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A detailed clinical history which includes recent travel history, recent camping or hunting, consumption of unpasteurized milk or raw meat products, and occupational history should be obtained, in order to differentiate [[Brucellosis]] from other diseases.
A detailed clinical history which includes recent travel history, recent camping or hunting, consumption of unpasteurized milk or raw meat products, and occupational history should be obtained, in order to differentiate [[Brucellosis]] from other diseases.
!✔/✘
!✔/✘
!✘
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center class="wikitable" style="border: 2; background: none;"
! colspan="2" rowspan="2" style="border: 1; background: 1;" | Classification of acute abdomen based on etiology
! colspan="1" rowspan="2" |Presentation
! colspan="4" rowspan="1" | Symptoms
! colspan="3" rowspan="1" | Signs
! colspan="2" rowspan="1" | Diagnosis
! colspan="1" rowspan="2" | Additional Findings
|-
! colspan="1" rowspan="1"| Fever || Abdominal Pain || Diarrhea || Constipation
! colspan="1" rowspan="1"| Guarding || Rebound Tenderness || Bowel sounds
! colspan="1" rowspan="1"| Lab Findings || Imaging Findings
|-
! colspan="1" rowspan="8" | Common causes of Peritonitis
! colspan="1" | Primary Peritonitis
| colspan="1" rowspan="1" | Spontateous Bacterial Peritonitis
|✔
|Diffuse
|✘
|✘
|✘
|✘
|Diminished
|'''Ascitic fluid''' PMN
>250cells/mm<small>³</small>
'''Culture''': Positive for single organism
|
|
|-
! colspan="1" rowspan="7" | Secondary Peritonitis
| colspan="1" rowspan="1" | Perforated gastric and duodenal ulcer || ✔
||  Diffuse
|| ✘
||✘
|✔
|✔
|✘
|Glucose
< 50mg/dl
Ascitic fluid LDH > serum LDH
Total Protein
> 1g/dl
|
|
|-
| colspan="1" rowspan="1" |  Acute Cholangitis || ✔
|| RUQ
|| ✘
|| ✘
|✘
|✘
|N
|Increased LFT
|
|
|-
| colspan="1" rowspan="1" | Acute Cholecystitis || ✔
|| RUQ
||  ✘
|| ✘
|✘
|✘
|N
|
|
|
|-
| colspan="1" rowspan="1" |  Acute Pancreatitis || ✔
|| Diffuse
||  ✔
|| ✘
|✘
|✘
|N
|Increased Amylase / Lipase
|
|
|-
| colspan="1" rowspan="1" | Acute Appendicitis || ✔
|| RLQ
|| ✘
|| ✘
|✘
|✔
|N
|
|
|-
| colspan="1" rowspan="1" | Acute Diverticulitis || ✔
|| LLQ
|| ✔/✘
|| ✔/✘
|✘
|✘
|N
|
|
|
|-
| colspan="1" rowspan="1" | Acute Salphingitis || ✔
|| LLQ/ RLQ
|| ✘
|| ✘
|✔/✘
|✔/✘
|N
|
|
|
|-
! colspan="2" rowspan="4" | Hollow Viscous Obstruction
| colspan="1" rowspan="1" |Small Intestine obstruction
|✘
|Diffuse
|✘
|✔✔
|✘
|✘
|Absent
|
|
|
|-
|Volvulus
|
|LLQ
|
|
|
|
|
|
|
|
|-
|Biliary Colic
|
|RUQ
|
|
|
|
|
|
|
|
|-
|Renal Colic
|
|Flank Pain
|
|
|
|
|
|
|
|
|-
! rowspan="4" |Vascular Disorders
! rowspan="2" |Ischemic causes
|Mesentric Ischemia
|
|Periumbilical
|
|
|
|
|
|Increased AG Acidosis
|
|
|-
|Acute Ischemic Colitis
|
|
|
|
|
|
|
|
|
|
|-
! rowspan="2" |Hemorrhagic causes
|Ruptured Abdominal Aortic Aneurysm
|
|Diffuse
|
|
|
|
|
|
|
|
|-
|Intraabdominal or Retroperitoneal Hemorrhage
|
|Diffuse
|
|
|
|
|
|
|
|
|-
! rowspan="3" |Gynaecological Causes
! rowspan="2" |Ovarian Cyst Complications
|Torsion of the Cyst
|
|RLQ / LLQ
|
|
|
|
|
|
|
|
|-
|Cyst Rupture
|
|RLQ / LLQ
|
|
|
|
|
|
|
|
|-
!Pregnancy
|Ruptured Ectopic Pregnancy
|
|RLQ / LLQ
|
|
|
|
|
|Positive Urine beta HCG
|
|
|-
|}
{| class="wikitable"
{| class="wikitable"
! colspan="11" |Differentiating Brucellosis from other diseases
! colspan="11" |Differentiating Brucellosis from other diseases

Revision as of 17:16, 21 February 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac Vishal Devarkonda, M.B.B.S[2]

Overview

Brucellosis must be differentiated from Typhoid fever, Malaria, Tuberculosis, Lymphoma, Dengue, Leptospirosis, Rheumatic disease, Epstein-barr virus, Toxoplasmosis, Cytomegalovirus, and HIV.

Differentiating Brucellosis from other Diseases

Brucellosis must be differentiated from Typhoid fever, Malaria, Tuberculosis, Lymphoma, Dengue, Leptospirosis, Rheumatic disease, Epstein-barr virus, Toxoplasmosis, Cytomegalovirus, and HIV.[1][2][3][4]

A detailed clinical history which includes recent travel history, recent camping or hunting, consumption of unpasteurized milk or raw meat products, and occupational history should be obtained, in order to differentiate Brucellosis from other diseases. ✔ !✔/✘ !✔/✘ !✘


Classification of acute abdomen based on etiology Presentation Symptoms Signs Diagnosis Additional Findings
Fever Abdominal Pain Diarrhea Constipation Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging Findings
Common causes of Peritonitis Primary Peritonitis Spontateous Bacterial Peritonitis Diffuse Diminished Ascitic fluid PMN

>250cells/mm³

Culture: Positive for single organism

Secondary Peritonitis Perforated gastric and duodenal ulcer Diffuse Glucose

< 50mg/dl

Ascitic fluid LDH > serum LDH

Total Protein

> 1g/dl

Acute Cholangitis RUQ N Increased LFT
Acute Cholecystitis RUQ N
Acute Pancreatitis Diffuse N Increased Amylase / Lipase
Acute Appendicitis RLQ N
Acute Diverticulitis LLQ ✔/✘ ✔/✘ N
Acute Salphingitis LLQ/ RLQ ✔/✘ ✔/✘ N
Hollow Viscous Obstruction Small Intestine obstruction Diffuse ✔✔ Absent
Volvulus LLQ
Biliary Colic RUQ
Renal Colic Flank Pain
Vascular Disorders Ischemic causes Mesentric Ischemia Periumbilical Increased AG Acidosis
Acute Ischemic Colitis
Hemorrhagic causes Ruptured Abdominal Aortic Aneurysm Diffuse
Intraabdominal or Retroperitoneal Hemorrhage Diffuse
Gynaecological Causes Ovarian Cyst Complications Torsion of the Cyst RLQ / LLQ
Cyst Rupture RLQ / LLQ
Pregnancy Ruptured Ectopic Pregnancy RLQ / LLQ Positive Urine beta HCG
Differentiating Brucellosis from other diseases
Disease History of consumption of unpasteurized milk or daily products History of recent weight loss Situated in endemic area or travel to endemic area IV abuse or

multiple sexual partners

Fever Rash Painless lymphadenopathy Painful Lymphadenopathy White patches on the tonsil and back of throat Keys distinguishing features
Brucellosis
Typhoid fever
  • Step ladder fever
  • Rash which is salmon-colored and blanching
Malaria
  • Paroxysms of spike in fever
  • Chills
  • Sweating
Tuberculosis
  • Night sweats
  • Weight loss
  • Fatigue
Lymphoma
  • Insidious in nature
  • Painless lymphadenopathy
Epstein-Barr virus Posterior cervical lymphadenopathy
Toxoplasma Immunocompromised
Cytomegalovirus History of Blood transfusion
HIV History of  highest risk of contracting disease include contaminated blood transfusions, childbirth, needle sharing, and receptive anal intercourse.

Reference

  1. Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). "Brucellosis". N Engl J Med. 352 (22): 2325–36. doi:10.1056/NEJMra050570. PMID 15930423.
  2. Brucellosis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on January,2017
  3. Young EJ (1995). "Brucellosis: current epidemiology, diagnosis, and management". Curr Clin Top Infect Dis. 15: 115–28. PMID 7546364.
  4. Enfermedades infecciosas: Brucelosis -Diagnóstico de Brucelosis,Guia para el Equipo de Salud. Ministerio de Salud-Argentina. http://www.msal.gob.ar/images/stories/bes/graficos/0000000304cnt-guia-medica-brucelosis.pdf. Accessed on February 2, 2016