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>
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.
{{CMG}}: {{AE}} {{Trusha}}, {{Qurrat}}


==Overview==
==Overview==
Line 11: Line 11:
*Colorectal cancer must be differentiated from other diseases that cause [[Abdominal pain|lower abdominal pain]] and [[fever]] like [[appendicitis]], [[diverticulitis]], [[inflammatory bowel disease]], [[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>
*Colorectal cancer must be differentiated from other diseases that cause [[Abdominal pain|lower abdominal pain]] and [[fever]] like [[appendicitis]], [[diverticulitis]], [[inflammatory bowel disease]], [[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"
'''Other conditions that can be mistaken for colorectal cancer include the following:'''
! colspan="2" rowspan="2" |Diseases
*Benign colon polyps
! colspan="2" |Symptoms  
*[[Infectious colitis]]
! colspan="3" |Signs
*[[Arteriovenous malformation]] ([[AVM]])
! colspan="2" |Diagnosis
*[[Carcinoid]]/[[neuroendocrine]] tumors
! rowspan="2" |Comments
*[[Small intestine]] carcinomas
*Gastrointestinal lymphoma
*[[Pregnancy]]
*[[Appendicitis]]
*[[Hernia]]
*[[Lactose intolerance]]
*[[Flatulence]]
*[[Ulcer]]
*[[Cholecystitis]]
 
<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;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| 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="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
|-
| colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
! 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
! 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: #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; 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;" |
*[[Weight loss]]
*[[Fatigue]]
*Low caliber of stools
*[[Mucus]] in stools
| style="background: #F5F5F5; padding: 5px; text-align: center; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
*[[Polyp|Polyps]] (villous, tubular, tubulo-villous)
*[[Ulcer|Ulcerating polyps]]
*[[Cancerous]] [[lesions]]
| style="background: #F5F5F5; padding: 5px;" |
*Luminal narrowing
*[[Bowel obstruction]]
*Thickening of the bowel wall
*[[Lymphadenopathy]]
*[[Metastases]]
| style="background: #F5F5F5; padding: 5px;" |'''PET scans'''
*[[Metastasis]]
'''Barium enema'''
*[[Cancer]] or [[Premalignant condition|precancerous]] [[polyp]]
| style="background: #F5F5F5; padding: 5px;" |
* Different grades of differentiation of [[glandular]] structures
** Sheets or cords of [[malignant]] cells
**[[Cellular]] [[atypia]] and [[pleomorphism]]
**High [[Mitosis|mitotic]] rate
* [[Necrosis|Necrotic]] debris in [[Glandular tissue|glandular lumina]]
* [[Desmoplastic|Desmoplastic reaction (sign of invasion)]]
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]], [[genetic testing]], and [[histopathological]] analysis
|-
|-
!Abdominal pain
| 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>
!Bowel habits
| style="background: #F5F5F5; padding: 5px; text-align: center;" |↑ or ↓
!Rebound tenderness
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
!Guarding
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
!Genitourinary signs
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
!Lab findings
| style="background: #F5F5F5; padding: 5px;" |
!Imaging
* [[Weight loss]]
* [[Fatigue]]
* [[Hyperpigmentation|Mucocutaneous  hyperpigmentation]]
* [[Rectal prolapse]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Hamartomatous intestinal polyposis|Multiple polyps]]
* [[Mucocutaneous]] [[pigmentation]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Polyps|Multiple polyps]]
*[[Intussusception]]
*[[Bowel obstruction]]
| style="background: #F5F5F5; padding: 5px;" |'''Barium enema'''
* Multiple [[Polyp|polyps]]
'''MRI'''
* Multiple [[Hamartoma|hamartomatous]] [[Polyp|polyps]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Hamartoma|Hamartomatous]] [[Polyps|mucosal polyps]] with core of [[smooth muscle]] associated with [[Mucous membrane|mucosa]]
* Smaller [[Polyp|polyps]] lack the prominent arborizing [[smooth muscle]]
| style="background: #F5F5F5; padding: 5px;" |[[Genetic testing]] for [[STK11]] and [[colonoscopy]]
|-
|-
| rowspan="5" |GI diseases
| 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>
|[[Colon carcinoma|Colorectal cancer]]  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |↑
|LLQ
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
|[[Constipation]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
*[[Weight gain|Weight loss]]
*[[Weakness]]
*[[Flushing (physiology)|Flushing]]
*[[Wheezing]]
*[[Shortness of breath]]
*[[Palpitations]]
*[[Leg edema]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Infiltration (medical)|Infiltrating]], [[Ulceration|ulcerating]] or fungating lesions in the [[Colon (anatomy)|wall of colon]]
| style="background: #F5F5F5; padding: 5px;" |
* Well-defined single/multiple lesions
* Round/ovoid in shape
* Variable in size between 2-5 cm
| style="background: #F5F5F5; padding: 5px;" |'''PET scan''' (11C-5-hydroxytryptophan, 11C-5-HTP)
* Detects [[metastasis]]
'''MRI'''
* Nodular mass
* Wall thickening
* [[Metastasis]]
'''Ki-67 index'''
| style="background: #F5F5F5; padding: 5px;" |
* Solid/spongy nests of cells accentuated by neatly outlined luminal spaces


| -
* Peripheral nuclear palisading
| -
* [[Granule cell|Granular]] [[eosinophilic]] [[cytoplasm]]
| -
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]] and [[Histopathology|histopathological analysis]]
|
|-
* Serum [[carcino-embryogenic antigen]] 
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
* Low Vit b12
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bowel frequency
* [[Hypercalcemia]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
|CT scan, x-ray and MRI used to show [[metastasis]]
! 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'''
|-
|-
|[[Inflammatory bowel disease]]
| 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>
|LLQ
| style="background: #F5F5F5; padding: 5px; text-align: center;" |↑
|[[Bloody diarrhea]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| -
| style="background: #F5F5F5; padding: 5px;" |
|
* Prolapsing [[polyp]]
* [[Leukocytosis]]
* [[Intussusception]]
|<nowiki>-</nowiki>
* [[Macrocephalus]]
|[[Colonoscopy]] and tissue sampling are recommended for differentiating between [[Crohn's disease]] and [[ulcerative colitis]]  
* [[Hypotonia]]
* [[Intestinal obstruction|Bowel obstruction]]
* [[Heart]] or [[brain]] abnormalities
* [[Cleft lip and palate|Cleft palate]]
* [[Polydactyly]]
* Genitalia or urinary abnormalities
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* >5 juvenile [[Polyp|polyps]] in the [[colon]] and [[rectum]]
* Multiple [[Polyps|juvenile polyps]] in [[gastrointestinal tract]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Polyp|Multiple polyps]] in [[gastrointestinal tract|GI tract]]
| style="background: #F5F5F5; padding: 5px;" |'''Barium study'''
* Multiple polyps in [[Gastrointestinal tract|GI tract]]
'''Stool DNA test'''
* ''[[SMAD4]]'' or ''[[BMPR1A]]''
'''Diagnose if any of the following positive:'''
* More than five juvenile [[Polyp|polyps]] of the colorectum
* Multiple juvenile [[Polyp|polyps]] throughout the [[Gastrointestinal tract|GI tract]]
* Any number of juvenile [[Polyp|polyps]] and a family history of juvenile [[polyposis]]
* [[Heterozygous]] pathogenic variant in ''[[Mothers against decapentaplegic homolog 4|SMAD4]]'' or ''[[BMPR1A]]''
| style="background: #F5F5F5; padding: 5px;" |
* [[Cyst|Cystic]] and dilated [[Crypt (anatomy)|crypts]] or [[Gland|glands]] with inspissated [[mucin]] and [[Lumen (anatomy)|intraluminal]] [[Neutrophil|neutrophils]]
* [[Lamina propria]] [[Edema|edematous]] with associated [[Lymphocyte|lymphocytes]], [[Plasma cell|plasma cells]], [[Eosinophil granulocyte|eosinophils]], and [[Neutrophil|neutrophils]]
* [[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]]
| style="background: #F5F5F5; padding: 5px;" |Diagnostic criteria fulfilment
|-
|-
|[[Diverticulitis]]  
| 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>
|LLQ
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|[[Constipation]]  
| 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;" |
* [[Asymptomatic]]
* [[Satiety|Early satiety]]
* [[Bloating]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
* Subepithelial round masses
* Smooth margins
* Normal overlying [[mucosa]] may be intact or [[Ulcerated lesion|ulcerated]]
* 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;" |
'''Endoscopic ultrasonography'''


[[Diarrhea]]
[[Benign]]:
| -
* [[Mucosal]] [[ulceration]] or [[bleeding]]
| +
* Smooth [[submucosal]] mass as [[hypoechoic mass]]
|<nowiki>+ </nowiki>
[[Malignant]] [[Gastrointestinal stromal tumor|GIST]]:
|
* [[Heterogeneous]] mass >4 cm in size
* [[Leukocytosis]]
* Irregular borders
|CT scan shows evidence of [[inflammation]] and out-pouchings of the colonic wall
* [[Intraluminal|Intra]]/extraluminal growth
|
* Multiple [[cysts]]
| 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]]
[[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: #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;" |
* N/A
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Large polypoid mass
| style="background: #F5F5F5; padding: 5px;" |
* Isodense/hypodense solid [[Mass|masses]]
* [[Heterogeneous]] mass
* Presence of [[fat]]
* [[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;" |
* Poorly circumscribed, short fascicles of uniform [[spindle cells]] replacing the [[Colon (anatomy)|colonic]] [[lamina propria]], separating and entrapping the [[Crypt (anatomy)|crypts]]
* The [[Cell nucleus|nuclei]] are bland and mostly uniform, occasional larger [[Cell nucleus|nuclei]] are found. The [[Cytoplasm|cytoplasmic]] borders are indistinct
* Involvement of [[Mucous membrane|mucosa]] but never the [[submucosa]]
| 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: #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;" |
* Weight loss
| style="background: #F5F5F5; padding: 5px;" text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Polypoid or ulcerated mass, intramural lesion, aphthous ulcer, stricture, extraluminal mass, or diffuse, multiple polypoid lesions
| style="background: #F5F5F5; padding: 5px;" |
* Polypoid mass
* Circumferential-[[Cavity|cavitary lesions]]
* Focal mucosal nodularity
* Diffuse [[Ulcer|ulcerative]] or [[Nodule (medicine)|nodular]] lesions
* [[Lymphadenopathy]]
| style="background: #F5F5F5; padding: 5px;" |'''Double-contrast enema'''
* Subtle [[Mucous membrane|mucosal]] changes
* Gross [[tumor]] morphology
'''Biopsy'''
| style="background: #F5F5F5; padding: 5px;" |
* [[Diffuse large B cell lymphoma|Diffuse large B-cell lymphoma]]:
* [[MALT lymphoma|Extranodal marginal zone lymphoma (MALT)]]
* [[Mantle cell lymphoma]]
* [[Burkitt's lymphoma|Burkitt’s lymphoma]]
* [[Follicular lymphoma]]
*
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]
|-
| 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;" |
* [[Nausea and vomiting]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Localized [[Purpura|purpuric]] lesion
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |'''Serology'''
* [[Antibodies]] against [[Kaposi's sarcoma|Kaposi sarcoma]] [[Kaposi's sarcoma-associated herpesvirus|herpes virus  (HHV-8)]]
'''Biopsy'''
| style="background: #F5F5F5; padding: 5px;" |
* [[Vascular]] proliferation
* [[Red blood cell|RBC]] and [[hemosiderin]] extravasation
* [[Lymphocyte|Lymphocytes]] and [[Monocyte|monocytes]]
* [[Premonitory sign]] [[Neovascularization|(neovascular]] lesion wrapped around a pre-existing space)
* Intracytoplasmic [[Periodic acid-Schiff stain|PAS +ve]] [[hyaline]] globules
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]
|-
|-
|[[Appendicitis]]
| 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>
|LLQ / RRQ
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|[[Constipation]]
| 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;" |
|
* N/A
* [[Leukocytosis]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|
| style="background: #F5F5F5; padding: 5px;" |
* Ultrasound shows evidence of [[inflammation]]
* Bright red, flat lesions
 
* Rarely, polypoid
* CT scan shows acute gangrenous appendix with calcified appendicolith
| style="background: #F5F5F5; padding: 5px;" |
|[[Nausea and vomiting|Nausea & vomiting]],[[decreased appetite]]
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* Aberrant [[Blood vessel|vessels]] with thickened, hypertrophic walls in the [[Mucous membrane|mucosa]] and the [[submucosa]]
* [[Artery|Arteries]] directly connected to [[Vein|veins]] without [[capillary beds]]
| style="background: #F5F5F5; padding: 5px;" |Accidental finding
|-
|-
|[[Strangulated hernia]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
|LLQ
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bowel frequency
|<nowiki>-</nowiki>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
|<nowiki>-</nowiki>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
|<nowiki>-</nowiki>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenesmus
|<nowiki>-</nowiki>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
|
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
* No specific tests
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Colonoscopy
|
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
* CT scan used to detect the [[hernia]] and to show if it is single or multiple
! 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'''
|-
|-
| rowspan="3" |Gentiourinary diseases
| 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>
|[[Cystitis]]  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |↑ or ↓
|LLQ
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|<nowiki>+</nowiki>
RLQ
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|
| style="background: #F5F5F5; padding: 5px;" |
* Suprapubic tenderness
* [[Fever]]
|
* [[Rigor|Chills]]
* [[Pyuria]]  
* [[Nausea and vomiting|N/V]]
* Presence of [[nitrites]] and [[leukocyte esterase]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|
| style="background: #F5F5F5; padding: 5px;" |
* X ray is done to probe the suspicion of emphysematous cystitis.
* Not recommended
* CT scan shows gas in the [[Urinary bladder|bladder]] in cases of emphysematous cystitis.
| style="background: #F5F5F5; padding: 5px;" |
|
* Outpouchings of the [[Colon (anatomy)|colonic wall]] [[Diverticular|(diverticula)]]
* [[Diverticulitis|Inflamed diverticula]]
* [[Abscess|Abscess formation]]
* Intraperitoneal free air (microperforation)
| style="background: #F5F5F5; padding: 5px;" |'''Barium enema'''
* Circumferential narrowing
* Spiculated contour
* Tapered margins
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]
|-
|-
|[[Prostatitis]]  
| 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>
|LLQ
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Constipation|↓]]
 
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
Groin pain
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>-</nowiki>
* Perianal Itching
|
* Pain with [[defecation]]  
* Tender and enlarged
* Painful-hard lump in anus
|
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
* Serum [[Prostate specific antigen|PSA]] elevated
| style="background: #F5F5F5; padding: 5px;" |[[Anoscopy]]
* [[Leukocytosis]]
* Protruding mass from the [[anus]]
* Elevated [[C-reactive protein|CRP]]
| style="background: #F5F5F5; padding: 5px;" |
|
* N/A
* CT scan shows [[edema]] and enlarged [[prostate]]  
| style="background: #F5F5F5; padding: 5px;" |'''DRE'''
* [[Abscess]] may be observed
* [[Palpation|Palpable]] mass, tender if [[Thrombosis|thrombosed]]
|
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |Clinical
|-
|-
|[[Pelvic inflammatory disease]]
| 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>
|Bilateral
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|
| style="background: #F5F5F5; padding: 5px;" |
* [[Vaginal discharge|Purulent vaginal discharge]]
* [[Dyschezia|Painful defecation]]
|
* [[Itching]]
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] is the best laboratory test for PID.
* [[Irritation]]
|
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
* [[Transvaginal ultrasound|Transvaginal utrasonography]]
| style="background: #F5F5F5; padding: 5px;" |[[Anoscopy]]
|
* Anal wall laceration
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |Clinical
|-
|-
| rowspan="2" |Gynecological diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
|[[Endometritis]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bowel frequency
|LLQ
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
|<nowiki>-</nowiki>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
|<nowiki>+</nowiki>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenesmus
|<nowiki>-</nowiki>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
|<nowiki>+</nowiki>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
|
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Colonoscopy
* No specific tests
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
|
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other diagnostic study
* Ultrasound is helpful to rule out other differential diagnosis such as [[pelvic abscess]], [[thrombosis]] and [[Tumor|masses]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
* [[Vaginal discharge]]
 
* [[Vaginal bleeding]]
|-
|-
|[[Salpingitis]]  
| 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>
|LLQ/ RLQ
| 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;" |
|
* [[Fever]], [[Rigor|chills]]
* [[Nausea and vomiting|N/V]]
* [[Bloating]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Patchy or diffuse [[Erythematous|erythematous mucosa]]
* [[Edema]], [[hemorrhage]], with or without [[ulcers]] of [[Mucous membrane|mucosa]]
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |'''Stool analysis'''
* [[Leukocytosis]]
* [[Leukocytosis]]
|
'''Stool cultures'''
* [[Pelvic ultrasound]]
| style="background: #F5F5F5; padding: 5px;" |
|
* N/A
* [[Vaginal discharge]]
| 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>V
| 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;" | +


*The table below summarizes the findings that differentiate colorectal cancer from other common conditions that cause unexplained [[weight loss]], unexplained [[loss of appetite]], [[nausea]], [[vomiting]], [[diarrhea]], [[anemia]], [[jaundice]], and  <ref><nowiki>{{Colorectal Cancer [Internet]. BMJ Publishing Group. 2011 [updated 2013 Feb 4]. Available from: </nowiki>http://bestpractice.bmj.com/best-practice/monograph/258/diagnosis/differential.html<nowiki>}}</nowiki></ref>.
[[Left lower quadrant abdominal pain resident survival guide|LLQ]]
{| style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" cellspacing="0" cellpadding="4" {{table}}
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background:#f0f0f0;" align="center" |'''Condition'''
| style="background: #F5F5F5; padding: 5px;" |
 
* [[Weight loss|Weight loss]]
| style="background:#f0f0f0;" align="center" |'''Differentiating Signs/Symptoms'''
* [[Diarrhea]] with[[mucus]]  
 
* Urgency
| style="background:#f0f0f0;" align="center" |'''Differentiating Tests'''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Continuous lesions
* [[Erythema]] (or redness of the [[mucosa]]) and friability of the [[mucosa]]
* [[Crypt (anatomy)|Crypts]], formation of residual [[Mucous membrane|mucosal tissue]]
* [[Polyp (medicine)|Pseudopolyps]]
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* [[Mucous membrane|Mucosal]] and [[Submucosa|submucosal]] [[inflammation]]
* [[Hemorrhages|Hemorrhage]] or [[Inflammation|inflammatory]] [[Neutrophil|polymorphonuclear cells]] aggregate in the [[lamina propria]]
* Distorted [[Crypt (anatomy)|crypts]]
* [[Crypt abscess]]
| 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: #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;" |
* [[Nausea and vomiting|N/V]]
* [[Bowel obstruction]]
* [[Fever]]
*
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Discontinuous lesions
* [[Strictures]]
* Linear [[Ulcer|ulcerations]]
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* Transmural pattern of [[inflammation]]
* [[Mucous membrane|Mucosal]] damage
* Focal [[Infiltration (medical)|infiltration]] of [[White blood cells|leukocytes]] into the [[epithelium]]
* [[Granuloma|Granulomas]]
| 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>
| '''[[Irritable Bowel Syndrome|Irritable Bowel Syndrome (IBS)]]'''||A clinical diagnosis is based on either Rome I, II, or III Criteria.
| style="background: #F5F5F5; padding: 5px; text-align: center;" |↑ ↓
* '''Rome I''': is continuous or recurrent symptoms for at least 3 months; [[abdominal pain]] or [[discomfort]], relieved with [[defecation]] and/or associated with change in frequency and/or consistency of stool; and an irregular pattern of [[defecation]] with at least 25% of the time with two or more of the following: altered stool frequency, altered stool form, altered stool passage, passage of mucus, [[bloating]] or feeling of [[abdominal distention]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
* '''Rome II''' is at least 12 weeks of [[abdominal discomfort]] or [[Pain(patient information)|pain]], which need not be consecutive, in the preceding 12 months with two or more of the following: relieved with [[defecation]], onset associated with a change in frequency of stool, onset associated with a change in form of stool
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
* '''Rome III''' is recurrent [[abdominal pain]] or discomfort 3 days per month in the last 3 months, associated with two or more of the following: improvement of [[abdominal pain]] with [[defecation]], change in [[frequency]] of stool, change in appearance of stool; with onset at least 6 months prior to diagnosis
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|
| style="background: #F5F5F5; padding: 5px;" |
* There is no specific diagnostic test for [[Irritable bowel syndrome|IBS]]; patients who fulfill the clinical criteria for [[IBS]] and have no alarm features have a very low probability of organic disease
* [[Weight loss]]
* [[Colonoscopy]] or [[Colon (anatomy)|colonic imaging]] is recommended for patients older than 50 years of age due to higher pre-test probability of colorectal cancer
* Straining
 
* [[Urgency]]
* [[Mucus]] passage
* [[Bloating]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Not recommended
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |'''Diagnosis of exclusion'''
* Fulfilment of [[Irritable bowel syndrome diagnostic criteria|Rome criteria]]
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| 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
| '''[[Ulcerative Colitis]]'''||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bowel frequency
* The average age of onset of [[inflammatory bowel disease]] (20 to 40 years) is younger than with colorectal cancer
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
* Patients with [[inflammatory bowel disease]] frequently have [[watery diarrhea]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
* Patients with [[colitis]] are at higher risk of colorectal cancer and may need reassessment if symptoms are atypical or do not respond to treatment
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenesmus
|[[Colonoscopy]] shows:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
* [[rectal]] involvement
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
* Continuous uniform involvement
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Colonoscopy
* Loss of vascular marking
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
* Diffuse [[erythema]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other diagnostic study
* Mucosal granularity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
* Normal terminal ileum (or mild 'backwash' [[ileitis]] in [[pancolitis]])
! 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: #F5F5F5; padding: 5px; text-align: center;" |[[Diarrhea|↑]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +


| '''[[Crohn's disease|Crohn's Disease]]'''||
[[Right lower quadrant abdominal pain resident survival guide|RLQ]]
* Patients with [[colitis]] are at higher risk of colorectal cancer and need reassessment if symptoms are atypical or do not respond to treatment
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|[[Colonoscopy]] with [[intubation]] of the [[ileum]] is the definitive test to diagnose [[Crohn's disease]] and will show:
| style="background: #F5F5F5; padding: 5px;" |
* [[Mucosal|Mucosal inflammation]]  
* Pain starting periumbilical before localizing to the [[Right lower quadrant abdominal pain resident survival guide|RLQ]]
* Discrete deep or superficial [[ulcers]] located transversely and longitudinally, creating a cobblestone appearance
* [[Nausea and vomiting|N/V]]
* [[Lesions]] that are discontinuous, with intermittent areas of normal-appearing bowel (skip lesions)
* [[Fever]]
 
* [[Rigor|Chills]]
* [[Anorexia|Loss of appetite]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* [[Appendicitis CT|Appendiceal]] wall thickening (≥ 3mm)
* Periappendiceal fat stranding
* Thick [[Fascia|lateral conal fascia]] and [[mesoappendix]]
* Extraluminal fluid
* [[Phlegmon]]
* [[Abscess]]
| style="background: #F5F5F5; padding: 5px;" |
'''Ultrasound'''
* Aperistaltic, noncompressible, dilated [[Appendicitis ultrasound|appendix]] (>6 mm)
* [[Appendicolith]]
* Echogenic prominent pericaecal fat
* Periappendiceal fluid collection
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]
|-
|-
| 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;" | +


| '''[[Hemorrhoids]]'''||
[[Right lower quadrant abdominal pain resident survival guide|RLQ]]
* Bright red [[rectal bleeding]] that is separate from the stool
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
* No [[abdominal discomfort]] or [[pain]]
| style="background: #F5F5F5; padding: 5px;" |
* Altered bowel habits
* [[Nausea and vomiting|N/V]]
* [[Weight loss]]
* Heaviness/dull discomfort in the groin, with straining, lifting, [[Cough|coughing]], or [[Physical exercise|exercising]]
|
* [[Weakness]], heaviness, burning, or aching in the groin
* [[Colonoscopy]] or colonic imaging is recommended in patients with abdominal symptoms in addition to [[rectal bleeding]] and in those older than 50 years of age
* [[Swelling]]
* [[Fever]]


| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* [[Abdominal wall defect|Defect in the abdominal wall]] [[Rectus abdominis muscle|muscles]]
* [[Intestine|Bowel loops]] within the lesion
* Lateral crescent sign
* The [[Hernia|hernia neck]] superolateral to the course of the inferior [[epigastric]] vessels
*
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
* Hypoechoic mass suggesting dilated and edematous [[Intestine|intestinal segment]]
| style="background: #F5F5F5; padding: 5px;" |
* 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>
| '''[[Anal Fissure]]'''||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |↑ or ↓
* Severe pain on [[defecation]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
* Blood is usually present on wiping
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
* No [[abdominal discomfort]] or [[pain]]
[[Pelvic pain|Pelvic]]
* Altered bowel habits
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
* [[Weight loss]]
| style="background: #F5F5F5; padding: 5px;" |
|
* [[Dyschezia]]
* [[Colonoscopy]] or colonic imaging is recommended in patients with abdominal symptoms in addition to rectal bleeding and in those older than 50 years of age
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
 
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |'''Transvaginal ultrasound'''
* Heterogeneous, hypoechoic, spiculated mass
'''T1-weighted or fat-suppression T1-weighted MRIs'''
* Contrast enhanced mass
* Hyperintense [[hemorrhagic]]  
* Hyperintense [[Cavity|cavities]]  
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| 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>
| '''[[Diverticular disease]]'''||
* [[Diverticular disease|Diverticular stricture]] or [[Inflammatory|inflammatory mass]] may be clinically indistinguishable from colorectal cancer
|
* [[Colonoscopy]] with [[biopsies]] and [[Computed tomography|CT imaging]] will usually differentiate [[diverticular disease]] from colorectal cancer
 
|}
|}
 
</small>
'''Other conditions that can be mistaken for colorectal cancer include the following:'''
</div>
*Benign colon polyps
*[[Ischemic colitis]]
*[[Infectious colitis]]
*[[Arteriovenous malformation]] ([[AVM]])
*[[Carcinoid]]/[[neuroendocrine]] tumors
*[[Small intestine]] carcinomas
*Gastrointestinal lymphoma
*[[Ileus]]
*[[Pregnancy]]
*[[Appendicitis]]
*[[Hernia]]
*[[Lactose intolerance]]
*[[Flatulence]]
*[[Ulcer]]
*[[Cholecystitis]]


==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

References

  1. ↑ Laurell H, Hansson LE, Gunnarsson U (2007). "Acute diverticulitis--clinical presentation and differential diagnostics". Colorectal Dis. 9 (6): 496–501, discussion 501-2. doi:10.1111/j.1463-1318.2006.01162.x. PMID 17573742.
  2. ↑ Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
  3. ↑ Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.
  4. ↑ Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016
  5. ↑ Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016
  6. ↑ Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.
  7. ↑ Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C (1994). "Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum". Oncology. 51 (1): 30–4. doi:10.1159/000227306. PMID 8265100.
  8. ↑ Zhong ME, Niu BZ, Ji WY, Wu B (June 2016). "Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer". World J. Gastroenterol. 22 (22): 5293–6. doi:10.3748/wjg.v22.i22.5293. PMID 27298573.
  9. ↑ Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan (2009). "Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach". World Journal of Gastroenterology. 15 (43): 5397. doi:10.3748/wjg.15.5397. ISSN 1007-9327.
  10. ↑ Giardiello, F; Trimbath, J (2006). "Peutz-Jeghers Syndrome and Management Recommendations". Clinical Gastroenterology and Hepatology. 4 (4): 408–415. doi:10.1016/j.cgh.2005.11.005. ISSN 1542-3565.
  11. ↑ Beggs, A. D.; Latchford, A. R.; Vasen, H. F. A.; Moslein, G.; Alonso, A.; Aretz, S.; Bertario, L.; Blanco, I.; Bulow, S.; Burn, J.; Capella, G.; Colas, C.; Friedl, W.; Moller, P.; Hes, F. J.; Jarvinen, H.; Mecklin, J.-P.; Nagengast, F. M.; Parc, Y.; Phillips, R. K. S.; Hyer, W.; Ponz de Leon, M.; Renkonen-Sinisalo, L.; Sampson, J. R.; Stormorken, A.; Tejpar, S.; Thomas, H. J. W.; Wijnen, J. T.; Clark, S. K.; Hodgson, S. V. (2010). "Peutz-Jeghers syndrome: a systematic review and recommendations for management". Gut. 59 (7): 975–986. doi:10.1136/gut.2009.198499. ISSN 0017-5749.
  12. ↑ Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan (2009). "Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach". World Journal of Gastroenterology. 15 (43): 5397. doi:10.3748/wjg.15.5397. ISSN 1007-9327.
  13. ↑ Chung TP, Hunt SR (May 2006). "Carcinoid and neuroendocrine tumors of the colon and rectum". Clin Colon Rectal Surg. 19 (2): 45–8. doi:10.1055/s-2006-942343. PMC 2780103. PMID 20011309.
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  16. ↑ Fang C, Wang W, Zhang Y, Feng X, Sun J, Zeng Y, Chen Y, Li Y, Chen M, Zhou Z, Chen J (June 2017). "Clinicopathologic characteristics and prognosis of gastroenteropancreatic neuroendocrine neoplasms: a multicenter study in South China". Chin J Cancer. 36 (1): 51. doi:10.1186/s40880-017-0218-3. PMC 5480192. PMID 28637502.
  17. ↑ Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq
  18. ↑ Grotsky HW, Rickert RR, Smith WD, Newsome JF (March 1982). "Familial juvenile polyposis coli. A clinical and pathologic study of a large kindred". Gastroenterology. 82 (3): 494–501. PMID 7054044.
  19. ↑ Brosens LA, Langeveld D, van Hattem WA, Giardiello FM, Offerhaus GJ (November 2011). "Juvenile polyposis syndrome". World J. Gastroenterol. 17 (44): 4839–44. doi:10.3748/wjg.v17.i44.4839. PMC 3235625. PMID 22171123.
  20. ↑ Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
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  22. ↑ Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
  23. ↑ Niazi AK, Kaley K, Saif MW (May 2014). "Gastrointestinal stromal tumor of colon: a case report and review of literature". Anticancer Res. 34 (5): 2547–50. PMID 24778074.
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  29. ↑ 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 (April 2002). "Diagnosis of gastrointestinal stromal tumors: a consensus approach". Int. J. Surg. Pathol. 10 (2): 81–9. doi:10.1177/106689690201000201. PMID 12075401.
  30. ↑ Cauchin E, Touchefeu Y, Matysiak-Budnik T (September 2015). "Hamartomatous Tumors in the Gastrointestinal Tract". Gastrointest Tumors. 2 (2): 65–74. doi:10.1159/000437175. PMC 4668787. PMID 26672891.
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  32. ↑ Quayle, Frank; Lowney, Jennifer (2006). "Colorectal Lymphoma". Clinics in Colon and Rectal Surgery. 19 (2): 049–053. doi:10.1055/s-2006-942344. ISSN 1531-0043.
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  34. ↑ Lee HH, Kwon HM, Gil S, Kim YS, Cho M, Seo KJ, Chae HS, Cho YS (2017). "Endoscopic resection of asymptomatic, colonic, polypoid arteriovenous malformations: Two case reports and a literature review". Saudi J Gastroenterol. 23 (1): 67–70. doi:10.4103/1319-3767.199111. PMC 5329980. PMID 28139503.
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  36. ↑ Shen, Shu-Huei; Chen, Jen-Dar; Tiu, Chui-Mei; Chou, Yi-Hong; Chiang, Jen-Huei; Chang, Cheng-Yen; Lee, Chen-Hsen (2005). "Differentiating Colonic Diverticulitis from Colon Cancer: The Value of Computed Tomography in the Emergency Setting". Journal of the Chinese Medical Association. 68 (9): 411–418. doi:10.1016/S1726-4901(09)70156-X. ISSN 1726-4901.
  37. ↑ Sheiman, Laura; Levine, Marc S.; Levin, Alicia A.; Hogan, Jonathan; Rubesin, Stephen E.; Furth, Emma E.; Laufer, Igor (2008). "Chronic Diverticulitis: Clinical, Radiographic, and Pathologic Findings". American Journal of Roentgenology. 191 (2): 522–528. doi:10.2214/AJR.07.3597. ISSN 0361-803X.
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