Appendicitis differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{ | [[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Appendicitis]] | ||
{{ | {{CMG}}; {{AE}} {{FH}} | ||
==Overview== | ==Overview== | ||
Appendicitis must be differentiated from other causes of abdominal pain such as acute [[gastroenteritis]] and luminal obstruction. | Appendicitis must be differentiated from other causes of abdominal pain such as acute [[gastroenteritis]] and luminal obstruction. Age group can be another factor used to differentiate appendicitis. | ||
==Differentiating Appendicitis from other Diseases== | ==Differentiating Appendicitis from other Diseases== | ||
*Appendicitis can be differentiated from other diseases that cause [[Abdominal pain|lower abdominal pain]] and [[fever]] like [[diverticulitis]], [[inflammatory bowel disease]], [[colon cancer]], [[cystitis]], and [[endometritis]].<ref name="pmid17573742">{{cite journal| author=Laurell H, Hansson LE, Gunnarsson U| title=Acute diverticulitis--clinical presentation and differential diagnostics. | journal=Colorectal Dis | year= 2007 | volume= 9 | issue= 6 | pages= 496-501; discussion 501-2 | pmid=17573742 | doi=10.1111/j.1463-1318.2006.01162.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17573742 }} </ref><ref>Hardin, M. Acute Appendicitis: Review and Update. ''Am Fam Physician".1999, Nov 1;60(7):2027-2034''</ref><ref name="pmid8596552">{{cite journal| author=Hanauer SB| title=Inflammatory bowel disease. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 13 | pages= 841-8 | pmid=8596552 | doi=10.1056/NEJM199603283341307 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8596552 }} </ref><ref name="hhh">Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016</ref><ref name="nlm">Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016</ref><ref name="pmid27107781">{{cite journal |vauthors=Ford GW, Decker CF |title=Pelvic inflammatory disease |journal=Dis Mon |volume=62 |issue=8 |pages=301–5 |year=2016 |pmid=27107781 |doi=10.1016/j.disamonth.2016.03.015 |url=}}</ref> | |||
=== | {| class="wikitable" | ||
* | ! colspan="2" rowspan="2" |Diseases | ||
*[[ | ! colspan="2" |Symptoms | ||
* | ! colspan="3" |Signs | ||
* | ! colspan="2" |Diagnosis | ||
* | ! rowspan="2" |Comments | ||
* | |- | ||
*[[ | !Abdominal pain | ||
* | !Bowel habits | ||
!Rebound tenderness | |||
!Guarding | |||
!Genitourinary signs | |||
!Lab findings | |||
!Imaging | |||
|- | |||
| rowspan="5" |GI diseases | |||
|[[Diverticulitis]] | |||
|LLQ | |||
|[[Constipation]] | |||
Or | |||
[[Diarrhea]] | |||
| - | |||
| + | |||
|<nowiki>+ </nowiki> | |||
| | |||
* [[Leukocytosis]] | |||
|CT scan shows evidence of [[inflammation]] | |||
| | |||
|- | |||
|[[Appendicitis]] | |||
|LLQ / RRQ | |||
|Constipation | |||
| + | |||
| + | |||
| - | |||
| | |||
* [[Leukocytosis]] | |||
|Ultrasound shows evidence of [[inflammation]] | |||
|[[Nausea and vomiting|Nausea & vomiting]],[[decreased appetite]] | |||
|- | |||
|[[Inflammatory bowel disease]] | |||
|LLQ | |||
|[[Bloody diarrhea]] | |||
|<nowiki>-</nowiki> | |||
| - | |||
| - | |||
| | |||
* Leukocytosis | |||
| | |||
|[[Colonoscopy]] and tissue sampling are recommended for differentiating between [[Crohn's disease]] and [[ulcerative colitis]]. | |||
|- | |||
|[[Colon carcinoma]] | |||
|LLQ | |||
|Constipation | |||
| - | |||
| - | |||
| - | |||
| | |||
* Serum [[carcino-embryogenic antigen]] | |||
* Low [[vitamin B12]] | |||
* [[Hypercalcemia]] | |||
|CT scan, x-ray and MRI used to show [[metastasis]] | |||
| | |||
|- | |||
|[[Strangulated hernia]] | |||
|LLQ | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
| | |||
* No specific tests | |||
| | |||
* CT scan used to detect the [[hernia]] and to show if it is single or multiple | |||
| | |||
|- | |||
| rowspan="3" |Gentiourinary diseases | |||
|[[Cystitis]] | |||
|LLQ | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
| | |||
* Suprapubic [[tenderness]] | |||
| | |||
* [[Pyuria]] | |||
* Presence of [[nitrites]] and leukocyte estrase | |||
| | |||
* X ray is done to probe the suspicion of emphysematous cystitis. | |||
* CT scan shows gas in the [[Urinary bladder|bladder]] in cases of emphysematous [[cystitis]]. | |||
| | |||
|- | |||
|[[Prostatitis]] | |||
|LLQ | |||
Groin pain | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
| | |||
* Tender and enlarged | |||
| | |||
* Serum [[Prostate specific antigen|PSA]] elevated | |||
* [[Leukocytosis]] | |||
* Elevated [[C-reactive protein|CRP]] | |||
| | |||
* CT scan shows [[edema]] and enlarged [[prostate]] | |||
* [[Abscess]] may be observed | |||
| | |||
|- | |||
|[[Pelvic inflammatory disease]] | |||
|Bilateral | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
| - | |||
| | |||
* Purulent vaginal discharge | |||
| | |||
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] is the best laboratory test for PID. | |||
|[[Transvaginal ultrasound|Transvaginal utrasonography]] | |||
| | |||
|- | |||
| rowspan="2" |Gynecological diseases | |||
|[[Endometritis]] | |||
|LLQ | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
| | |||
* No specific tests | |||
| | |||
* Ultrasound is helpful to rule out other differential diagnosis such as pelvic abscess, thrombosis and masses | |||
| | |||
* Vaginal discharge | |||
* Vaginal bleeding | |||
|- | |||
|[[Salpingitis]] | |||
|LLQ/ RLQ | |||
| | |||
| +/- | |||
| +/- | |||
| | |||
| | |||
* Leukocytosis | |||
|Pelvic ultrasound | |||
| | |||
* Vaginal discharge | |||
|} | |||
=== | *Since appendicitis presents as the general symptom of [[abdominal pain]], appendicitis must be differentiated from other diseases and disorders causing similar pain and symptoms. This differentiation can be done according to four categories: surgical, urological, gynaecological, and medical.<ref name="Humes2006">{{cite journal|last1=Humes|first1=D J|title=Acute appendicitis|journal=BMJ|volume=333|issue=7567|year=2006|pages=530–534|issn=0959-8138|doi=10.1136/bmj.38940.664363.AE}}</ref> | ||
=== | {| align="center" | ||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* | {| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | ||
! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" | Classification of acute abdomen based | |||
on etiology | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Presentation | |||
! colspan="8" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Clinical findings | |||
! colspan="2" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Diagnosis | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" | Comments | |||
|- | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Fever | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and Chills | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal Pain | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Hypotension | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Guarding | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rebound Tenderness | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel sounds | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Lab Findings | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging | |||
|- | |||
| colspan="2" rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Common causes of | |||
Peritonitis | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Spontaneous bacterial peritonitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
|− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ascitic fluid [[PMN]]>250 cells/mm<small>³</small> | |||
=== | * Culture: Positive for single organism | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound for evaluation of liver cirrhosis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
* | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Perforated [[Gastric ulcer|gastric]] and [[duodenal ulcer]] | |||
* | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Ascitic fluid | |||
**[[LDH]] > serum [[LDH]] | |||
** Glucose < 50mg/dl | |||
** Total protein > 1g/dl | |||
== | | style="padding: 5px 5px; background: #F5F5F5;" align="left" |Air under [[diaphragm]] in upright [[CXR]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Upper GI [[endoscopy]] for diagnosis | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Acute suppurative cholangitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[RUQ]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
* | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Acute cholangitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
|− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | [[RUQ]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
|− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Abnormal [[LFT]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[biliary]] dilatation | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Biliary drainage ([[Endoscopic retrograde cholangiopancreatography|ERCP]]) + IV antibiotics | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute Cholecystitis|Acute cholecystitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | [[RUQ]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Hyperbilirubinemia]] | |||
* [[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows gallstone and evidence of inflammation | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]] | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute pancreatitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | [[Epigastric]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[amylase]] / [[lipase]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Pain radiation to back | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute appendicitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | RLQ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], [[decreased appetite]] | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Diverticulitis|Acute diverticulitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | LLQ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound shows evidence of inflammation | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
|- | |||
| colspan="2" rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Hollow Viscous Obstruction | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Small intestine obstruction | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Abdominal X-ray|Abdominal X ray]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]] | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gall stone disease|Gall stone '''disease''']]/'''Cholelithiasis''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Volvulus]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and [[Abdominal x-ray|abdominal X ray]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Biliary colic]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |RUQ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[bilirubin]] and [[alkaline phosphatase]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Renal colic]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Flank pain]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Hematuria]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Colicky [[abdominal pain]] associated with [[Nausea and vomiting|nausea & vomiting]] | |||
|- | |||
| rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Vascular Disorders | |||
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ischemic causes | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Periumbilical | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]] and [[lactic acidosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], normal physical examination | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ischemic colitis|Acute ischemic colitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] | |||
|- | |||
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hemorrhagic causes | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ruptured abdominal aortic aneurysm]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Unstable hemodynamics | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intra-abdominal or [[retroperitoneal hemorrhage]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Anemia]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of [[trauma]] | |||
|- | |||
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gynaecological Causes | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Fallopian tube | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Salpingitis|Acute salpingitis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | LLQ/ RLQ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |− | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Pelvic ultrasound]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Vaginal discharge]] | |||
|- | |||
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ovarian cyst]] complications and endometrial disease | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Torsion of the cyst | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Endometriosis | |||
| - | |||
| | |||
|RLQ/LLQ | |||
| - | |||
| | |||
| +/- | |||
| +/- | |||
|N | |||
|Normal | |||
|Laproscopy | |||
|Menstrual-associated symptoms, pelvic | |||
symptoms | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cyst rupture | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pregnancy | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ruptured [[ectopic pregnancy]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Positive [[pregnancy test]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of missed period and [[vaginal bleeding]] | |||
|- | |||
| rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" | | |||
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Irritable Bowel Syndrome | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki> | |||
| align="left" style="padding: 5px 5px; background: #F5F5F5;" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
[[Diagnosis|Clinical diagnosis]] | |||
* ROME III/IV criteria | |||
* [[Pharmacological|Pharmacologic]] studies based criteria | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* High [[dietary fiber]] | |||
In Children | * [[Osmotic]] [[laxatives]] | ||
* [[Antispasmodic]]<nowiki/>drugs | |||
|- | |||
|} | |||
===Differentials to be considered In Children for appendicitis=== | |||
*[[Mesenteric adenitis]] | *[[Mesenteric adenitis]] | ||
*[[Meckel's diverticulum]] | *[[Meckel's diverticulum]] | ||
*[[Intussusception]] | *[[Intussusception]] | ||
*[[Henoch-Schõnlein purpura]], and [[lobar pneumonia]] | *[[Henoch-Schõnlein purpura]], and [[lobar pneumonia]] | ||
==References== | ==References== | ||
{{ | {{Reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
|} | |||
[[Category:Emergency medicine]] | |||
[[Category:Surgery]] | |||
[[Category:Gastroenterology]] |
Latest revision as of 20:27, 29 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farwa Haideri [2]
Overview
Appendicitis must be differentiated from other causes of abdominal pain such as acute gastroenteritis and luminal obstruction. Age group can be another factor used to differentiate appendicitis.
Differentiating Appendicitis from other Diseases
- Appendicitis can be differentiated from other diseases that cause lower abdominal pain and fever like diverticulitis, inflammatory bowel disease, colon cancer, cystitis, and endometritis.[1][2][3][4][5][6]
Diseases | Symptoms | Signs | Diagnosis | Comments | |||||
---|---|---|---|---|---|---|---|---|---|
Abdominal pain | Bowel habits | Rebound tenderness | Guarding | Genitourinary signs | Lab findings | Imaging | |||
GI diseases | Diverticulitis | LLQ | Constipation
Or |
- | + | + | CT scan shows evidence of inflammation | ||
Appendicitis | LLQ / RRQ | Constipation | + | + | - | Ultrasound shows evidence of inflammation | Nausea & vomiting,decreased appetite | ||
Inflammatory bowel disease | LLQ | Bloody diarrhea | - | - | - |
|
Colonoscopy and tissue sampling are recommended for differentiating between Crohn's disease and ulcerative colitis. | ||
Colon carcinoma | LLQ | Constipation | - | - | - | CT scan, x-ray and MRI used to show metastasis | |||
Strangulated hernia | LLQ | - | - | - | - |
|
|
||
Gentiourinary diseases | Cystitis | LLQ | - | + | - |
|
|||
Prostatitis | LLQ
Groin pain |
- | - | - |
|
|
|||
Pelvic inflammatory disease | Bilateral | - | + | - |
|
|
Transvaginal utrasonography | ||
Gynecological diseases | Endometritis | LLQ | - | + | - | + |
|
|
|
Salpingitis | LLQ/ RLQ | +/- | +/- |
|
Pelvic ultrasound |
|
- Since appendicitis presents as the general symptom of abdominal pain, appendicitis must be differentiated from other diseases and disorders causing similar pain and symptoms. This differentiation can be done according to four categories: surgical, urological, gynaecological, and medical.[7]
Differentials to be considered In Children for appendicitis
References
|