Cystitis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Cystitis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Cystitis]]
{{CMG}} {{AE}} {{Maliha}}
{{CMG}} {{AE}} {{Maliha}}, {{USAMA}}
 
==Overview==
==Overview==
Cystitis must be differentiated from other causes of [[dysuria]] such as [[acute pyelonephritis]], [[urethritis]], [[prostatitis]], [[vulvovaginitis]], [[urethral stricture]]s or diverticula, [[benign prostatic hyperplasia]] and [[neoplasm]]s such as [[renal cell carcinoma]] and cancers of the bladder, prostate, and penis.<ref name="pmid11989635">{{cite journal| author=Bremnor JD, Sadovsky R| title=Evaluation of dysuria in adults. | journal=Am Fam Physician | year= 2002 | volume= 65 | issue= 8 | pages= 1589-96 | pmid=11989635 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11989635  }} </ref><ref name="pmid9606306">{{cite journal| author=Kurowski K| title=The woman with dysuria. | journal=Am Fam Physician | year= 1998 | volume= 57 | issue= 9 | pages= 2155-64, 2169-70 | pmid=9606306 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9606306  }} </ref>
Cystitis must be differentiated from other causes of [[dysuria]] such as [[acute pyelonephritis]], [[urethritis]], [[prostatitis]], [[vulvovaginitis]], [[urethral stricture]]s or diverticula, [[benign prostatic hyperplasia]] and [[neoplasm]]s such as [[renal cell carcinoma]] and cancers of the bladder, prostate, and penis. It must also be differentiated from sexually transmitted diseases such as [[syphilis]].<ref name="Workowski-2010">{{Cite journal  | last1 = Workowski | first1 = KA. | last2 = Berman | first2 = S. | last3 = Workowski | first3 = KA. | last4 = Bauer | first4 = H. | last5 = Bachman | first5 = L. | last6 = Burstein | first6 = G. | last7 = Eckert | first7 = L. | last8 = Geisler | first8 = WM. | last9 = Ghanem | first9 = K. | title = Sexually transmitted diseases treatment guidelines, 2010. | journal = MMWR Recomm Rep | volume = 59 | issue = RR-12 | pages = 1-110 | month = Dec | year = 2010 | doi =  | PMID = 21160459 }}</ref><ref name="pmid11989635">{{cite journal| author=Bremnor JD, Sadovsky R| title=Evaluation of dysuria in adults. | journal=Am Fam Physician | year= 2002 | volume= 65 | issue= 8 | pages= 1589-96 | pmid=11989635 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11989635  }} </ref><ref name="pmid9606306">{{cite journal| author=Kurowski K| title=The woman with dysuria. | journal=Am Fam Physician | year= 1998 | volume= 57 | issue= 9 | pages= 2155-64, 2169-70 | pmid=9606306 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9606306  }} </ref>


==Differential Diagnosis==
==Differential Diagnosis==
Cystitis must be differentiated from other causes of [[dysuria]] such as:<ref name="pmid11989635">{{cite journal| author=Bremnor JD, Sadovsky R| title=Evaluation of dysuria in adults. | journal=Am Fam Physician | year= 2002 | volume= 65 | issue= 8 | pages= 1589-96 | pmid=11989635 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11989635  }} </ref><ref name="pmid9606306">{{cite journal| author=Kurowski K| title=The woman with dysuria. | journal=Am Fam Physician | year= 1998 | volume= 57 | issue= 9 | pages= 2155-64, 2169-70 | pmid=9606306 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9606306  }} </ref>
*Cystitis must be differentiated from other diseases that cause [[Abdominal pain|lower abdominal pain]] and [[fever]] like [[appendicitis]], [[diverticulitis]], [[inflammatory bowel disease]], [[colorectal cancer]], 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"
! colspan="2" rowspan="2" |Diseases
! colspan="2" |Symptoms
! colspan="3" |Signs
! colspan="2" |Diagnosis
! rowspan="2" |Other Features
|-
!Abdominal pain
!Bowel habits
!Rebound tenderness
!Guarding
!Genitourinary signs
!Lab findings
!Imaging
|-
| rowspan="5" |GI diseases
|[[Colon carcinoma|Colorectal cancer]]
|LLQ
|Constipation
 
| -
| -
| -
|
* Serum [[carcino-embryogenic antigen]] 
* Low Vit b12
* [[Hypercalcemia]]
|CT scan, x-ray and MRI used to show [[metastasis]]
|
|-
|[[Inflammatory bowel disease]]
|LLQ
|Bloody diarrhea
|<nowiki>-</nowiki>
| -
| -
|
* Leukocytosis
|
|[[Colonoscopy]] and tissue sampling are recommended for differentiating between [[Crohn's disease]] and [[ulcerative colitis]].
|-
|[[Diverticulitis]]
|LLQ
|[[Constipation]]
Or
 
[[Diarrhea]]
| -
| +
|<nowiki>+ </nowiki>
|
* [[Leukocytosis]]
|CT scan shows evidence of [[inflammation]]
|
|-
|[[Appendicitis]]
|LLQ / RRQ
|Constipation
| +
| +
| -
|
* [[Leukocytosis]]
|Ultrasound shows evidence of [[inflammation]]
|[[Nausea and vomiting|Nausea & vomiting]],[[decreased appetite]]
|-
|[[Strangulated hernia]]
|LLQ
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* No specific tests
|
* CT scan used to detect the [[hernia]] and to show if it is single or multiple
|
|-
| rowspan="3" |Gentiourinary diseases
|[[Cystitis]]
|LLQ
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* Suprapubic tenderness
|
* [[Pyuria]]
* Presence of [[nitrites]] and leukocyte estrase
|
* X ray is done to probe the suspicion of emphysematous cystitis.
* CT scan shows gas in the [[Urinary bladder|bladder]] in cases of emphysematous cystitis.
|
|-
|[[Prostatitis]]
|LLQ
 
Groin pain
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Tender and enlarged
|
* Serum [[Prostate specific antigen|PSA]] elevated
* [[Leukocytosis]]
* Elevated [[C-reactive protein|CRP]]
|
* CT scan shows [[edema]] and enlarged [[prostate]]
* [[Abscess]] may be observed
|
|-
|[[Pelvic inflammatory disease]]
|Bilateral
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
| -
|
* Purulent vaginal discharge
|
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] is the best laboratory test for PID.
|[[Transvaginal ultrasound|Transvaginal utrasonography]]
|
|-
| rowspan="2" |Gynecological diseases
|[[Endometritis]]  
|LLQ
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
* No specific tests
|
* Ultrasound is helpful to rule out other differential diagnosis such as pelvic abscess, thrombosis and masses
|
* Vaginal discharge
 
* Vaginal bleeding
|-
|[[Salpingitis]]
|LLQ/ RLQ
|
| +/-
| +/-
|
|
* Leukocytosis
|Pelvic ultrasound
|
* Vaginal discharge
|}
 
*The differential diagnoses of Cystitis include:<ref name="pmid11989635">{{cite journal| author=Bremnor JD, Sadovsky R| title=Evaluation of dysuria in adults. | journal=Am Fam Physician | year= 2002 | volume= 65 | issue= 8 | pages= 1589-96 | pmid=11989635 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11989635  }} </ref><ref name="pmid9606306">{{cite journal| author=Kurowski K| title=The woman with dysuria. | journal=Am Fam Physician | year= 1998 | volume= 57 | issue= 9 | pages= 2155-64, 2169-70 | pmid=9606306 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9606306  }} </ref><ref name="pmid15443228">{{cite journal| author=IMMERGUT S, COTTLER ZR| title=Mucin producing adenocarcinoma of the bladder associated with cystitis follicularis and glandularis. | journal=Urol Cutaneous Rev | year= 1950 | volume= 54 | issue= 9 | pages= 531-4 | pmid=15443228 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15443228  }} </ref>
 
*[[Acute pyelonephritis]]
*[[Acute pyelonephritis]]
*[[Ureteritis]]
*[[Urethritis]]
*[[Urethritis]]
*[[Prostatitis]]
*[[Prostatitis]]
*[[Vulvovaginitis]]
*[[Vulvovaginitis]]
*[[Cervicitis]]
*[[Urethral stricture]]s or diverticula
*[[Urethral stricture]]s or diverticula
*[[Benign prostatic hyperplasia]]
*[[Benign prostatic hyperplasia]]
*[[Syphilis]]
*Genital [[Herpes]]
*[[Neoplasm]]s such as [[renal cell carcinoma]] and cancers of the bladder, prostate, and penis
*[[Neoplasm]]s such as [[renal cell carcinoma]] and cancers of the bladder, prostate, and penis
Cystitis must also be differentiated from sexually transmitted diseases, such as [[syphilis]].<ref name="Workowski-2010">{{Cite journal  | last1 = Workowski | first1 = KA. | last2 = Berman | first2 = S. | last3 = Workowski | first3 = KA. | last4 = Bauer | first4 = H. | last5 = Bachman | first5 = L. | last6 = Burstein | first6 = G. | last7 = Eckert | first7 = L. | last8 = Geisler | first8 = WM. | last9 = Ghanem | first9 = K. | title = Sexually transmitted diseases treatment guidelines, 2010. | journal = MMWR Recomm Rep | volume = 59 | issue = RR-12 | pages = 1-110 | month = Dec | year = 2010 | doi =  | PMID = 21160459 }}</ref>
Cystitis can be differentiated from other diseases that cause lower urinary tract irritation symptoms, such as: ''[[dysuria]]'', ''[[urgency]]'' and ''[[frequency]]'' in addition to ''urethral dyscharge'' , the differential list include: '''[[urethritis]]''', '''[[cervicitis]]''', '''[[vaginitis|vulvovaginitis]]''', '''[[Epididymo-orchitis|epididimitis]]''', '''[[prostatitis]]''' , and '''[[syphilis]]'''.<ref name="pmid9606306">{{cite journal| author=Kurowski K| title=The woman with dysuria. | journal=Am Fam Physician | year= 1998 | volume= 57 | issue= 9 | pages= 2155-64, 2169-70 | pmid=9606306 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9606306  }} </ref><ref name="MooreSeward2006">{{cite journal|last1=Moore|first1=Zack S|last2=Seward|first2=Jane F|last3=Lane|first3=J Michael|title=Smallpox|journal=The Lancet|volume=367|issue=9508|year=2006|pages=425–435|issn=01406736|doi=10.1016/S0140-6736(06)68143-9}}</ref><ref name="pmid8801649">{{cite journal |vauthors=Taylor-Robinson D |title=The history of nongonococcal urethritis. Thomas Parran Award Lecture |journal=Sex Transm Dis |volume=23 |issue=1 |pages=86–91 |year=1996 |pmid=8801649 |doi= |url=}}</ref><ref>{{cite book |last = Bennett |first = John |title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases |publisher = Elsevier/Saunders |location = Philadelphia, PA |year = 2015 |isbn=9781455748013}}</ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cystitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Bladder inflammation, Features with increased frequency and urgency, [[dysuria]], and suprapubic pain. Is more common among women. [[E.coli]] is the most common pathogen<ref>{{Cite journal
| author = [[Stephen Bent]], [[Brahmajee K. Nallamothu]], [[David L. Simel]], [[Stephan D. Fihn]] & [[Sanjay Saint]]
| title = Does this woman have an acute uncomplicated urinary tract infection?
| journal = [[JAMA]]
| volume = 287
| issue = 20
| pages = 2701–2710
| year = 2002
| month = May
| pmid = 12020306
}}</ref><ref>{{Cite journal
| author = [[W. E. Stamm]]
| title = Etiology and management of the acute urethral syndrome
| journal = [[Sexually transmitted diseases]]
| volume = 8
| issue = 3
| pages = 235–238
| year = 1981
| month = July-September
| pmid = 7292216
}}</ref><ref>{{Cite journal
| author = [[W. E. Stamm]], [[K. F. Wagner]], [[R. Amsel]], [[E. R. Alexander]], [[M. Turck]], [[G. W. Counts]] & [[K. K. Holmes]]
| title = Causes of the acute urethral syndrome in women
| journal = [[The New England journal of medicine]]
| volume = 303
| issue = 8
| pages = 409–415
| year = 1980
| month = August
| doi = 10.1056/NEJM198008213030801
| pmid = 6993946
}}</ref><ref>{{Cite journal
| author = [[Leonie G. M. Giesen]], [[Grainne Cousins]], [[Borislav D. Dimitrov]], [[Floris A. van de Laar]] & [[Tom Fahey]]
| title = Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs
| journal = [[BMC family practice]]
| volume = 11
| pages = 78
| year = 2010
| month =
| doi = 10.1186/1471-2296-11-78
| pmid = 20969801
}}</ref>.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Urethritis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |infection of the urethra,causes dysuria and urethral discharge<ref name="pmid8801649">{{cite journal |vauthors=Taylor-Robinson D |title=The history of nongonococcal urethritis. Thomas Parran Award Lecture |journal=Sex Transm Dis |volume=23 |issue=1 |pages=86–91 |year=1996 |pmid=8801649 |doi= |url=}}</ref><ref>{{cite book |last = Bennett |first = John |title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases |publisher = Elsevier/Saunders |location = Philadelphia, PA |year = 2015 |isbn=9781455748013}}</ref><ref name="pmid20353145">{{cite journal |vauthors=Brill JR |title=Diagnosis and treatment of urethritis in men |journal=Am Fam Physician |volume=81 |issue=7 |pages=873–8 |year=2010 |pmid=20353145 |doi= |url=}}</ref>
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[vaginitis|Bacterial vulvovaginitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with dysuria and pruritus, Vaginal discharge and odor are almost always present, caused by [[Gardnerella]] species<ref>{{Cite journal
| author = [[Daniel V. Landers]], [[Harold C. Wiesenfeld]], [[R. Phillip Heine]], [[Marijane A. Krohn]] & [[Sharon L. Hillier]]
| title = Predictive value of the clinical diagnosis of lower genital tract infection in women
| journal = [[American journal of obstetrics and gynecology]]
| volume = 190
| issue = 4
| pages = 1004–1010
| year = 2004
| month = April
| doi = 10.1016/j.ajog.2004.02.015
| pmid = 15118630
}}</ref>.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cervicitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Often asymptomatic,some women have an abnormal vaginal discharge and vaginal bleeding (especially after sexual intercourse)<ref>{{Cite journal
| author = [[Kimberly A. Workowski]] & [[Gail A. Bolan]]
| title = Sexually transmitted diseases treatment guidelines, 2015
| journal = [[MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control]]
| volume = 64
| issue = RR-03
| pages = 1–137
| year = 2015
| month = June
| pmid = 26042815
}}</ref>
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Prostatitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |bacterial infection of the prostate,causes discomfort during ejaculation<ref>{{Cite journal
| author = [[Felix Millan-Rodriguez]], [[J. Palou]], [[Anna Bujons-Tur]], [[Mireia Musquera-Felip]], [[Carlota Sevilla-Cecilia]], [[Marc Serrallach-Orejas]], [[Carlos Baez-Angles]] & [[Humberto Villavicencio-Mavrich]]
| title = Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract
| journal = [[World journal of urology]]
| volume = 24
| issue = 1
| pages = 45–50
| year = 2006
| month = February
| doi = 10.1007/s00345-005-0040-4
| pmid = 16437219
}}</ref>
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Epididymo-orchitis|Epididymitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with scrotal pain and swelling accompanied by fever and lower urinary tract irritation symptoms([[dysuria]] and frequency)<ref>{{Cite journal
| author = [[A. Stewart]], [[S. S. Ubee]] & [[H. Davies]]
| title = Epididymo-orchitis
| journal = [[BMJ (Clinical research ed.)]]
| volume = 342
| pages = d1543
| year = 2011
| month =
| pmid = 21490048
}}</ref>.
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Syphilis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with generalized systemic [[symptoms]] such as [[malaise]], [[fatigue]], [[headache]] and [[fever]]. [[Skin]] eruptions may be subtle and [[asymptomatic]]. It is classically described as 1) non-pruritic bilateral symmetrical mucocutaneous [[rash]]; 2) non-tender regional [[lymphadenopathy]]; 3) condylomata lata; and 4) patchy [[alopecia]].<ref name="MooreSeward2006">{{cite journal|last1=Moore|first1=Zack S|last2=Seward|first2=Jane F|last3=Lane|first3=J Michael|title=Smallpox|journal=The Lancet|volume=367|issue=9508|year=2006|pages=425–435|issn=01406736|doi=10.1016/S0140-6736(06)68143-9}}</ref>
|-
|}


==References==
==References==
{{Reflist|2}}
{{WH}}
{{WS}}


{{Reflist|2}}
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Latest revision as of 21:12, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2], Usama Talib, BSc, MD [3]

Overview

Cystitis must be differentiated from other causes of dysuria such as acute pyelonephritis, urethritis, prostatitis, vulvovaginitis, urethral strictures or diverticula, benign prostatic hyperplasia and neoplasms such as renal cell carcinoma and cancers of the bladder, prostate, and penis. It must also be differentiated from sexually transmitted diseases such as syphilis.[1][2][3]

Differential Diagnosis

Diseases Symptoms Signs Diagnosis Other Features
Abdominal pain Bowel habits Rebound tenderness Guarding Genitourinary signs Lab findings Imaging
GI diseases Colorectal cancer LLQ Constipation - - - CT scan, x-ray and MRI used to show metastasis
Inflammatory bowel disease LLQ Bloody diarrhea - - -
  • Leukocytosis
Colonoscopy and tissue sampling are recommended for differentiating between Crohn's disease and ulcerative colitis.
Diverticulitis LLQ Constipation

Or

Diarrhea

- + + CT scan shows evidence of inflammation
Appendicitis LLQ / RRQ Constipation + + - Ultrasound shows evidence of inflammation Nausea & vomiting,decreased appetite
Strangulated hernia LLQ - - - -
  • No specific tests
  • CT scan used to detect the hernia and to show if it is single or multiple
Gentiourinary diseases Cystitis LLQ - + -
  • Suprapubic tenderness
  • X ray is done to probe the suspicion of emphysematous cystitis.
  • CT scan shows gas in the bladder in cases of emphysematous cystitis.
Prostatitis LLQ

Groin pain

- - -
  • Tender and enlarged
Pelvic inflammatory disease Bilateral - + -
  • Purulent vaginal discharge
Transvaginal utrasonography
Gynecological diseases Endometritis LLQ - + - +
  • No specific tests
  • Ultrasound is helpful to rule out other differential diagnosis such as pelvic abscess, thrombosis and masses
  • Vaginal discharge
  • Vaginal bleeding
Salpingitis LLQ/ RLQ +/- +/-
  • Leukocytosis
Pelvic ultrasound
  • Vaginal discharge
  • The differential diagnoses of Cystitis include:[2][3][10]

Cystitis must also be differentiated from sexually transmitted diseases, such as syphilis.[1]

Cystitis can be differentiated from other diseases that cause lower urinary tract irritation symptoms, such as: dysuria, urgency and frequency in addition to urethral dyscharge , the differential list include: urethritis, cervicitis, vulvovaginitis, epididimitis, prostatitis , and syphilis.[3][11][12][13]

Disease Findings
Cystitis Bladder inflammation, Features with increased frequency and urgency, dysuria, and suprapubic pain. Is more common among women. E.coli is the most common pathogen[14][15][16][17].
Urethritis infection of the urethra,causes dysuria and urethral discharge[12][18][19]
Bacterial vulvovaginitis Presents with dysuria and pruritus, Vaginal discharge and odor are almost always present, caused by Gardnerella species[20].
Cervicitis Often asymptomatic,some women have an abnormal vaginal discharge and vaginal bleeding (especially after sexual intercourse)[21]
Prostatitis bacterial infection of the prostate,causes discomfort during ejaculation[22]
Epididymitis Presents with scrotal pain and swelling accompanied by fever and lower urinary tract irritation symptoms(dysuria and frequency)[23].
Syphilis Presents with generalized systemic symptoms such as malaise, fatigue, headache and fever. Skin eruptions may be subtle and asymptomatic. It is classically described as 1) non-pruritic bilateral symmetrical mucocutaneous rash; 2) non-tender regional lymphadenopathy; 3) condylomata lata; and 4) patchy alopecia.[11]

References

  1. 1.0 1.1 Workowski, KA.; Berman, S.; Workowski, KA.; Bauer, H.; Bachman, L.; Burstein, G.; Eckert, L.; Geisler, WM.; Ghanem, K. (2010). "Sexually transmitted diseases treatment guidelines, 2010". MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459. Unknown parameter |month= ignored (help)
  2. 2.0 2.1 Bremnor JD, Sadovsky R (2002). "Evaluation of dysuria in adults". Am Fam Physician. 65 (8): 1589–96. PMID 11989635.
  3. 3.0 3.1 3.2 Kurowski K (1998). "The woman with dysuria". Am Fam Physician. 57 (9): 2155–64, 2169–70. PMID 9606306.
  4. 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.
  5. Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
  6. Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.
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