletcher JA, Fletcher CD |title=KIT-negative gastrointestinal stromal tumors: proof of concept and therapeutic implications |journal=Am. J. Surg. Pathol. |volume=28 |issue=7 |pages=889–94 |date=July 2004 |pmid=15223958 |doi= |url=}}</ref><ref name="pmid16222452">{{cite journal |vauthors=Kamiyama Y, Aihara R, Nakabayashi T, Mochiki E, Asao T, Kuwano H, Oriuchi N, Endo K |title=18F-fluorodeoxyglucose positron emission tomography: useful technique for predicting malignant potential of gastrointestinal stromal tumors |journal=World J Surg |volume=29 |issue=11 |pages=1429–35 |date=November 2005 |pmid=16222452 |doi=10.1007/s00268-005-0045-6 |url=}}</ref><ref name="pmid15613856">{{cite journal |vauthors=Miettinen M, Sobin LH, Lasota J |title=Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up |journal=Am. J. Surg. Pathol. |volume=29 |issue=1 |pages=52–68 |date=January 2005 |pmid=15613856 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Normal
* [[Asymptomatic]]
| style="background: #F5F5F5; padding: 5px;" | +/-
* [[Satiety|Early satiety]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Bloating]]
* No pain
| style="background: #F5F5F5; padding: 5px;" |
* Mostly [[asymptomatic]]
* Are discovered incidentally
* Non-specific symptoms
* Early satiety and bloating
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 217: Line 213:
* Normal overlying [[mucosa]] may be intact or [[Ulcerated lesion|ulcerated]]
* Normal overlying [[mucosa]] may be intact or [[Ulcerated lesion|ulcerated]]
* Bulging into [[Gastrointestinal tract|gastrointestinal]] [[lumen]]
* Bulging into [[Gastrointestinal tract|gastrointestinal]] [[lumen]]
| style="background: #F5F5F5; padding: 5px;" |[[Benign]]
* Small, < 10 cms
* [[Homogeneous]]
* Clear boundaries
* [[intraluminal]] or extraluminal growth
[[Malignant]] [[Gastrointestinal stromal tumor|GIST]] with [[metastasis]]:
* Size > 10 cm
* [[Calcification|Calcifications]]
* Irregular margins
* [[Heterogeneous]] and lobulated
* [[Lymphadenopathy]]
* [[Ulceration]]
* Extraluminal and [[mesenteric]] fat infiltration
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Small GIST (< 5 cms) are [[homogeneous]] with clear boundaries and have an [[intraluminal]] pattern of growth.
'''Endoscopic ultrasonography'''
* Intermediate GIST (size of 5-10 cms) are [[heterogeneous]] with irregular borders and [[Intraluminal|intra]] or extra-luminal pattern of [[growth]].
 
* Large GISTs (>10 cms) are [[heterogeneous]] with irregular borders and have local or distant spread
[[Benign]]:
* Malignant GIST with metastasis:
* [[Mucosal]] [[ulceration]] or [[bleeding]]
** Size greater than 10 cm
* Smooth [[submucosal]] mass as [[hypoechoic mass]]
** [[Calcification|Calcifications]]
[[Malignant]] [[Gastrointestinal stromal tumor|GIST]]:
** Irregular margins
* [[Heterogeneous]] mass >4 cm in size
** [[Heterogeneous]] and lobulated
* Irregular borders
** [[Lymphadenopathy]]
* [[Intraluminal|Intra]]/extraluminal growth
** [[Ulceration]]
* Multiple [[cysts]]
** Extraluminal and [[mesenteric]] fat infiltration
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[MRI]]
*[[Spindle cells|Spindle cell]] type are [[eosinophilic]] cells arranged in the form of whorls or fascicles<ref name="pmid12075401">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref><ref name="pmid120754012">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref>
** [[Hemorrhage]], [[necrosis]], surrounding structures and [[metastasis]].
*[[Epithelioid]] [[GIST|GISTs]] are rounded cells with oval nuclei and vesicular [[chromatin]] and appears nested
* [[Endoscopic ultrasound|Endoscopic]] [[ultrasonography]]:
*On [[immunohistochemical staining]] they are positive for [[Molecular marker|molecular markers]] [[CD117]] antigen and KIT protein
** [[Mucosal]] [[ulceration]] or [[bleeding]]
| style="background: #F5F5F5; padding: 5px;" |[[Endoscopic ultrasound]]
** Smooth [[submucosal]] mass as hypoechoic mass
[[biopsy]] and [[Histopathological|histopathological analysis]]
** [[Malignant]] GIST lesions present with:
*** [[Heterogeneous]] mass >4 cm in size
*** Irregular borders
*** [[Intraluminal|Intra]] and extraluminal growth
*** Multiple [[cysts]] within the main [[lesion]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Spindle cells|Spindle cell]] type are [[eosinophilic]] cells arranged in the form of whorls or fascicles.<ref name="pmid12075401">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref><ref name="pmid120754012">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref>
*[[Epithelioid]] [[GIST|GISTs]] are rounded cells with oval nuclei and vesicular chromatin and appears nested
*On [[immunohistochemical staining]] they are positive for [[Molecular marker|molecular markers]] [[CD117]] antigen and KIT protein.
| style="background: #F5F5F5; padding: 5px;" |Endoscopic ultrasound with [[biopsy]] and [[Histopathological|histopathological analysis]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hamartoma]]<ref name="pmid26672891">{{cite journal |vauthors=Cauchin E, Touchefeu Y, Matysiak-Budnik T |title=Hamartomatous Tumors in the Gastrointestinal Tract |journal=Gastrointest Tumors |volume=2 |issue=2 |pages=65–74 |date=September 2015 |pmid=26672891 |pmc=4668787 |doi=10.1159/000437175 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hamartoma]]<ref name="pmid26672891">{{cite journal |vauthors=Cauchin E, Touchefeu Y, Matysiak-Budnik T |title=Hamartomatous Tumors in the Gastrointestinal Tract |journal=Gastrointest Tumors |volume=2 |issue=2 |pages=65–74 |date=September 2015 |pmid=26672891 |pmc=4668787 |doi=10.1159/000437175 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Diarrhea|↑]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Diarrhea]]
* N/A
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Depending on location
| style="background: #F5F5F5; padding: 5px;" |
* [[Tenesmus]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Large polypoid mass
* Large polypoid mass
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Isodense or hypodense solid [[Mass|masses]]
* Isodense/hypodense solid [[Mass|masses]]
* [[Heterogeneous]] mass
* [[Heterogeneous]] mass
* Presence of [[fat]] in a well circumscribed nodule
* Presence of [[fat]]
* [[Calcification]]
* [[Calcification]]
| style="background: #F5F5F5; padding: 5px;" |'''Biopsy'''
* Proliferation of bland [[spindle cells]] in the [[lamina propria]]
* Mucosal [[Schwann cell tumor|Schwann cell hamartoma]] (MSCH)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Biopsy
* Poorly circumscribed, short fascicles of uniform [[spindle cells]] replacing the [[Colon (anatomy)|colonic]] [[lamina propria]], separating and entrapping the [[Crypt (anatomy)|crypts]]
** Proliferation of bland spindle cells in the lamina propria (mucosal Schwann cell hamartoma (MSCH))
* The [[Cell nucleus|nuclei]] are bland and mostly uniform, occasional larger [[Cell nucleus|nuclei]] are found. The [[Cytoplasm|cytoplasmic]] borders are indistinct
| style="background: #F5F5F5; padding: 5px;" |
* Involvement of [[Mucous membrane|mucosa]] but never the [[submucosa]]
* poorly circumscribed, short fascicles of uniform spindle cells replacing the colonic lamina propria, separating and entrapping the crypts
* The nuclei are bland and mostly uniform, occasional larger nuclei are found. The cytoplasmic borders are indistinct
* Involvement of mucosa but never the submucosa
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bowel frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenesmus
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Colonoscopy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other diagnostic study
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[MALT lymphoma|Colorectal Lymphoma]]<ref name="pmid20011310">{{cite journal |vauthors=Quayle FJ, Lowney JK |title=Colorectal lymphoma |journal=Clin Colon Rectal Surg |volume=19 |issue=2 |pages=49–53 |date=May 2006 |pmid=20011310 |pmc=2780105 |doi=10.1055/s-2006-942344 |url=}}</ref><ref name="QuayleLowney2006">{{cite journal|last1=Quayle|first1=Frank|last2=Lowney|first2=Jennifer|title=Colorectal Lymphoma|journal=Clinics in Colon and Rectal Surgery|volume=19|issue=2|year=2006|pages=049–053|issn=1531-0043|doi=10.1055/s-2006-942344}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[MALT lymphoma|Colorectal Lymphoma]]<ref name="pmid20011310">{{cite journal |vauthors=Quayle FJ, Lowney JK |title=Colorectal lymphoma |journal=Clin Colon Rectal Surg |volume=19 |issue=2 |pages=49–53 |date=May 2006 |pmid=20011310 |pmc=2780105 |doi=10.1055/s-2006-942344 |url=}}</ref><ref name="QuayleLowney2006">{{cite journal|last1=Quayle|first1=Frank|last2=Lowney|first2=Jennifer|title=Colorectal Lymphoma|journal=Clinics in Colon and Rectal Surgery|volume=19|issue=2|year=2006|pages=049–053|issn=1531-0043|doi=10.1055/s-2006-942344}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" text-align: center;" | -
* Normal
| style="background: #F5F5F5; padding: 5px;" text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" text-align: center;" | -
* Depending on location
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Weight loss
* Weight loss
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Polypoid or ulcerated mass, intramural lesion, aphthous ulcer, stricture, extraluminal mass, or diffuse, multiple polypoid lesions
* Polypoid or ulcerated mass, intramural lesion, aphthous ulcer, stricture, extraluminal mass, or diffuse, multiple polypoid lesions
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* CT scan: polypoid mass, circumferential-cavitary lesions, focal mucosal nodularity, diffuse ulcerative or nodular lesions, regional lymph node involvement
* Polypoid mass
| style="background: #F5F5F5; padding: 5px;" |
* Circumferential-[[Cavity|cavitary lesions]]
* Biopsy:
* Focal mucosal nodularity
** [[Diffuse large B cell lymphoma|Diffuse large B-cell lymphoma]]
* Diffuse [[Ulcer|ulcerative]] or [[Nodule (medicine)|nodular]] lesions
** [[MALT lymphoma|Extranodal marginal zone lymphoma (MALT)]]
* [[Lymphadenopathy]]
** [[Mantle cell lymphoma]]
| style="background: #F5F5F5; padding: 5px;" |'''Double-contrast enema'''
** [[Burkitt's lymphoma|Burkitt’s lymphoma]]
* Subtle [[Mucous membrane|mucosal]] changes
** [[Follicular lymphoma]]
* Gross [[tumor]] morphology
* Double-contrast enema: Subtle mucosal changes, gross tumor morphology
'''Biopsy'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Diffuse large B cell lymphoma|Diffuse large B-cell lymphoma]]:  
* [[Diffuse large B cell lymphoma|Diffuse large B-cell lymphoma]]:  
Line 302: Line 311:
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Kaposi's sarcoma]]<ref name="pmid20827371">{{cite journal |vauthors=Arora M, Goldberg EM |title=Kaposi sarcoma involving the gastrointestinal tract |journal=Gastroenterol Hepatol (N Y) |volume=6 |issue=7 |pages=459–62 |date=July 2010 |pmid=20827371 |pmc=2933764 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Kaposi's sarcoma]]<ref name="pmid20827371">{{cite journal |vauthors=Arora M, Goldberg EM |title=Kaposi sarcoma involving the gastrointestinal tract |journal=Gastroenterol Hepatol (N Y) |volume=6 |issue=7 |pages=459–62 |date=July 2010 |pmid=20827371 |pmc=2933764 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Diarrhea|↑]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Diarrhea]]
* [[Nausea and vomiting]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Diffuse abdominal pain
* Localized [[Purpura|purpuric]] lesion
| style="background: #F5F5F5; padding: 5px;" |
* [[Melena]]
 
* [[Hematochezia]]
* [[Abdominal pain]]
* [[Nausea and vomiting|N/V]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Localized purpuric lesion
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''Serology'''
* Electrophoresis
* [[Antibodies]] against [[Kaposi's sarcoma|Kaposi sarcoma]] [[Kaposi's sarcoma-associated herpesvirus|herpes virus  (HHV-8)]]
** [[Antibodies]] against Kaposi sarcoma herpes virus  (HHV-8)
'''Biopsy'''
* Biopsy
** [[Vascular]] proliferation, red blood cell and [[hemosiderin]] extravasation,[[Lymphocyte|lymphocytes]] and [[Monocyte|monocytes]], neovascular lesion wrapped around a pre-existing space, intracytoplasmic PAS +ve [[hyaline]] globules
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Vascular]] proliferation
* [[Vascular]] proliferation
* Red blood cell and [[hemosiderin]] extravasation
* [[Red blood cell|RBC]] and [[hemosiderin]] extravasation
* [[Lymphocyte|Lymphocytes]] and [[Monocyte|monocytes]]
* [[Lymphocyte|Lymphocytes]] and [[Monocyte|monocytes]]
* Premonitory sign (a neovascular lesion wrapped around a pre-existing space)
* [[Premonitory sign]] [[Neovascularization|(neovascular]] lesion wrapped around a pre-existing space)
* Intracytoplasmic PAS +ve [[hyaline]] globules
* Intracytoplasmic [[Periodic acid-Schiff stain|PAS +ve]] [[hyaline]] globules
| style="background: #F5F5F5; padding: 5px;" |Biopsy
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Arteriovenous malformation]]<ref name="pmid28139503">{{cite journal |vauthors=Lee HH, Kwon HM, Gil S, Kim YS, Cho M, Seo KJ, Chae HS, Cho YS |title=Endoscopic resection of asymptomatic, colonic, polypoid arteriovenous malformations: Two case reports and a literature review |journal=Saudi J Gastroenterol |volume=23 |issue=1 |pages=67–70 |date=2017 |pmid=28139503 |pmc=5329980 |doi=10.4103/1319-3767.199111 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Arteriovenous malformation]]<ref name="pmid28139503">{{cite journal |vauthors=Lee HH, Kwon HM, Gil S, Kim YS, Cho M, Seo KJ, Chae HS, Cho YS |title=Endoscopic resection of asymptomatic, colonic, polypoid arteriovenous malformations: Two case reports and a literature review |journal=Saudi J Gastroenterol |volume=23 |issue=1 |pages=67–70 |date=2017 |pmid=28139503 |pmc=5329980 |doi=10.4103/1319-3767.199111 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
* Normal
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
* No pain
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Bright red, flat lesions
* Bright red, flat lesions
Line 348: Line 349:
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Aberrant vessels with thickened, hypertrophic walls in the mucosa and the submucosa.
* Aberrant [[Blood vessel|vessels]] with thickened, hypertrophic walls in the [[Mucous membrane|mucosa]] and the [[submucosa]]
* Arteries directly connected to veins without capillary beds
* [[Artery|Arteries]] directly connected to [[Vein|veins]] without [[capillary beds]]
| style="background: #F5F5F5; padding: 5px;" |Accidental finding
| style="background: #F5F5F5; padding: 5px;" |Accidental finding
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bowel frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenesmus
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Colonoscopy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other diagnostic study
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Diverticular disease|Diverticular diseases]]<ref name="pmid16187597">{{cite journal |vauthors=Shen SH, Chen JD, Tiu CM, Chou YH, Chiang JH, Chang CY, Lee CH |title=Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting |journal=J Chin Med Assoc |volume=68 |issue=9 |pages=411–8 |date=September 2005 |pmid=16187597 |doi=10.1016/S1726-4901(09)70156-X |url=}}</ref><ref name="ShenChen2005">{{cite journal|last1=Shen|first1=Shu-Huei|last2=Chen|first2=Jen-Dar|last3=Tiu|first3=Chui-Mei|last4=Chou|first4=Yi-Hong|last5=Chiang|first5=Jen-Huei|last6=Chang|first6=Cheng-Yen|last7=Lee|first7=Chen-Hsen|title=Differentiating Colonic Diverticulitis from Colon Cancer: The Value of Computed Tomography in the Emergency Setting|journal=Journal of the Chinese Medical Association|volume=68|issue=9|year=2005|pages=411–418|issn=17264901|doi=10.1016/S1726-4901(09)70156-X}}</ref><ref name="SheimanLevine20082">{{cite journal|last1=Sheiman|first1=Laura|last2=Levine|first2=Marc S.|last3=Levin|first3=Alicia A.|last4=Hogan|first4=Jonathan|last5=Rubesin|first5=Stephen E.|last6=Furth|first6=Emma E.|last7=Laufer|first7=Igor|title=Chronic Diverticulitis: Clinical, Radiographic, and Pathologic Findings|journal=American Journal of Roentgenology|volume=191|issue=2|year=2008|pages=522–528|issn=0361-803X|doi=10.2214/AJR.07.3597}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Diverticular disease|Diverticular diseases]]<ref name="pmid16187597">{{cite journal |vauthors=Shen SH, Chen JD, Tiu CM, Chou YH, Chiang JH, Chang CY, Lee CH |title=Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting |journal=J Chin Med Assoc |volume=68 |issue=9 |pages=411–8 |date=September 2005 |pmid=16187597 |doi=10.1016/S1726-4901(09)70156-X |url=}}</ref><ref name="ShenChen2005">{{cite journal|last1=Shen|first1=Shu-Huei|last2=Chen|first2=Jen-Dar|last3=Tiu|first3=Chui-Mei|last4=Chou|first4=Yi-Hong|last5=Chiang|first5=Jen-Huei|last6=Chang|first6=Cheng-Yen|last7=Lee|first7=Chen-Hsen|title=Differentiating Colonic Diverticulitis from Colon Cancer: The Value of Computed Tomography in the Emergency Setting|journal=Journal of the Chinese Medical Association|volume=68|issue=9|year=2005|pages=411–418|issn=17264901|doi=10.1016/S1726-4901(09)70156-X}}</ref><ref name="SheimanLevine20082">{{cite journal|last1=Sheiman|first1=Laura|last2=Levine|first2=Marc S.|last3=Levin|first3=Alicia A.|last4=Hogan|first4=Jonathan|last5=Rubesin|first5=Stephen E.|last6=Furth|first6=Emma E.|last7=Laufer|first7=Igor|title=Chronic Diverticulitis: Clinical, Radiographic, and Pathologic Findings|journal=American Journal of Roentgenology|volume=191|issue=2|year=2008|pages=522–528|issn=0361-803X|doi=10.2214/AJR.07.3597}}</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |↑ or ↓
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
RLQ
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Constipation]]  
* [[Fever]]
and/or
* [[Rigor|Chills]]
* [[Diarrhea]]
* [[Nausea and vomiting|N/V]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Pain in RLQ
| style="background: #F5F5F5; padding: 5px;" |
* [[Fever]], [[Rigor|chills]]
* [[Nausea and vomiting|Nausea/vomiting(N/V)]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Not recommended  
* Not recommended  
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Outpouchings of the colonic wall (Diverticula)
* Outpouchings of the [[Colon (anatomy)|colonic wall]] [[Diverticular|(diverticula)]]
* Inflamed diverticula
* [[Diverticulitis|Inflamed diverticula]]
* Abscess formation
* [[Abscess|Abscess formation]]
* Intraperitoneal free air (microperforation)
* Intraperitoneal free air (microperforation)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''Barium enema'''
* Barium enema: Circumferential narrowing, spiculated contour and tapered margins  
* Circumferential narrowing
* Spiculated contour
* Tapered margins
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |CT scan
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhoids]]<ref name="JacobsSolomon2014">{{cite journal|last1=Jacobs|first1=Danny|last2=Solomon|first2=Caren G.|title=Hemorrhoids|journal=New England Journal of Medicine|volume=371|issue=10|year=2014|pages=944–951|issn=0028-4793|doi=10.1056/NEJMcp1204188}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhoids]]<ref name="JacobsSolomon2014">{{cite journal|last1=Jacobs|first1=Danny|last2=Solomon|first2=Caren G.|title=Hemorrhoids|journal=New England Journal of Medicine|volume=371|issue=10|year=2014|pages=944–951|issn=0028-4793|doi=10.1056/NEJMcp1204188}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Constipation|↓]]
* [[Constipation]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
* Localized  pain
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Perianal Itching
* Perianal Itching
* Pain with [[defecation]]  
* Pain with [[defecation]]  
* Painful, hard lump in anus
* Painful-hard lump in anus
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Anoscopy]]
* [[Anoscopy]]: Protruding mass from the [[anus]]
* Protruding mass from the [[anus]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''DRE'''
* [[Digital rectal examination|DRE]]
* [[Palpation|Palpable]] mass, tender if [[Thrombosis|thrombosed]]
** Palpable mass, tender if [[Thrombosis|thrombosed]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
Line 400: Line 413:
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Anal fissure]]<ref name="pmid27041801">{{cite journal |vauthors=Schlichtemeier S, Engel A |title=Anal fissure |journal=Aust Prescr |volume=39 |issue=1 |pages=14–7 |year=2016 |pmid=27041801 |pmc=4816871 |doi=10.18773/austprescr.2016.007 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Anal fissure]]<ref name="pmid27041801">{{cite journal |vauthors=Schlichtemeier S, Engel A |title=Anal fissure |journal=Aust Prescr |volume=39 |issue=1 |pages=14–7 |year=2016 |pmid=27041801 |pmc=4816871 |doi=10.18773/austprescr.2016.007 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Normal
* [[Dyschezia|Painful defecation]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Localized pain
| style="background: #F5F5F5; padding: 5px;" |
* Painful [[defecation]]
* [[Itching]]
* [[Itching]]
* [[Irritation]]
* [[Irritation]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Anoscopy]]
* [[Anoscopy]]: Anal wall laceration
* Anal wall laceration
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
Line 419: Line 431:
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |Clinical
| style="background: #F5F5F5; padding: 5px;" |Clinical
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bowel frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenesmus
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Colonoscopy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other diagnostic study
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Infectious colitis]]<ref name="pmid22080825">{{cite journal |vauthors=DuPont HL |title=Approach to the patient with infectious colitis |journal=Curr. Opin. Gastroenterol. |volume=28 |issue=1 |pages=39–46 |date=January 2012 |pmid=22080825 |doi=10.1097/MOG.0b013e32834d3208 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Infectious colitis]]<ref name="pmid22080825">{{cite journal |vauthors=DuPont HL |title=Approach to the patient with infectious colitis |journal=Curr. Opin. Gastroenterol. |volume=28 |issue=1 |pages=39–46 |date=January 2012 |pmid=22080825 |doi=10.1097/MOG.0b013e32834d3208 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Diarrhea|↑]]
* [[Diarrhea]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
* Diffuse abdominal
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Fever]], [[Rigor|chills]]
* [[Fever]], [[Rigor|chills]]
* [[Nausea and vomiting|N/V]]
* [[Nausea and vomiting|N/V]]
* [[Bloating]]
* [[Bloating]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Patchy or diffuse [[Erythematous|erythematous mucosa]]
* Patchy or diffuse [[Erythematous|erythematous mucosa]]
* Edema, [[hemorrhage]], with or without [[ulcers]] of mucosa
* [[Edema]], [[hemorrhage]], with or without [[ulcers]] of [[Mucous membrane|mucosa]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''Stool analysis'''
* [[Stool culture|Stool cultures]] in adequate [[culture media]]
* [[Leukocytosis]]
* Stool analysis
'''Stool cultures'''
** [[Leukocytosis]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |Stool culture
| style="background: #F5F5F5; padding: 5px;" |[[Stool culture]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ulcerative colitis]]<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ulcerative colitis]]<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>V
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Diarrhea|↑]]
* [[Diarrhea]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |<big>+</big>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
 
* Lain in LQ<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
[[Left lower quadrant abdominal pain resident survival guide|LLQ]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Diarrhea]] mixed with blood and [[mucus]]
* [[Weight loss|Weight loss]]
* W[[Weight loss|eight loss]]
* [[Diarrhea]] with[[mucus]]  
* Urgency
* Urgency
* [[Tenesmus]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Continuous lesions<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
* Continuous lesions
* [[Erythema]] (or redness of the [[mucosa]]) and friability of the [[mucosa]]
* [[Erythema]] (or redness of the [[mucosa]]) and friability of the [[mucosa]]
* Crypts, formation of residual mucosal tissue
* [[Crypt (anatomy)|Crypts]], formation of residual [[Mucous membrane|mucosal tissue]]
* [[Polyp (medicine)|Pseudopolyps]]
* [[Polyp (medicine)|Pseudopolyps]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 466: Line 489:
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Mucosal and submucosal inflammation<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
* [[Mucous membrane|Mucosal]] and [[Submucosa|submucosal]] [[inflammation]]
* Hemorrhage or inflammatory polymorphonuclear cells aggregate in the lamina propria
* [[Hemorrhages|Hemorrhage]] or [[Inflammation|inflammatory]] [[Neutrophil|polymorphonuclear cells]] aggregate in the [[lamina propria]]
* Distorted crypts
* Distorted [[Crypt (anatomy)|crypts]]
* Crypt abscess
* [[Crypt abscess]]
| style="background: #F5F5F5; padding: 5px;" |Endoscopy and a mucosal biopsy<ref name="pmid16902215">{{cite journal |vauthors=Collins P, Rhodes J |title=Ulcerative colitis: diagnosis and management |journal=BMJ |volume=333 |issue=7563 |pages=340–3 |date=August 2006 |pmid=16902215 |pmc=1539087 |doi=10.1136/bmj.333.7563.340 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy|Endoscopic biopsy]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Crohn's disease]]<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Crohn's disease]]<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Diarrhea|↑]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
[[Right lower quadrant abdominal pain resident survival guide|RLQ]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Diarrhea]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Lain in RQ
| style="background: #F5F5F5; padding: 5px;" |
* [[Tenesmus]]
* [[Nausea and vomiting|N/V]]
* [[Nausea and vomiting|N/V]]
* [[Bowel obstruction]]
* [[Bowel obstruction]]
* [[Fever]]
* [[Fever]]
*  
*  
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Discontinuous lesions
* Discontinuous lesions
* Strictures
* [[Strictures]]
* Linear ulcerations
* Linear [[Ulcer|ulcerations]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
Line 494: Line 517:
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Transmural pattern of inflammation
* Transmural pattern of [[inflammation]]
* Mucosal damage
* [[Mucous membrane|Mucosal]] damage
* Focal infiltration of leukocytes into the epithelium
* Focal [[Infiltration (medical)|infiltration]] of [[White blood cells|leukocytes]] into the [[epithelium]]
* Granulomas
* [[Granuloma|Granulomas]]
| style="background: #F5F5F5; padding: 5px;" |Endoscopy and a mucosal biopsy
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy|Endoscopic biopsy]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Irritable bowel syndrome]]<ref name="pmid28875974">{{cite journal |vauthors=Iwańczak B, Iwańczak F |title=[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria] |language=Polish |journal=Pol. Merkur. Lekarski |volume=43 |issue=254 |pages=75–82 |date=August 2017 |pmid=28875974 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Irritable bowel syndrome]]<ref name="pmid28875974">{{cite journal |vauthors=Iwańczak B, Iwańczak F |title=[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria] |language=Polish |journal=Pol. Merkur. Lekarski |volume=43 |issue=254 |pages=75–82 |date=August 2017 |pmid=28875974 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |↑ ↓
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Constipation]]  
* [[Weight loss]]
and/or
* Straining
* [[diarrhea]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Diffuse abdominal pain
| style="background: #F5F5F5; padding: 5px;" |
* Straining during [[defecation]]
* [[Urgency]]
* [[Urgency]]
* Sensation of incomplete evacuation
* [[Mucus]] passage
* [[Mucus]] passage
* [[Bloating]]
* [[Bloating]]
* Weight loss
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Not recommended
* Not recommended
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''Diagnosis of exclusion'''
* Diagnosis of exclusion with fulfilment of [[Irritable bowel syndrome diagnostic criteria|Rome criteria]]
* Fulfilment of [[Irritable bowel syndrome diagnostic criteria|Rome criteria]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |Clinical diagnosis  ([[Irritable bowel syndrome Diagnostic Study of Choice|Rome criteria]])
| style="background: #F5F5F5; padding: 5px;" |Clinical diagnosis  [[Irritable bowel syndrome Diagnostic Study of Choice|(Rome criteria)]]
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bowel frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenesmus
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Colonoscopy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other diagnostic study
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Appendicitis]]<ref name="pmid14616200">{{cite journal |vauthors=Choi D, Park H, Lee YR, Kook SH, Kim SK, Kwag HJ, Chung EC |title=The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT |journal=Acta Radiol |volume=44 |issue=6 |pages=574–82 |year=2003 |pmid=14616200 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Appendicitis]]<ref name="pmid14616200">{{cite journal |vauthors=Choi D, Park H, Lee YR, Kook SH, Kim SK, Kwag HJ, Chung EC |title=The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT |journal=Acta Radiol |volume=44 |issue=6 |pages=574–82 |year=2003 |pmid=14616200 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Diarrhea|↑]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
[[Right lower quadrant abdominal pain resident survival guide|RLQ]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Diarrhea]]
* Pain starting periumbilical before localizing to the [[Right lower quadrant abdominal pain resident survival guide|RLQ]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Pain in RLQ
| style="background: #F5F5F5; padding: 5px;" |
* Pain starting periumbilical before localizing to the [[right iliac fossa]]
* [[Nausea and vomiting|N/V]]
* [[Nausea and vomiting|N/V]]
* [[Fever]], [[Rigor|chills]]
* [[Fever]]
* [[Rigor|Chills]]
* [[Anorexia|Loss of appetite]]
* [[Anorexia|Loss of appetite]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Appendiceal wall thickening (wall ≥ 3mm)
* [[Appendicitis CT|Appendiceal]] wall thickening (≥ 3mm)
* Periappendiceal fat stranding
* Periappendiceal fat stranding
* Thickening of the [[Fascia|lateral conal fascia]] and [[mesoappendix]]
* Thick [[Fascia|lateral conal fascia]] and [[mesoappendix]]
* Extraluminal fluid
* Extraluminal fluid
* [[Phlegmon]]
* [[Phlegmon]]
* [[Abscess]]
* [[Abscess]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Tc-99m labeled anti-CD15 antibodies
'''Ultrasound'''
* Ultrasound
* Aperistaltic, noncompressible, dilated [[Appendicitis ultrasound|appendix]] (>6 mm)
** Aperistaltic, noncompressible, dilated appendix (>6 mm outer diameter)
* [[Appendicolith]]
** [[Appendicolith]]
* Echogenic prominent pericaecal fat
** Echogenic prominent pericaecal fat
* Periappendiceal fluid collection
** Periappeniceal fluid collection
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
Line 559: Line 592:
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Strangulated hernia]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Strangulated hernia]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |↓
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
[[Right lower quadrant abdominal pain resident survival guide|RLQ]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Constipation
* [[Nausea and vomiting|N/V]]
| style="background: #F5F5F5; padding: 5px;" | -
* Heaviness/dull discomfort in the groin, with straining, lifting, [[Cough|coughing]], or [[Physical exercise|exercising]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Weakness]], heaviness, burning, or aching in the groin
* Pain in [[Right lower quadrant abdominal pain resident survival guide|RLQ]]
* [[Swelling]]
| style="background: #F5F5F5; padding: 5px;" |[[Nausea and vomiting|N/V]]
* [[Fever]]
 
Heaviness or dull discomfort in the groin, with straining, lifting, coughing, or exercising
 
Weakness, heaviness, burning, or aching in the groin


Pain and [[swelling]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
 
[[Fever]]
 
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Defect in the abdominal wall muscles
* [[Abdominal wall defect|Defect in the abdominal wall]] [[Rectus abdominis muscle|muscles]]
* Appearance of bowel loops within the lesion
* [[Intestine|Bowel loops]] within the lesion
* Lateral crescent sign
* Lateral crescent sign
* The hernia neck will be superolateral to the course of the inferior [[epigastric]] vessels.
* The [[Hernia|hernia neck]] superolateral to the course of the inferior [[epigastric]] vessels
* Ultrasound:
** Hypoechoic mass suggesting dilated and edematous intestinal segment
*
*
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
* Hypoechoic mass suggesting dilated and edematous [[Intestine|intestinal segment]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Ultrasound]]
* N/A
| style="background: #F5F5F5; padding: 5px;" |Ultrasound
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Endometriosis|Bowel endometriosis]]<ref name="pmid25400445">{{cite journal |vauthors=Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A |title=Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team |journal=World J. Gastroenterol. |volume=20 |issue=42 |pages=15616–23 |date=November 2014 |pmid=25400445 |pmc=4229526 |doi=10.3748/wjg.v20.i42.15616 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Endometriosis|Bowel endometriosis]]<ref name="pmid25400445">{{cite journal |vauthors=Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A |title=Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team |journal=World J. Gastroenterol. |volume=20 |issue=42 |pages=15616–23 |date=November 2014 |pmid=25400445 |pmc=4229526 |doi=10.3748/wjg.v20.i42.15616 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |↑ or ↓
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
[[Pelvic pain|Pelvic]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Constipation]]
* [[Dyschezia]]
and/or
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
* [[Diarrhea]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Pelvic pain
| style="background: #F5F5F5; padding: 5px;" |
* Dyschezia
* Tenesmus
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''Transvaginal ultrasound'''
* Transvaginal ultrasonography
* Heterogeneous, hypoechoic, spiculated mass
** Heterogeneous, hypoechoic, spiculated mass
'''T1-weighted or fat-suppression T1-weighted MRIs'''
* Barium enema
* Contrast enhanced mass  
** Extrinsic mass compressing the bowel, fine crenulation of the mucosa, bowel strictures at the rectosigmoid junction
* Hyperintense [[hemorrhagic]]
* T1-weighted or fat-suppression T1-weighted MRIs
* Hyperintense [[Cavity|cavities]]
** Contrast enhanced mass or hyperintense foci, hemorrhagic foci or hyperintense cavities  
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |Transvaginal ultrasonography
| style="background: #F5F5F5; padding: 5px;" |[[Gynecologic ultrasonography|Transvaginal ultrasound]]
|-
| colspan="12" |'''<small>ABBREVIATIONS''':'''N/A''': Not available , '''N/V''': Nausea/vomiting, '''M/C''': Most common, '''DRE''': Digital rectal exam, '''RLQ''': Right lower quadrant, '''LLQ''': Left lower quadrant </small><small><nowiki/></small><small><nowiki/></small>
|}
|}
</small>
</div>


==References==
==References==

Latest revision as of 20:51, 13 February 2019

To view the differential diagnosis of familial adenomatous polyposis (FAP), click here
To view the differential diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC), click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2], Qurrat-ul-ain Abid, M.D.[3]

Overview

Colorectal cancer must be differentiated from other diseases that cause unexplained weight loss, unexplained loss of appetite, nausea, vomiting, diarrhea, anemia, jaundice, and fatigue, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), hemorrhoids, anal fissures, and diverticular disease. There are less common conditions that may be confused as colorectal cancer such as infectious colitis and gastrointestinal lymphoma.

Colorectal Cancer Differential Diagnosis

Other conditions that can be mistaken for colorectal cancer include the following:

ABBREVIATIONS:N/A: Not available , N/V: Nausea/vomiting, M/C: Most common, DRE: Digital rectal exam, RLQ: Right lower quadrant, LLQ: Left lower quadrant
Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms
Lab Findings Imaging Histopathology
Bowel frequency Blood in stool Abdominal pain Tenesmus Other symptoms Anemia Colonoscopy CT scan Other diagnostic study
Colorectal carcinoma (Adenocarcinoma)[7] ↑ or ↓ + +/- + + PET scans

Barium enema

Biopsy, genetic testing, and histopathological analysis
Peutz-Jeghers syndrome
[8][9][10][11][12]
↑ or ↓ + + - + Barium enema

MRI

Genetic testing for STK11 and colonoscopy
Carcinoids
[13][14][15][16][17]
+/- + - +
  • Well-defined single/multiple lesions
  • Round/ovoid in shape
  • Variable in size between 2-5 cm
PET scan (11C-5-hydroxytryptophan, 11C-5-HTP)

MRI

Ki-67 index

  • Solid/spongy nests of cells accentuated by neatly outlined luminal spaces
Biopsy and histopathological analysis
Diseases Bowel frequency Blood in stool Abdominal pain Tenesmus Other symptoms Anemia Colonoscopy CT scan Other diagnostic study Histopathology Gold standard
Juvenile Polyposis Coli[18][19][20][21][22] + + - + Barium study

Stool DNA test

Diagnose if any of the following positive:

Diagnostic criteria fulfilment
Gastrointestinal Stromal Tumors (GIST)[23][24][25][26][27] - +/- - - +/- Benign

Malignant GIST with metastasis:

Endoscopic ultrasonography

Benign:

Malignant GIST:

Endoscopic ultrasound

biopsy and histopathological analysis

Hamartoma[30] + + +
  • N/A
-
  • Large polypoid mass
Biopsy Biopsy
Diseases Bowel frequency Blood in stool Abdominal pain Tenesmus Other symptoms Anemia Colonoscopy CT scan Other diagnostic study Histopathology Gold standard
Colorectal Lymphoma[31][32] - +/- + -
  • Weight loss
+
  • Polypoid or ulcerated mass, intramural lesion, aphthous ulcer, stricture, extraluminal mass, or diffuse, multiple polypoid lesions
Double-contrast enema

Biopsy

Biopsy
Kaposi's sarcoma[33] + + - +
  • N/A
Serology

Biopsy

Biopsy
Arteriovenous malformation[34] - + - -
  • N/A
+
  • Bright red, flat lesions
  • Rarely, polypoid
  • N/A
  • N/A
Accidental finding
Diseases Bowel frequency Blood in stool Abdominal pain Tenesmus Other symptoms Anemia Colonoscopy CT scan Other diagnostic study Histopathology Gold standard
Diverticular diseases[35][36][37] ↑ or ↓ +/- +

RLQ

- -
  • Not recommended
Barium enema
  • Circumferential narrowing
  • Spiculated contour
  • Tapered margins
  • N/A
CT scan
Hemorrhoids[38] + + -
  • Perianal Itching
  • Pain with defecation
  • Painful-hard lump in anus
+ Anoscopy
  • Protruding mass from the anus
  • N/A
DRE
  • N/A
Clinical
Anal fissure[39] - + + - +/- Anoscopy
  • Anal wall laceration
  • N/A
  • N/A
  • N/A
Clinical
Diseases Bowel frequency Blood in stool Abdominal pain Tenesmus Other symptoms Anemia Colonoscopy CT scan Other diagnostic study Histopathology Gold standard
Infectious colitis[40] + + - -
  • N/A
Stool analysis

Stool cultures

  • N/A
Stool culture
Ulcerative colitis[41]V + +

LLQ

+ +
  • N/A
  • N/A
Endoscopic biopsy
Crohn's disease[41] + +

RLQ

+ +
  • N/A
  • N/A
Endoscopic biopsy
Irritable bowel syndrome[42] ↑ ↓ + + + -
  • Not recommended
  • N/A
Diagnosis of exclusion
  • N/A
Clinical diagnosis (Rome criteria)
Diseases Bowel frequency Blood in stool Abdominal pain Tenesmus Other symptoms Anemia Colonoscopy CT scan Other diagnostic study Histopathology Gold standard
Appendicitis[43] - +

RLQ

- -
  • N/A

Ultrasound

  • Aperistaltic, noncompressible, dilated appendix (>6 mm)
  • Appendicolith
  • Echogenic prominent pericaecal fat
  • Periappendiceal fluid collection
  • N/A
CT scan
Strangulated hernia - +

RLQ

- -
  • N/A
Ultrasound:
  • N/A
Ultrasound
Bowel endometriosis[44] ↑ or ↓ + +

Pelvic

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

T1-weighted or fat-suppression T1-weighted MRIs

  • N/A
Transvaginal ultrasound
ABBREVIATIONS:N/A: Not available , N/V: Nausea/vomiting, M/C: Most common, DRE: Digital rectal exam, RLQ: Right lower quadrant, LLQ: Left lower quadrant

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