Differentiating carcinoid syndrome from other diseases: Difference between revisions

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__NOTOC__
__NOTOC__
{{Carcinoid syndrome}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Carcinoid_syndrome]]
{{CMG}}{{AE}}{{PSD}}
{{CMG}}{{AE}}{{PSD}}
==Overview==
==Overview==
Carcinoid syndrome must be differentiated from [[systemic mastocytosis]], [[medullary thyroid carcinoma]], [[irritable bowel syndrome]], [[malignant neoplasms]] of the [[small intestine]], [[Flushing|benign cutaneous flushing]], and [[Anaphylaxis|recurrent idiopathic anaphylaxis]].
[[Carcinoid Syndrome|Carcinoid syndrome]] must be differentiated from [[systemic mastocytosis]], [[medullary thyroid carcinoma]], [[irritable bowel syndrome]], [[malignant neoplasms]] of the [[small intestine]], [[Flushing|benign cutaneous flushing]], and [[Anaphylaxis|recurrent idiopathic anaphylaxis]].


==Differentiating Carcinoid Syndrome from other Diseases==
==Differentiating Carcinoid Syndrome from other Diseases==
Carcinoid syndrome must be differentiated from:<ref name="pmid10748948">{{cite journal| author=Metcalfe DD| title=Differential diagnosis of the patient with unexplained flushing/anaphylaxis. | journal=Allergy Asthma Proc | year= 2000 | volume= 21 | issue= 1 | pages= 21-4 | pmid=10748948 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10748948  }} </ref>
[[Carcinoid Syndrome|Carcinoid syndrome]] must be differentiated from:<ref name="pmid10748948">{{cite journal| author=Metcalfe DD| title=Differential diagnosis of the patient with unexplained flushing/anaphylaxis. | journal=Allergy Asthma Proc | year= 2000 | volume= 21 | issue= 1 | pages= 21-4 | pmid=10748948 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10748948  }} </ref>
*[[Systemic mastocytosis]]
*[[Systemic mastocytosis]]
*[[Medullary thyroid carcinoma]]
*[[Medullary thyroid carcinoma]]
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*[[Anaphylaxis|Recurrent idiopathic anaphylaxis]]
*[[Anaphylaxis|Recurrent idiopathic anaphylaxis]]


On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! colspan="2" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
!
| colspan="9" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
| colspan="9" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
|
|
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! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
|-
|
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
|
|
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!
!
|-
|-
!
!
!
!
!
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! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
|-
!
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Abdominal pain]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Diarrhea]]
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diarrhea
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Flushing]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Flushing
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Dyspnea]]
!Dyspnea
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Palpitations]]
!Palpitations
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
!Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Wheezing]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Wheezing
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Telangiectasia]]
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Telangiectasia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Hypotension]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hypotension
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Tachycardia]]
!Tachycardia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Systolic murmurs|Systolic murmur]] of [[tricuspid regurgitation]]
!Systolic murmur of tricuspid regurgitation
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other physical findings
!Other physical findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinary 5-hydroxyindoleacetic acid (5-HIAA)
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinary 5-hydroxyindoleacetic acid (5-HIAA)
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Serum Chromogranin A (CgA)
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Serum [[Chromogranin]] A (CgA)
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other markers
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other markers
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal computed tomography (CT)
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Computed tomography|Abdominal computed tomography]] (CT)
!MRI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Mri|Abdominal MRI]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Somatostatin receptor scintigraphy [SRS], or Octreoscan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Somatostatin receptor scintigraphy [SRS], or Octreoscan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Metaiodobenzylguanidine (MIBG) scintigraphy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Metaiodobenzylguanidine (MIBG) scintigraphy
!Other diagnostic studies
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other diagnostic studies
!
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Transthoracic echocardiography
* Transthoracic echocardiography
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Carcinoid Syndrome<ref name="pmid30133565">{{cite journal |vauthors=Rubin de Celis Ferrari AC, Glasberg J, Riechelmann RP |title=Carcinoid syndrome: update on the pathophysiology and treatment |journal=Clinics (Sao Paulo) |volume=73 |issue=suppl 1 |pages=e490s |date=August 2018 |pmid=30133565 |pmc=6096975 |doi=10.6061/clinics/2018/e490s |url=}}</ref><ref name="pmid14693013">{{cite journal |vauthors=Hegyi J, Schwartz RA, Hegyi V |title=Pellagra: dermatitis, dementia, and diarrhea |journal=Int. J. Dermatol. |volume=43 |issue=1 |pages=1–5 |date=January 2004 |pmid=14693013 |doi= |url=}}</ref><ref name="pmid15100502">{{cite journal |vauthors=Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E |title=Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours |journal=Nucl Med Commun |volume=25 |issue=5 |pages=445–9 |date=May 2004 |pmid=15100502 |doi= |url=}}</ref><ref name="pmid151005022">{{cite journal |vauthors=Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E |title=Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours |journal=Nucl Med Commun |volume=25 |issue=5 |pages=445–9 |date=May 2004 |pmid=15100502 |doi= |url=}}</ref>
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Carcinoid Syndrome<ref name="pmid30133565">{{cite journal |vauthors=Rubin de Celis Ferrari AC, Glasberg J, Riechelmann RP |title=Carcinoid syndrome: update on the pathophysiology and treatment |journal=Clinics (Sao Paulo) |volume=73 |issue=suppl 1 |pages=e490s |date=August 2018 |pmid=30133565 |pmc=6096975 |doi=10.6061/clinics/2018/e490s |url=}}</ref><ref name="pmid14693013">{{cite journal |vauthors=Hegyi J, Schwartz RA, Hegyi V |title=Pellagra: dermatitis, dementia, and diarrhea |journal=Int. J. Dermatol. |volume=43 |issue=1 |pages=1–5 |date=January 2004 |pmid=14693013 |doi= |url=}}</ref><ref name="pmid15100502">{{cite journal |vauthors=Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E |title=Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours |journal=Nucl Med Commun |volume=25 |issue=5 |pages=445–9 |date=May 2004 |pmid=15100502 |doi= |url=}}</ref><ref name="pmid151005022">{{cite journal |vauthors=Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E |title=Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours |journal=Nucl Med Commun |volume=25 |issue=5 |pages=445–9 |date=May 2004 |pmid=15100502 |doi= |url=}}</ref><ref name="BoraVithiavathi2012">{{cite journal|last1=Bora|first1=ManashKumar|last2=Vithiavathi|first2=S|title=Primary bronchial carcinoid: A rare differential diagnosis of pulmonary koch in young adult patient|journal=Lung India|volume=29|issue=1|year=2012|pages=59|issn=0970-2113|doi=10.4103/0970-2113.92366}}</ref><ref name="pmid25207053">{{cite journal |vauthors=Yazıcıoğlu A, Yekeler E, Bıcakcıoğlu P, Ozaydın E, Karaoğlanoğlu N |title=Synchronous bilateral multiple typical pulmonary carcinoid tumors: a unique case with 10 typical carcinoids |journal=Balkan Med J |volume=29 |issue=4 |pages=450–2 |date=December 2012 |pmid=25207053 |pmc=4115868 |doi=10.5152/balkanmedj.2012.081 |url=}}</ref><ref name="pmid14616879">{{cite journal |vauthors=Krausz Y, Keidar Z, Kogan I, Even-Sapir E, Bar-Shalom R, Engel A, Rubinstein R, Sachs J, Bocher M, Agranovicz S, Chisin R, Israel O |title=SPECT/CT hybrid imaging with 111In-pentetreotide in assessment of neuroendocrine tumours |journal=Clin. Endocrinol. (Oxf) |volume=59 |issue=5 |pages=565–73 |date=November 2003 |pmid=14616879 |doi= |url=}}</ref><ref name="van der LelyHerder2005">{{cite journal|last1=van der Lely|first1=Aart J.|last2=Herder|first2=Wouter W. de|title=Carcinoid syndrome: diagnosis and medical management|journal=Arquivos Brasileiros de Endocrinologia & Metabologia|volume=49|issue=5|year=2005|pages=850–860|issn=0004-2730|doi=10.1590/S0004-27302005000500028}}</ref><ref name="pmid28238592">{{cite journal |vauthors=Halperin DM, Shen C, Dasari A, Xu Y, Chu Y, Zhou S, Shih YT, Yao JC |title=Frequency of carcinoid syndrome at neuroendocrine tumour diagnosis: a population-based study |journal=Lancet Oncol. |volume=18 |issue=4 |pages=525–534 |date=April 2017 |pmid=28238592 |pmc=6066284 |doi=10.1016/S1470-2045(17)30110-9 |url=}}</ref>
|
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neuroendocrine tumor]] of [[midgut]] <ref name="pmid3227292">{{cite journal |vauthors=Sjöblom SM |title=Clinical presentation and prognosis of gastrointestinal carcinoid tumours |journal=Scand. J. Gastroenterol. |volume=23 |issue=7 |pages=779–87 |date=September 1988 |pmid=3227292 |doi= |url=}}</ref><ref name="pmid24059366">{{cite journal |vauthors=Ganeshan D, Bhosale P, Yang T, Kundra V |title=Imaging features of carcinoid tumors of the gastrointestinal tract |journal=AJR Am J Roentgenol |volume=201 |issue=4 |pages=773–86 |date=October 2013 |pmid=24059366 |doi=10.2214/AJR.12.9758 |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><ref name="pmid15887161">{{cite journal |vauthors=Modlin IM, Kidd M, Latich I, Zikusoka MN, Shapiro MD |title=Current status of gastrointestinal carcinoids |journal=Gastroenterology |volume=128 |issue=6 |pages=1717–51 |date=May 2005 |pmid=15887161 |doi= |url=}}</ref>
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Mild
Mild
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* Intermittent
* Intermittent
* Secretory type
* Secretory [[diarrhea]]
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|<nowiki>+</nowiki>
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|<nowiki>+</nowiki>
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|
* [[Pellagra]]
* Pellagra
[[Dermatitis]]
Dermatitis
 
[[Diarrhea]]


Diarrhea
[[Dementia]]


Dementia
[[Metastatic]] [[tumors]] in the [[Liver (2)|liver]]: [[Right upper quadrant]] pain, [[Hepatomegaly (new)|hepatomegaly]], and early [[satiety]]
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| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
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|<nowiki>+</nowiki>
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|
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* NT-proBNP
* [[NT-proBNP]]
** Screening of carcinoid heart disease
** [[Screening]] of [[Carcinoid disease|carcinoid heart disease]]
** Blood Serotonin levels
** Blood [[Serotonin]] levels
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* [[Neuroendocrine tumor]] of [[midgut]] are difficult to identify on [[CT]] because of their small size.
 
* Findings: [[Mass|mass-]]<nowiki/>like process with soft tissue "spokes" radiating into the [[mesenteric]] [[fat]] toward the [[small bowel]] causing retraction.
* [[Liver]] [[metastases]]
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*[[Sensitivity|Sensitive]] for detection of [[Liver (2)|liver]] [[metastases]]
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* Localization of [[carcinoid tumor]]
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* Localization of carcinoid tumor
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* 68-Ga DOTATATE [[PET scan]]
* Positron emission tomography-computed tomography (PET-CT) using 18-fluoro-dihydroxyphenylalanine
 
* [[Positron emission tomography-computed tomography]] ([[PET-CT]]) using 18[[-fluoro-dihydroxyphenylalanine]]
* Ki-67 labeling index
* Ki-67 labeling index
* [[Endoscopy]] for [[metastatic]] [[Neuroendocrine tumour]] with an unknown primary site.
|
|
* Valve thickening with retraction and reduction in the mobility of the tricuspid valve
* Valve thickening with retraction and reduction in the mobility of the [[Tricuspid valves|tricuspid valve]]
*  
*  
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* [[Enterochromaffin cells|Enterochromaffin]] [[cells]] stain with [[Potassium chromate|potassium chromate (chromaffin]]).
*On [[electron microscopy]] ,the [[cells]] in [[tumors]] are found to contain [[membrane]]-bound [[Granules|secretory granules]] with dense-core [[granules]] in the [[cytoplasm]].
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* Somatostatin receptor scintigraphy [SRS], or Octreoscan
* Somatostatin receptor scintigraphy [SRS], or [[Octreoscan]]
* [[Biopsy]] and [[histopathology]]
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* Mesenteric fibrosis  
* [[Mesenteric]] [[fibrosis]]
Pathognomonic radiological sign of midgut NET.
Pathognomonic radiological sign of [[midgut]] [[Neuroendocrine tumor|NET]].
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Irritable Bowel Syndrome
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neuroendocrine tumor]] of [[lung]]<ref name="pmid18473355">{{cite journal |vauthors=Gustafsson BI, Kidd M, Chan A, Malfertheiner MV, Modlin IM |title=Bronchopulmonary neuroendocrine tumors |journal=Cancer |volume=113 |issue=1 |pages=5–21 |date=July 2008 |pmid=18473355 |doi=10.1002/cncr.23542 |url=}}</ref><ref name="JeungGasser2002">{{cite journal|last1=Jeung|first1=Mi-Young|last2=Gasser|first2=Bernard|last3=Gangi|first3=Afshin|last4=Charneau|first4=Dominique|last5=Ducroq|first5=Xavier|last6=Kessler|first6=Romain|last7=Quoix|first7=Elisabeth|last8=Roy|first8=Catherine|title=Bronchial Carcinoid Tumors of the Thorax: Spectrum of Radiologic Findings|journal=RadioGraphics|volume=22|issue=2|year=2002|pages=351–365|issn=0271-5333|doi=10.1148/radiographics.22.2.g02mr01351}}</ref><ref name="pmid1649924">{{cite journal |vauthors=Nessi R, Basso Ricci P, Basso Ricci S, Bosco M, Blanc M, Uslenghi C |title=Bronchial carcinoid tumors: radiologic observations in 49 cases |journal=J Thorac Imaging |volume=6 |issue=2 |pages=47–53 |date=April 1991 |pmid=1649924 |doi= |url=}}</ref><ref name="pmid5831899">{{cite journal |vauthors=Melmon KL, Sjoerdsma A, Mason DT |title=Distinctive clinical and therapeutic aspects of the syndrome associated with bronchial carcinoid tumors |journal=Am. J. Med. |volume=39 |issue=4 |pages=568–81 |date=October 1965 |pmid=5831899 |doi= |url=}}</ref>
|
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* [[Cough]]
* [[Hemoptysis]]
* [[Chest pain]]
* [[Fever]] due to [[Pneumonia|post -obstructuve pneuomnia]]
*
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| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
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| style="background: #F5F5F5; padding: 5px;" | -
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* Intermittent
* [[Immunohistochemical  stains]]:
* Chronic history
* [[Synaptophysin]]
* [[Neuron-specific enolase]]
 
* [[NT-proBNP]]
* Low [[serotonin]] content as compared to [[midgut]] [[Tumors|tumors.]]
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* Atypical [[neuroendocrine tumors]] have a greater tendency to [[metastasize]] to [[Liver|liver,]][[hypervascular]], and becomies isodense relative to th[[Liver|e liver]] [[parenchyma]] after [[contrast]] administration.
|
 
|
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| style="background: #F5F5F5; padding: 5px;" |[[Sensitivity (tests)|Sensitive]] for detection o[[Liver (2)|f liver]] [[metastases]] if present
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* [[Chest X ray]]: round or oval [[Opacity|opacities]] from 2-5cm with sharp and notched margins
* [[Chest]] [[CT]] : [[Hilar]] or Perihilar Masses, Endobronchial [[Nodules]],Related to [[Bronchial|bronchial Obstruction]]:peripheral [[atelectasis]] and postobstructive [[pneumonia]]
* [[PFTs|Pulmonary funcation test]]
* [[Bronchoscopy]]
* [[68-Ga DOTATATE PET scan]]
* Fluorodeoxyglucose [[PET scan|PET scans]] for atypical [[lung]] [[Neuroendocrine|NETs]] .
| -
| style="background: #F5F5F5; padding: 5px;" |Typical low-grade:bland cells containing regular round [[nuclei]] with finely dispersed [[chromatin]] and inconspicuous small [[nucleoli]].Mitotic figures are scarce and [[necrosis]] is absent.
Intermediate-grade atypical: presence of [[Neuroendocrine]] morphology and either [[necrosis]] or 2 to 10 [[mitoses]] per 10 HPF
|
* [[Biopsy]] and [[histopathology]]
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Irritable Bowel Syndrome]]<ref name="pmid18371141">{{cite journal |vauthors=Ford AC, Forman D, Bailey AG, Axon AT, Moayyedi P |title=Irritable bowel syndrome: a 10-yr natural history of symptoms and factors that influence consultation behavior |journal=Am. J. Gastroenterol. |volume=103 |issue=5 |pages=1229–39; quiz 1240 |date=May 2008 |pmid=18371141 |doi=10.1111/j.1572-0241.2007.01740.x |url=}}</ref><ref name="pmid28374308">{{cite journal |vauthors=Simren M, Palsson OS, Whitehead WE |title=Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice |journal=Curr Gastroenterol Rep |volume=19 |issue=4 |pages=15 |date=April 2017 |pmid=28374308 |pmc=5378729 |doi=10.1007/s11894-017-0554-0 |url=}}</ref><ref name="pmid12454865">{{cite journal |vauthors= |title=American Gastroenterological Association medical position statement: irritable bowel syndrome |journal=Gastroenterology |volume=123 |issue=6 |pages=2105–7 |date=December 2002 |pmid=12454865 |doi=10.1053/gast.2002.37095b |url=}}</ref><ref name="pmid27144627">{{cite journal |vauthors=Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R |title=Bowel Disorders |journal=Gastroenterology |volume= |issue= |pages= |date=February 2016 |pmid=27144627 |doi=10.1053/j.gastro.2016.02.031 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | +
Perioidic
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
* Intermittent
|
* Chronic history of [[Diarrhea|diarhea]] alternating with [[constipation]]
|
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*
* [[Fibromyalgia]]
* [[Chronic fatigue syndrome]]
* [[Gastroesophageal reflux disease]],
* [[Functional dyspepsia]]
* [[Non-cardiac chest pain]],
* [[Major depression]]
* ,[[Anxiety Disorder|Anxiety]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
|
|
|
* [[Bristol stool]] form scale should to record [[stool]] consistency
* [[Abdominal|Abdomina]]<nowiki/>l [[Radiographic|radiograph]] to assess for [[Stool|stoo]]<nowiki/>l accumulation and determine the severity.
* Age-appropriate [[colorectal cancer]] [[screening]] in all [[patients]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Rome IV criteria]]
* Recurrent [[abdominal pain]],  at least 1day/week in the last 3 months, a/s with 2 or more of the following criteria:
•Related to [[defecation]]
 
•Associated with a change in [[stool]] frequency
 
•Associated with a change in [[stool]] form (appearance)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Small intestine cancer|Malignant neoplasms of small intestine]]<ref name="pmid23789703">{{cite journal |vauthors=McLaughlin PD, Maher MM |title=Primary malignant diseases of the small intestine |journal=AJR Am J Roentgenol |volume=201 |issue=1 |pages=W9–14 |date=July 2013 |pmid=23789703 |doi=10.2214/AJR.12.8492 |url=}}</ref><ref name="pmid17372046">{{cite journal |vauthors=Hatzaras I, Palesty JA, Abir F, Sullivan P, Kozol RA, Dudrick SJ, Longo WE |title=Small-bowel tumors: epidemiologic and clinical characteristics of 1260 cases from the connecticut tumor registry |journal=Arch Surg |volume=142 |issue=3 |pages=229–35 |date=March 2007 |pmid=17372046 |doi=10.1001/archsurg.142.3.229 |url=}}</ref><ref name="pmid17026561">{{cite journal |vauthors=Lepage C, Bouvier AM, Manfredi S, Dancourt V, Faivre J |title=Incidence and management of primary malignant small bowel cancers: a well-defined French population study |journal=Am. J. Gastroenterol. |volume=101 |issue=12 |pages=2826–32 |date=December 2006 |pmid=17026561 |doi=10.1111/j.1572-0241.2006.00854.x |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Constipation]]
|-
* [[Fatigue]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Systemic mastocytosis
* Early [[satiety]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |* [[Abdominal mass]]
* [[Ascites]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Abdominal]] [[CT scan]] may be diagnostic of [[Small intestine cancer|small intestine cancer.]] Findings on [[CT scan]] suggestive of [[Small intestine cancer CT|small intestine cancer]] include intrinsic [[mass]] with a short segment of [[Bowel|bowel wall]] thickening
| style="background: #F5F5F5; padding: 5px;" |[[MRI]] and [[MRI enteroscopy]] are other advance modalities to [[diagnose]] and [[Staging (pathology)|stage]] [[Small intestine cancer|small intestinal cancers]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Endoscopy|Enteroscopy]], [[capsule endoscopy]] and double balloon [[enteroscopy]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Adenocarcinoma|Adenocarcinomas]] may be polypoid, infiltrating, or as annular constricting lesions is [[small intestine]].
| style="background: #F5F5F5; padding: 5px;" |
*[[Polyps]] and [[adenomas]] of [[small intestine]] are considered precursor lesions of [[adenocarcinoma]].
|
*[[Lymphoma|Lymphomas]] of [[small intestine]] present with suspicious growths in [[submucosa]] with normal appearing [[muscosa]].
|
*[[Endoscopy|Endoscopic]] evaluation may show multifocal involvement and large [[biopsies]] are required for diagnoses
|[[Biopsy]] and [[histopathology]]
|
|
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Crohn disease]]<ref name="pmid18649092">{{cite journal |vauthors=Hara AK, Swartz PG |title=CT enterography of Crohn's disease |journal=Abdom Imaging |volume=34 |issue=3 |pages=289–95 |date=2009 |pmid=18649092 |doi=10.1007/s00261-008-9443-1 |url=}}</ref><ref name="BaumgartSandborn2012">{{cite journal|last1=Baumgart|first1=Daniel C|last2=Sandborn|first2=William J|title=Crohn's disease|journal=The Lancet|volume=380|issue=9853|year=2012|pages=1590–1605|issn=01406736|doi=10.1016/S0140-6736(12)60026-9}}</ref><ref name="FeuersteinCheifetz2017">{{cite journal|last1=Feuerstein|first1=Joseph D.|last2=Cheifetz|first2=Adam S.|title=Crohn Disease: Epidemiology, Diagnosis, and Management|journal=Mayo Clinic Proceedings|volume=92|issue=7|year=2017|pages=1088–1103|issn=00256196|doi=10.1016/j.mayocp.2017.04.010}}</ref><ref name="García-BoschOrdás2016">{{cite journal|last1=García-Bosch|first1=O.|last2=Ordás|first2=I.|last3=Aceituno|first3=M.|last4=Rodríguez|first4=S.|last5=Ramírez|first5=A. M.|last6=Gallego|first6=M.|last7=Ricart|first7=E.|last8=Rimola|first8=J.|last9=Panes|first9=J.|title=Comparison of Diagnostic Accuracy and Impact of Magnetic Resonance Imaging and Colonoscopy for the Management of Crohn’s Disease|journal=Journal of Crohn's and Colitis|volume=10|issue=6|year=2016|pages=663–669|issn=1873-9946|doi=10.1093/ecco-jcc/jjw015}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Right lower quadrant abdominal pain resident survival guide|Right lower quadrant]] [[pain]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Gross [[bloody diarrhea]] +/-
* [[Weight loss]]
* [[Fatigue (physical)|Fatigue]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
*
|
* [[Weight loss]]
|
* [[Pallor]]
* [[Oral lesions]]
* [[Odynophagia]]
* [[Dysphagia]]
* Perianal skin tags
* [[Sinus tracts]]
* [[Gallstones]]
* Extraintestinal manifestations
* [[Arthritis]]
* [[Uveitis]], [[Iritis]], and [[Episcleritis]]
* [[Erythema nodosum]] and [[Pyoderma gangrenosum]]
* [[Primary sclerosing cholangitis]]
* Secondary [[amyloidosis]]
* [[Thromboembolism]]
* [[Renal stones]]
* [[Osteoporosis]]
* [[Vitamin B12 deficiency]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[CRP]]  may be high
* [[p-ANCA]] and [[Anti saccharomyces cerevisiae antibodies|ASCA]]
*
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* CT enterography [[:Small bowel]] [[inflammation]] by displaying mural hyperenhancement and thickening; engorged [[vasa recta]]; and [[perienteric]] [[inflammatory]] changes.
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
|
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
|
|
* [[CBC]]
* [[Blood chemistry tests|Blood chemistry]] including [[Electrolyte|electrolytes]]
* [[Kidney function|Renal function tests]]
* [[liver enzymes]]
* [[Blood glucose]]
* [[ESR]]
* [[CRP]]
* [[Serum iron]]
* [[Vitamin D]] & [[vitamin B12 levels]]
* [[Stool D/R]] and [[Culture media|culture]] for [[ova]] and [[parasites]],
* [[Clostridium difficile|''C. difficile'' toxin]]
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Focal ulcerations and acute and chronic inflammation
* [[Granulomas]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Colonoscopic|Colonoscop]]<nowiki/>y:focal ulcerations adjacent to areas of normal appearing [[mucosa]] along with polypoid mucosa[[Skip lesion|l,skip lesion]]<nowiki/>s,[[pseudopolyps]],
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
|Malignant neoplasms of small intestine
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Benign cutaneous flushing]]<ref name="IziksonEnglish2006">{{cite journal|last1=Izikson|first1=Leonid|last2=English|first2=Joseph C.|last3=Zirwas|first3=Matthew J.|title=The flushing patient: Differential diagnosis, workup, and treatment|journal=Journal of the American Academy of Dermatology|volume=55|issue=2|year=2006|pages=193–208|issn=01909622|doi=10.1016/j.jaad.2005.07.057}}</ref><ref name="İkizoğlu2014">{{cite journal|last1=İkizoğlu|first1=Güliz|title=Red face revisited: Flushing|journal=Clinics in Dermatology|volume=32|issue=6|year=2014|pages=800–808|issn=0738081X|doi=10.1016/j.clindermatol.2014.02.019}}</ref><ref name="SadeghianRouhana2017">{{cite journal|last1=Sadeghian|first1=Azeen|last2=Rouhana|first2=Hailey|last3=Oswald-Stumpf|first3=Brittany|last4=Boh|first4=Erin|title=Etiologies and management of cutaneous flushing|journal=Journal of the American Academy of Dermatology|volume=77|issue=3|year=2017|pages=391–402|issn=01909622|doi=10.1016/j.jaad.2016.12.031}}</ref>
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | +
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
| style="background: #F5F5F5; padding: 5px;" | -
|
|
|
|-
|-
|Benign cutaneous flushing
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mastocytosis|Systemic mastocytosis]]<ref name="HartmannEscribano2016">{{cite journal|last1=Hartmann|first1=Karin|last2=Escribano|first2=Luis|last3=Grattan|first3=Clive|last4=Brockow|first4=Knut|last5=Carter|first5=Melody C.|last6=Alvarez-Twose|first6=Ivan|last7=Matito|first7=Almudena|last8=Broesby-Olsen|first8=Sigurd|last9=Siebenhaar|first9=Frank|last10=Lange|first10=Magdalena|last11=Niedoszytko|first11=Marek|last12=Castells|first12=Mariana|last13=Oude Elberink|first13=Joanna N.G.|last14=Bonadonna|first14=Patrizia|last15=Zanotti|first15=Roberta|last16=Hornick|first16=Jason L.|last17=Torrelo|first17=Antonio|last18=Grabbe|first18=Jürgen|last19=Rabenhorst|first19=Anja|last20=Nedoszytko|first20=Boguslaw|last21=Butterfield|first21=Joseph H.|last22=Gotlib|first22=Jason|last23=Reiter|first23=Andreas|last24=Radia|first24=Deepti|last25=Hermine|first25=Olivier|last26=Sotlar|first26=Karl|last27=George|first27=Tracy I.|last28=Kristensen|first28=Thomas K.|last29=Kluin-Nelemans|first29=Hanneke C.|last30=Yavuz|first30=Selim|last31=Hägglund|first31=Hans|last32=Sperr|first32=Wolfgang R.|last33=Schwartz|first33=Lawrence B.|last34=Triggiani|first34=Massimo|last35=Maurer|first35=Marcus|last36=Nilsson|first36=Gunnar|last37=Horny|first37=Hans-Peter|last38=Arock|first38=Michel|last39=Orfao|first39=Alberto|last40=Metcalfe|first40=Dean D.|last41=Akin|first41=Cem|last42=Valent|first42=Peter|title=Cutaneous manifestations in patients with mastocytosis: Consensus report of the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology|journal=Journal of Allergy and Clinical Immunology|volume=137|issue=1|year=2016|pages=35–45|issn=00916749|doi=10.1016/j.jaci.2015.08.034}}</ref><ref name="LeeWhittaker2008">{{cite journal|last1=Lee|first1=Jason K|last2=Whittaker|first2=Scott J|last3=Enns|first3=Robert A|last4=Zetler|first4=Peter|title=Gastrointestinal manifestations of systemic mastocytosis|journal=World Journal of Gastroenterology|volume=14|issue=45|year=2008|pages=7005|issn=1007-9327|doi=10.3748/wjg.14.7005}}</ref><ref name="pmid2002264">{{cite journal |vauthors=Horan RF, Austen KF |title=Systemic mastocytosis: retrospective review of a decade's clinical experience at the Brigham and Women's Hospital |journal=J. Invest. Dermatol. |volume=96 |issue=3 |pages=5S–13S; discussion 13S–14S |date=March 1991 |pmid=2002264 |doi= |url=}}</ref><ref name="SokolGeorgin-Lavialle2010">{{cite journal|last1=Sokol|first1=Harry|last2=Georgin-Lavialle|first2=Sophie|last3=Grandpeix-Guyodo|first3=Catherine|last4=Canioni|first4=Danielle|last5=Barete|first5=Stéphane|last6=Dubreuil|first6=Patrice|last7=Lortholary|first7=Olivier|last8=Beaugerie|first8=Laurent|last9=Hermine|first9=Olivier|title=Gastrointestinal involvement and manifestations in systemic mastocytosis|journal=Inflammatory Bowel Diseases|volume=16|issue=7|year=2010|pages=1247–1253|issn=1078-0998|doi=10.1002/ibd.21218}}</ref><ref name="pmid17063092">{{cite journal |vauthors=Bedeir A, Jukic DM, Wang L, Mullady DK, Regueiro M, Krasinskas AM |title=Systemic mastocytosis mimicking inflammatory bowel disease: A case report and discussion of gastrointestinal pathology in systemic mastocytosis |journal=Am. J. Surg. Pathol. |volume=30 |issue=11 |pages=1478–82 |date=November 2006 |pmid=17063092 |doi=10.1097/01.pas.0000213310.51553.d7 |url=}}</ref><ref name="KleeweinLang2011">{{cite journal|last1=Kleewein|first1=Kristin|last2=Lang|first2=Roland|last3=Diem|first3=Anja|last4=Vogel|first4=Tobias|last5=Pohla-Gubo|first5=Gabriela|last6=Bauer|first6=Johann W.|last7=Hintner|first7=Helmut|last8=Laimer|first8=Martin|title=Diffuse Cutaneous Mastocytosis Masquerading as Epidermolysis Bullosa|journal=Pediatric Dermatology|volume=28|issue=6|year=2011|pages=720–725|issn=07368046|doi=10.1111/j.1525-1470.2011.01479.x}}</ref><ref name="KatsudaOkada2008">{{cite journal|last1=Katsuda|first1=Shogo|last2=Okada|first2=Yoshikatsu|last3=Oda|first3=Yoshio|last4=Tanimoto|first4=Kazuo|last5=Takabatake|first5=Satoru|title=SYSTEMIC MASTOCYTOSIS WITHOUT CUTANEOUS INVOLVEMENT|journal=Pathology International|volume=37|issue=1|year=2008|pages=167–177|issn=13205463|doi=10.1111/j.1440-1827.1987.tb03144.x}}</ref>
|
| style="background: #F5F5F5; padding: 5px;" | +
|
| style="background: #F5F5F5; padding: 5px;" | +
|
| style="background: #F5F5F5; padding: 5px;" | +
|
| style="background: #F5F5F5; padding: 5px;" | +
|
| style="background: #F5F5F5; padding: 5px;" | -
|
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|-
|Recurrent idiopathic anaphylaxis
|
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Crohn disease
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Right lower quadrant pain
* [[Maculopapular rash]]
* [[Pruritus]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Diffuse [[musculoskeletal pain]]
* [[Neuropsychiatric symptoms]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| -
| -
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Activating [[mutations]] of ''[[KIT]]''
* Serum [[Tryptase]] levels
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
|
|
* oral lesions
* Perianal lesions
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* CRP  may be high
*
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|Endoscopy
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Asthma exacerbation  
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Asthma]] exacerbation<ref name="pmid22386508">{{cite journal |vauthors=Fuhlbrigge A, Peden D, Apter AJ, Boushey HA, Camargo CA, Gern J, Heymann PW, Martinez FD, Mauger D, Teague WG, Blaisdell C |title=Asthma outcomes: exacerbations |journal=J. Allergy Clin. Immunol. |volume=129 |issue=3 Suppl |pages=S34–48 |date=March 2012 |pmid=22386508 |pmc=3595577 |doi=10.1016/j.jaci.2011.12.983 |url=}}</ref><ref name="pmid16337448">{{cite journal |vauthors=Limb SL, Brown KC, Wood RA, Wise RA, Eggleston PA, Tonascia J, Adkinson NF |title=Irreversible lung function deficits in young adults with a history of childhood asthma |journal=J. Allergy Clin. Immunol. |volume=116 |issue=6 |pages=1213–9 |date=December 2005 |pmid=16337448 |doi=10.1016/j.jaci.2005.09.024 |url=}}</ref><ref name="pmid17468458">{{cite journal |vauthors=Aldington S, Beasley R |title=Asthma exacerbations. 5: assessment and management of severe asthma in adults in hospital |journal=Thorax |volume=62 |issue=5 |pages=447–58 |date=May 2007 |pmid=17468458 |pmc=2117186 |doi=10.1136/thx.2005.045203 |url=}}</ref><ref name="pmid19187331">{{cite journal |vauthors=Dougherty RH, Fahy JV |title=Acute exacerbations of asthma: epidemiology, biology and the exacerbation-prone phenotype |journal=Clin. Exp. Allergy |volume=39 |issue=2 |pages=193–202 |date=February 2009 |pmid=19187331 |pmc=2730743 |doi=10.1111/j.1365-2222.2008.03157.x |url=}}</ref><ref name="pmid11371411">{{cite journal |vauthors=Côté J, Bowie DM, Robichaud P, Parent JG, Battisti L, Boulet LP |title=Evaluation of two different educational interventions for adult patients consulting with an acute asthma exacerbation |journal=Am. J. Respir. Crit. Care Med. |volume=163 |issue=6 |pages=1415–9 |date=May 2001 |pmid=11371411 |doi=10.1164/ajrccm.163.6.2006069 |url=}}</ref><ref name="DoughertyFahy2009">{{cite journal|last1=Dougherty|first1=R. H.|last2=Fahy|first2=J. V.|title=Acute exacerbations of asthma: epidemiology, biology and the exacerbation-prone phenotype|journal=Clinical & Experimental Allergy|volume=39|issue=2|year=2009|pages=193–202|issn=09547894|doi=10.1111/j.1365-2222.2008.03157.x}}</ref>
|
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Tachypnea
* Prolonged expiratory phase of respiration (decreased I:E ratio)
* Seated position with use of extended arms to support the upper chest (tripod position)
* +/- Pulsus paradoxus
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | --
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
|[[Chest X ray]]
| -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Loss of the normal pseudostratified structure of airway epithelium
* Increase in the proportion of goblet cells
* Fibrotic thickening of the sub-epithelial reticular basement membrane
* Increased numbers of myofibroblasts
* Increased vascularity
* Increased airway smooth muscle mass
* Increased extracellular matrix
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Anaphylaxis]]<ref name="pmid18596587">{{cite journal |vauthors=Peavy RD, Metcalfe DD |title=Understanding the mechanisms of anaphylaxis |journal=Curr Opin Allergy Clin Immunol |volume=8 |issue=4 |pages=310–5 |date=August 2008 |pmid=18596587 |pmc=2683407 |doi=10.1097/ACI.0b013e3283036a90 |url=}}</ref><ref name="pmid20944042">{{cite journal |vauthors=Tupper J, Visser S |title=Anaphylaxis: A review and update |journal=Can Fam Physician |volume=56 |issue=10 |pages=1009–11 |date=October 2010 |pmid=20944042 |pmc=2954079 |doi= |url=}}</ref><ref name="pmid12209078">{{cite journal |vauthors=Kemp SF, Lockey RF |title=Anaphylaxis: a review of causes and mechanisms |journal=J. Allergy Clin. Immunol. |volume=110 |issue=3 |pages=341–8 |date=September 2002 |pmid=12209078 |doi= |url=}}</ref><ref name="pmid21293765">{{cite journal |vauthors=Bjornsson HM, Graffeo CS |title=Improving diagnostic accuracy of anaphylaxis in the acute care setting |journal=West J Emerg Med |volume=11 |issue=5 |pages=456–61 |date=December 2010 |pmid=21293765 |pmc=3027438 |doi= |url=}}</ref><ref name="urlUsefulness and Limitations of Sequential Serum Tryptase for the Diagnosis of Anaphylaxis in 102 Patients - FullText - International Archives of Allergy and Immunology 2013, Vol. 160, No. 2 - Karger Publishers">{{cite web |url=https://www.karger.com/Article/Fulltext/339749 |title=Usefulness and Limitations of Sequential Serum Tryptase for the Diagnosis of Anaphylaxis in 102 Patients - FullText - International Archives of Allergy and Immunology 2013, Vol. 160, No. 2 - Karger Publishers |format= |work= |accessdate=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|Chest X ray
* [[Vomiting]]
|
* [[Hives|Generalized hives]],
* [[Pruritus]]
* [[Itching]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Swollen [[lips]]-[[tongue]]-[[uvula]]
* [[Periorbital edema]],
* [[Conjunctival|Conjunctival swelling]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* plasma [[tryptase]]
* Plasm[[Histamine|a histamine]] levels
* Take proper clinical history and medication history specially [[beta blockers]],[[Angiotensin Converting Enzyme Inhibitor|ACE-inhibitors,]][[opioids]]
* [[Skin testing]] with [[Allergens|allergen extracts]]
* [[Enzyme linked immunosorbent assay (ELISA)|enzyme-linked immunosorbent assays (ELISAs)]] for quantification of allergen-specific [[IgE]] levels
*
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|History of exposure to [[Insect allergy|insect]] stings,food alllergy,rubber latex,food [[Additives|additives,]],allergy to medications,physical factors such s excercise and cold
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Acute Urticaria
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Histaminergic [[Angioedema]]<ref name="pmid28687103">{{cite journal |vauthors=Busse PJ, Smith T |title=Histaminergic Angioedema |journal=Immunol Allergy Clin North Am |volume=37 |issue=3 |pages=467–481 |date=August 2017 |pmid=28687103 |doi=10.1016/j.iac.2017.03.001 |url=}}</ref><ref name="pmid28818177">{{cite journal |vauthors=Hahn J, Hoffmann TK, Bock B, Nordmann-Kleiner M, Trainotti S, Greve J |title=Angioedema |journal=Dtsch Arztebl Int |volume=114 |issue=29-30 |pages=489–496 |date=July 2017 |pmid=28818177 |pmc=5569554 |doi=10.3238/arztebl.2017.0489 |url=}}</ref><ref name="pmid28405953">{{cite journal |vauthors=Bernstein JA, Cremonesi P, Hoffmann TK, Hollingsworth J |title=Angioedema in the emergency department: a practical guide to differential diagnosis and management |journal=Int J Emerg Med |volume=10 |issue=1 |pages=15 |date=December 2017 |pmid=28405953 |pmc=5389952 |doi=10.1186/s12245-017-0141-z |url=}}</ref><ref name="pmid23131076">{{cite journal |vauthors=Bernstein JA, Moellman J |title=Emerging concepts in the diagnosis and treatment of patients with undifferentiated angioedema |journal=Int J Emerg Med |volume=5 |issue=1 |pages=39 |date=November 2012 |pmid=23131076 |pmc=3518251 |doi=10.1186/1865-1380-5-39 |url=}}</ref><ref name="pmid23282406">{{cite journal |vauthors=Kaplan AP |title=Angioedema |journal=World Allergy Organ J |volume=1 |issue=6 |pages=103–13 |date=June 2008 |pmid=23282406 |pmc=3651192 |doi=10.1097/WOX.0b013e31817aecbe |url=}}</ref><ref name="Zuraw2008">{{cite journal|last1=Zuraw|first1=Bruce L.|title=Hereditary Angioedema|journal=New England Journal of Medicine|volume=359|issue=10|year=2008|pages=1027–1036|issn=0028-4793|doi=10.1056/NEJMcp0803977}}</ref>
|
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Generalized [[pruritus]]
* [[Throat]] tightness
* [[Hoarse voice]]
* [[Difficulty swallowing]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Urticaria]]
* Localized [[swelling]] of [[skin]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
* [[Bowel|Bowel wall]] edema
|
* Circumferential thickening of the [[Small bowel|small bowel wall]] with [[ascites]] or incomplete [[obstruction]]
|
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[CBC|CBC with differential,]]
* [[Electrolyte|Electrolytes]]
* [[Liver function tests]]
* [[C-reactive protein (CRP)|C-reactive protein]]
* [[ESR|Erythrocyte sedimentation rate]]
* Levels of the [[Complement System|complement protein C4]]
* Serum tota[[Tryptase|l tryptase]]
* Allergen-specific [[IgE immunoassay|IgE immunoassays]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Take proper clinical history of previous similar episodes
* Medication history
* Any allergy to insects stings , foods or any ingestion within previous 24 hours
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Medullary carcinoma of thyroid|Medullary Thyroid Carcinoma]]<ref name="pmid20627492">{{cite journal |vauthors=Pacini F, Castagna MG, Cipri C, Schlumberger M |title=Medullary thyroid carcinoma |journal=Clin Oncol (R Coll Radiol) |volume=22 |issue=6 |pages=475–85 |date=August 2010 |pmid=20627492 |doi=10.1016/j.clon.2010.05.002 |url=}}</ref><ref name="pmid24037980">{{cite journal |vauthors=Roy M, Chen H, Sippel RS |title=Current understanding and management of medullary thyroid cancer |journal=Oncologist |volume=18 |issue=10 |pages=1093–100 |date=2013 |pmid=24037980 |pmc=3805151 |doi=10.1634/theoncologist.2013-0053 |url=}}</ref><ref name="pmid24552221">{{cite journal |vauthors=Mian C, Perrino M, Colombo C, Cavedon E, Pennelli G, Ferrero S, De Leo S, Sarais C, Cacciatore C, Manfredi GI, Verga U, Iacobone M, De Pasquale L, Pelizzo MR, Vicentini L, Persani L, Fugazzola L |title=Refining calcium test for the diagnosis of medullary thyroid cancer: cutoffs, procedures, and safety |journal=J. Clin. Endocrinol. Metab. |volume=99 |issue=5 |pages=1656–64 |date=May 2014 |pmid=24552221 |doi=10.1210/jc.2013-4088 |url=}}</ref><ref name="pmid26494386">{{cite journal |vauthors=Bae YJ, Schaab M, Kratzsch J |title=Calcitonin as Biomarker for the Medullary Thyroid Carcinoma |journal=Recent Results Cancer Res. |volume=204 |issue= |pages=117–37 |date=2015 |pmid=26494386 |doi=10.1007/978-3-319-22542-5_5 |url=}}</ref><ref name="LeboulleuxBaudin2004">{{cite journal|last1=Leboulleux|first1=Sophie|last2=Baudin|first2=Eric|last3=Travagli|first3=Jean-Paul|last4=Schlumberger|first4=Martin|title=Medullary thyroid carcinoma|journal=Clinical Endocrinology|volume=61|issue=3|year=2004|pages=299–310|issn=0300-0664|doi=10.1111/j.1365-2265.2004.02037.x}}</ref>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
* [[Neck pain]]
|
* [[Hoarseness]]
|
* [[Cough]]
* [[Difficulty swallowing]]
* [[Difficulty breathing]]
* [[Lethargy]]
* [[Bone pain]] from [[metastasis]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Solitary thyroid nodule]]
* [[Cervical lymph nodes|Cervical lymph node involvement]]
* [[Weight loss]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Basal serum [[calcitonin]] concentrations
* [[Carcinoembryonic antigen peptide-1|Carcinoembryonic antigen (CEA) concentration]]
* [[Thyroid function tests]]: normal
* [[Germline]] ''[[RET gene|RET]]'' testing
* [[Calcium|Serum calcium]]
* Plasma fractionated [[Metanephrine|metanephrines]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Ultrasonography]] of the [[neck]]
Fo[[Metastasis|r metastasis]]
* [[Chest]] [[computed tomography]]
* [[Neck]] [[CT]]
* Three-phase contrast-enhanced [[Liver (2)|liver]] [[CT-scans|CT]]
* Axial [[MRI]]
* Bone [[scintigraphy]].
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
* [[Immunohistochemical staining]] for [[calcitonin]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Spindle cells|Spindle]]-shaped and frequently [[Pleomorphic|pleomorphic cells]] without follicle development
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
* [[Fine-needle aspiration|Fine-needle aspiration (FNA) biopsy]]
|
* [[TNM staging system|TNM staging]]
| style="background: #F5F5F5; padding: 5px;" |
* American Thyroid Association (ATA) Guidelines for Management and evaluation of [[Medullary carcinoma of the thyroid|Medullary Thyroid Cancer]]
| style="background: #F5F5F5; padding: 5px;" |
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|Anaphylaxis
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|Drugs causing flushing
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* Nicotinic acid
* Levodopa
* Bromocriptine
* Diltiazem
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|Medullary Thyroid Carcinoma
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Latest revision as of 20:07, 15 May 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

Overview

Carcinoid syndrome must be differentiated from systemic mastocytosis, medullary thyroid carcinoma, irritable bowel syndrome, malignant neoplasms of the small intestine, benign cutaneous flushing, and recurrent idiopathic anaphylaxis.

Differentiating Carcinoid Syndrome from other Diseases

Carcinoid syndrome must be differentiated from:[1]

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Abdominal pain Diarrhea Flushing Dyspnea Palpitations Other symptoms Wheezing Telangiectasia Hypotension Tachycardia Systolic murmur of tricuspid regurgitation Other physical findings Urinary 5-hydroxyindoleacetic acid (5-HIAA) Serum Chromogranin A (CgA) Other markers Abdominal computed tomography (CT) Abdominal MRI Somatostatin receptor scintigraphy [SRS], or Octreoscan Metaiodobenzylguanidine (MIBG) scintigraphy Other diagnostic studies Transthoracic echocardiography
Carcinoid Syndrome[2][3][4][5][6][7][8][9][10] Neuroendocrine tumor of midgut [11][12][13][14] +

Mild

+ + + +

Dermatitis

Diarrhea

Dementia

Metastatic tumors in the liver: Right upper quadrant pain, hepatomegaly, and early satiety

+ +/- +/- + + - + + + +
  • Valve thickening with retraction and reduction in the mobility of the tricuspid valve

Pathognomonic radiological sign of midgut NET.

Neuroendocrine tumor of lung[15][16][17][18] + + + + +
+ +/- +/- + + - + + Sensitive for detection of liver metastases if present + + - Typical low-grade:bland cells containing regular round nuclei with finely dispersed chromatin and inconspicuous small nucleoli.Mitotic figures are scarce and necrosis is absent.

Intermediate-grade atypical: presence of Neuroendocrine morphology and either necrosis or 2 to 10 mitoses per 10 HPF

Irritable Bowel Syndrome[19][20][21][22] +

Perioidic

- - - - - - - - - - - - - - - - Rome IV criteria
  • Recurrent abdominal pain, at least 1day/week in the last 3 months, a/s with 2 or more of the following criteria:

•Related to defecation

•Associated with a change in stool frequency

•Associated with a change in stool form (appearance)

Malignant neoplasms of small intestine[23][24][25] +/- +/- - - +/- - - +/- - * Abdominal mass - + Abdominal CT scan may be diagnostic of small intestine cancer. Findings on CT scan suggestive of small intestine cancer include intrinsic mass with a short segment of bowel wall thickening MRI and MRI enteroscopy are other advance modalities to diagnose and stage small intestinal cancers - - Enteroscopy, capsule endoscopy and double balloon enteroscopy Biopsy and histopathology
Crohn disease[26][27][28][29] +/- - - - - - - - - - - - - -
  • Focal ulcerations and acute and chronic inflammation
Benign cutaneous flushing[30][31][32] - - + - - - - - - - - - - - - - - - - - - -
Systemic mastocytosis[33][34][35][36][37][38][39] + + + + - +/- +/- + - - - - - -
Asthma exacerbation[40][41][42][43][44][45] - - - + + + - - + -
  • Tachypnea
  • Prolonged expiratory phase of respiration (decreased I:E ratio)
  • Seated position with use of extended arms to support the upper chest (tripod position)
  • +/- Pulsus paradoxus
- - - -- - - - Chest X ray -
  • Loss of the normal pseudostratified structure of airway epithelium
  • Increase in the proportion of goblet cells
  • Fibrotic thickening of the sub-epithelial reticular basement membrane
  • Increased numbers of myofibroblasts
  • Increased vascularity
  • Increased airway smooth muscle mass
  • Increased extracellular matrix
Anaphylaxis[46][47][48][49][50] + -/+ + + + +/- - + + - - - - - - - - - - History of exposure to insect stings,food alllergy,rubber latex,food additives,,allergy to medications,physical factors such s excercise and cold
Histaminergic Angioedema[51][52][53][54][55][56] +/- +/- + + + + - + + - - - - - - - - - -
  • Take proper clinical history of previous similar episodes
  • Medication history
  • Any allergy to insects stings , foods or any ingestion within previous 24 hours
Medullary Thyroid Carcinoma[57][58][59][60][61] - +/- +/- +/- - - - - - - - - - - - -

For metastasis

-

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