Sandbox:Trusha

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

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Diseases	Clinical manifestations						Para-clinical findings							Gold standard	Comments
	Symptoms
							Lab Findings			Imaging			Histopathology
	Constipation/Diarrhea	Blood in stool	Abdominal pain	Other symptoms			Anemia	Tumor marker		Endoscopy	CT scan	Other diagnostic study
Adenocarcinoma
Arteriovenous malformation	-	+	-	-			+	-		Bright red, flat lesions Rarely, polypoid	-	-	Aberrant vessels with thickened, hypertrophic walls in the mucosa and the submucosa. Arteries directly connected to veins without capillary beds
Diverticular diseases	Constipation and/or Diarrhea	+/-	+	Fever, chills Nausea/vomiting(N/V)			-	-		Not recommended	Outpouchings of the colonic wall (Diverticula) Inflamed diverticula Abscess formation Intraperitoneal free air (microperforation)	Barium enema: Circumferential narrowing Spiculated contour and tapered margins
Hemorrhoids	Constipation	+	-	Perianal Itching Pain with defecation Painful, hard lump in anus			+	-		Anoscopy: Protruding mass from the anus	-	DRE: Palpable mass, tender if thrombosed
Anal fissure	-	+	-	Painful defecation Itching Irritation			+/-	-		Anoscopy: Anal wall laceration	-	-
Infectious colitis	Diarrhea	+	+	Fever, chills N/V Bloating			-	-		Patchy or diffuse erythematous mucosa Edema, hemorrhage, with or without ulcers of mucosa	-	Stool cultures in adequate culture media Stool analysis: Leukocytosis
Peutz-Jeghers syndrome
Diseases	Clinical manifestations						Para-clinical findings							Gold standard	Comments
	Symptoms
							Lab Findings			Imaging			Histopathology
	Constipation/Diarrhea	Blood in stool	Abdominal pain	Other symptoms			Anemia	Tumor marker		Colonoscopy	CT scan	Other diagnostic study
Carcinoids
Juvenile Polyposis Coli
Gastrointestinal Stromal Tumors (GIST)
Hamartoma	Diarrhea	+	Depending on location	Tenesmus			-	S100 (mucosal Schwann cell hamartoma (MSCH))		Large polypoid mass	Isodense or hypodense solid masses Heterogeneous mass Presence of fat in a well circumscribed nodule Calcification	Biopsy: Proliferation of bland spindle cells in the lamina propria (mucosal Schwann cell hamartoma (MSCH))	poorly circumscribed, short fascicles of uniform spindle cells replacing the colonic lamina propria, separating and entrapping the crypts The nuclei are bland and mostly uniform, occasional larger nuclei are found. The cytoplasmic borders are indistinct Involvement of mucosa but never the submucosa	Biopsy
Colorectal Lymphoma	Normal	+/-	Depending on location	Weight loss			+	Non-Hodgkin’s lymphomas: CD-20		Polypoid or ulcerated mass, intramural lesion, aphthous ulcer, stricture, extraluminal mass, or diffuse, multiple polypoid lesions	CT scan: polypoid mass, circumferential-cavitary lesions, focal mucosal nodularity, diffuse ulcerative or nodular lesions, regional lymph node involvement	Biopsy: Diffuse large B-cell lymphoma Extranodal marginal zone lymphoma (MALT) Mantle cell lymphoma Burkitt’s lymphoma Follicular lymphoma Double-contrast enema: Subtle mucosal changes, gross tumor morphology	Diffuse large B-cell lymphoma: Extranodal marginal zone lymphoma (MALT) Mantle cell lymphoma Burkitt’s lymphoma Follicular lymphoma	Biopsy
Kaposi's sarcoma	Diarrhea	+	Diffuse	Melena Hematochezia Abdominal pain N/V			+	CD34 CD31 D2-40 HHV-8 FHI-1 antibody LANA-1		Localized purpuric lesion	N/A	Electrophoresis: antibodies against Kaposi sarcoma herpes virus (HHV-8) Biopsy: Vascular proliferation, red blood cell and hemosiderin extravasation,lymphocytes and monocytes, neovascular lesion wrapped around a pre-existing space, intracytoplasmic PAS +ve hyaline globules	Vascular proliferation Red blood cell and hemosiderin extravasation Lymphocytes and monocytes Premonitory sign (a neovascular lesion wrapped around a pre-existing space) Intracytoplasmic PAS +ve hyaline globules	Biopsy
Ulcerative colitis	Diarrhea	+	LLQ				+			Continuous lesions Erythema (or redness of the mucosa) and friability of the mucosa Crypts, formation of residual mucosal tissue Pseudopolyps	-		Mucosal and submucosal inflammation Hemorrhage or inflammatory polymorphonuclear cells aggregate in the lamina propria Distorted crypts Crypt abscess	Endoscopy and a mucosal biopsy
Crohn's disease	Diarrhea	+	LRQ	Tenesmus			+			Discontinuous lesions Strictures Linear ulcerations	-		Transmural pattern of inflammation Mucosal damage Focal infiltration of leukocytes into the epithelium Granulomas	Endoscopy and a mucosal biopsy
Irritable bowel syndrome	Constipation and/or diarrhea	+		Straining during defecation Urgency Sensation of incomplete evacuation Mucus passage Bloating Weight loss			-	-		Nor recommended	-	Diagnosis of exclusion with fulfilment of Rome criteria	-	Clinical diagnosis (Rome criteria)
Appendicitis	Diarrhea	-	RLQ	Pain starting periumbilical before localizing to the right iliac fossa N/V Fever, chills Loss of appetite			-	-		-	Appendiceal wall thickening (wall ≥ 3mm) Periappendiceal fat stranding Thickening of the lateral conal fascia and mesoappendix Extraluminal fluid Phlegmon Abscess	Tc-99m labeled anti-CD15 antibodies Ultrasound: Aperistaltic, noncompressible, dilated appendix (>6 mm outer diameter) Appendicolith Echogenic prominent pericaecal fat Periappeniceal fluid collection		CT scan
Diseases	Symptom 1	Symptom 2	Symptom 3	Physical exam 1	Physical exam 2	Physical exam 3	Lab 1	Lab 2	Lab 3	Imaging 1	Imaging 2	Imaging 3	Histopathology	Gold standard	Additional findings
Strangulated hernia	Constipation	-	RLQ	N/V Heaviness or dull discomfort in the groin, with straining, lifting, coughing, or exercising Weakness, heaviness, burning, or aching in the groin Pain and swelling Fever			-	-		-	Defect in the abdominal wall muscles Appearance of bowel loops within the lesion Lateral crescent sign The hernia neck will be superolateral to the course of the inferior epigastric vessels.
Bowel endometriosis	Constipation and/or Diarrhea	+	Pelvic pain	Dyschezia Tenesmus			+	-		N/A	N/A	Transvaginal ultrasonography: heterogeneous, hypoechoic, spiculated mass Barium enema: Extrinsic mass compressing the bowel, fine crenulation of the mucosa, bowel strictures at the rectosigmoid junction T1-weighted or fat-suppression T1-weighted MRIs: Contrast enhanced mass or hyperintense foci, hemorrhagic foci or hyperintense cavities	N/A	Transvaginal ultrasonography