Diverticulitis differential diagnosis: Difference between revisions
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of missed period and [[vaginal bleeding]] | | style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of missed period and [[vaginal bleeding]] | ||
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'''The table below summarizes the findings that differentiate inflammatory causes of chronic diarrhea'''<ref name="pmid8209928">{{cite journal| author=Konvolinka CW| title=Acute diverticulitis under age forty. | journal=Am J Surg | year= 1994 | volume= 167 | issue= 6 | pages= 562-5 | pmid=8209928 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8209928 }} </ref><ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue= | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544 }} </ref><ref name="pmid16698746">{{cite journal| author=Satsangi J, Silverberg MS, Vermeire S, Colombel JF| title=The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. | journal=Gut | year= 2006 | volume= 55 | issue= 6 | pages= 749-53 | pmid=16698746 | doi=10.1136/gut.2005.082909 | pmc=1856208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16698746 }} </ref><ref name="pmid12700377">{{cite journal| author=Haque R, Huston CD, Hughes M, Houpt E, Petri WA| title=Amebiasis. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 16 | pages= 1565-73 | pmid=12700377 | doi=10.1056/NEJMra022710 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700377 }} </ref><ref name="pmid12700377">{{cite journal| author=Haque R, Huston CD, Hughes M, Houpt E, Petri WA| title=Amebiasis. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 16 | pages= 1565-73 | pmid=12700377 | doi=10.1056/NEJMra022710 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700377 }} </ref> | |||
{| class="wikitable" | |||
!Cause | |||
!History | |||
!Laboratory findings | |||
!Diagnosis | |||
!Treatment | |||
|- | |||
|[[Diverticulitis]] | |||
| | |||
* [[Bloody diarrhea]] | |||
* Left lower quadrant [[abdominal pain]] | |||
* [[Abdominal tenderness]] on [[physical examination]] | |||
* Low grade [[fever]] | |||
| | |||
* [[Leukocytosis]] | |||
* Elevated serum [[amylase]] and [[lipase]] | |||
* [[Sterile]] [[pyuria]] on [[urinalysis]] | |||
|Abdominal [[CT scan]] with oral and intravenous [[Contrast medium|(IV) contrast]] | |||
|bowel rest, [[Intravenous fluids|IV fluid]] resuscitation, and [[Broad-spectrum antibiotic|broad-spectrum antimicrobial therapy]] which covers [[Anaerobic organism|anaerobic]] [[bacteria]] and [[gram-negative]] [[Bacteria|rods]] | |||
|- | |||
|[[Ulcerative colitis]] | |||
| | |||
* [[Diarrhea]] mixed with blood and [[mucus]], of gradual onset. | |||
* Signs of [[weight loss]] | |||
* [[Rectal pain|Rectal urgency]] | |||
* [[Tenesmus]] | |||
* [[Blood]] is often noticed on underwear | |||
* Different degrees of [[abdominal pain]] | |||
| | |||
* [[Anemia]] | |||
* [[Thrombocytosis]] | |||
* A high [[platelet]] count | |||
* Elevated [[ESR]] (>30mm/hr) | |||
* Low [[albumin]] | |||
|[[Endoscopy]] | |||
|Induction of [[Remission (medicine)|remission]] with [[mesalamine]] and [[corticosteroids]] followed by the administration of [[sulfasalazine]] and [[Mercaptopurine|6-Mercaptopurine]] depending on the severity of the [[disease]]. | |||
|- | |||
|[[Entamoeba histolytica]] | |||
| | |||
* [[Abdominal cramps]] | |||
* [[Diarrhea]] | |||
** Passage of 3 - 8 semiformed [[stools]] per day | |||
** Passage of soft [[stools]] with [[mucus]] and occasional [[blood]] | |||
* [[Fatigue]] | |||
* [[Intestinal]] gas (excessive [[flatus]]) | |||
* [[Rectal pain]] while having a [[bowel movement]] ([[tenesmus]]) | |||
* Unintentional [[weight loss]] | |||
|cysts shed with the stool | |||
|detects ameba [[DNA]] in feces | |||
|[[Amebic dysentery]] | |||
* [[Metronidazole]] 500-750mg three times a day for 5-10 days | |||
* [[Tinidazole]] 2g once a day for 3 days is an alternative to [[metronidazole]] | |||
Luminal amebicides for ''[[E. histolytica]]'' in the [[colon]]: | |||
* [[Paromomycin]] 500mg three times a day for 10 days | |||
* [[Diloxanide furoate]] 500mg three times a day for 10 days | |||
* [[Iodoquinol]] 650mg three times a day for 20 days | |||
For [[Amoebiasis|amebic liver abscess]]: | |||
* [[Metronidazole]] 400mg three times a day for 10 days | |||
* [[Tinidazole]] 2g once a day for 6 days is an alternative to [[metronidazole]] | |||
* [[Diloxanide furoate]] 500mg three times a day for 10 days must always be given afterwards. | |||
|} | |} | ||
Revision as of 18:00, 26 July 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2],Seyedmahdi Pahlavani, M.D. [3], Omodamola Aje B.Sc, M.D. [4]
Overview
It is important to differentiate sigmoid diverticulitis from a lot of inflammatory and non-inflammatory diseases of the gastrointestinal tract and the urogenital system. Differential diagnosis of diverticulitis can be based on the diseases causing lower abdominal pain and fever, and the diseases causing peritonitis. Diverticulitis can be differentiated from other diseases that cause lower abdominal pain and fever like appendicitis, inflammatory bowel disease, cancer colon, cystitis and endometritis.
Differential Diagnosis
Differential diagnosis of diverticulitis can be based on the diseases causing lower abdominal pain and fever, and the diseases causing peritonitis.
Differentiating diverticulitis from diseases causing lower abdominal pain and fever
Diverticulitis can be differentiated from other diseases that cause lower abdominal pain and fever like appendicitis, inflammatory bowel disease, cancer colon, 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 Diarrhea |
- | + | + | 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 | - | - | - | - |
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||
Gentiourinary diseases | Cystitis | LLQ | - | + | - |
|
|
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Prostatitis | LLQ
Groin pain |
- | - | - |
|
|
|||
Pelvic inflammatory disease | Bilateral | - | + | - |
|
|
Transvaginal utrasonography | ||
Gynecological diseases | Endometritis | LLQ | - | + | - | + |
|
|
|
Salpingitis | LLQ/ RLQ | +/- | +/- |
|
Pelvic ultrasound |
|
Differential diagnosis of diverticulitis with diseases causing peritonitis
The table below summarizes the findings that differentiate inflammatory causes of chronic diarrhea[7][8][9][10][10]
References
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