Diverticulitis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Diverticulitis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Diverticulitis]]
{{CMG}}; {{AE}} {{CZ}},{{MehdiP}}, {{DAMI}}, {{AEL}}
{{CMG}}; {{AE}} {{CZ}},{{MehdiP}}, {{DAMI}}, {{AEL}}


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! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Other Features  
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Other Features  
|-
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Abdominal pain
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Location of abdominal pain
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Bowel habits
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Bowel habits
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Rebound tenderness
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Rebound tenderness
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
|-
|-
| rowspan="5" |GI diseases  
| rowspan="5" |'''GI diseases'''
|[[Diverticulitis]]  
|[[Diverticulitis]]  
|LLQ
|Left lower quadrant (LLQ)
|[[Constipation]]  
|[[Constipation]]  
or
or
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* [[Leukocytosis]]
* [[Leukocytosis]]
|
|
* CT scan show evidence of [[inflammation]]
* [[Computed tomography|CT scan]] show evidence of [[inflammation]]
|
|
|-
|-
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* [[Leukocytosis]]
* [[Leukocytosis]]
|
|
* Ultrasound shows evidence of [[inflammation]]
* [[Ultrasound]] shows evidence of [[inflammation]]
|
|
* [[Nausea and vomiting]], [[decreased appetite]]
* [[Nausea and vomiting]], [[decreased appetite]]
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|
|
|
|
* [[Colonoscopy]] and tissue sampling are recommended for differentiating between [[Crohn's disease]] and [[ulcerative colitis]].
* [[Colonoscopy]] and tissue sampling are recommended for differentiating between [[Crohn's disease]] and [[ulcerative colitis]]
|-
|-
|[[Colon carcinoma]]  
|[[Colon carcinoma]]  
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|
|
* Serum [[carcino-embryogenic antigen]] 
* Serum [[carcino-embryogenic antigen]] 
* Low Vit B12
* Low [[serum]] [[vitamin B12]]
* [[Hypercalcemia]]  
* [[Hypercalcemia]]  
|
|
* CT scan, X-ray and MRI show [[metastasis]]
* [[Computed tomography|CT scan]], [[X-ray]] and [[MRI]] show [[metastasis]]
|
|
|-
|-
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| align="center" style="padding: 5px 5px; background: " | -
| align="center" style="padding: 5px 5px; background: " | -
|
|
* Suprapubic tenderness  
* Supra-pubic [[tenderness]]
|
|
* [[Pyuria]]  
* [[Pyuria]]  
* Presence of [[nitrites]] and [[leukocyte]] estrase
* Presence of [[nitrites]] and [[Leukocyte esterase|leukocyte estrase]]
|
|
* [[X-ray]] is done to probe the suspicion of emphysematous [[cystitis]]
* [[X-ray]] is done to rule out the suspicion of emphysematous [[cystitis]]
* [[CT scan]] shows gas in the [[Urinary bladder|bladder]] in cases of emphysematous [[cystitis]]  
* [[CT scan]] shows gas in the [[Urinary bladder|bladder]] in cases of emphysematous [[cystitis]]  
|
|
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| align="center" style="padding: 5px 5px; background: " | -
| align="center" style="padding: 5px 5px; background: " | -
|
|
* Tender and enlarged  
* [[Tenderness (medicine)|Tender]] and enlarged  
|
|
* Serum [[Prostate specific antigen|PSA]] elevated
* Serum [[Prostate specific antigen|PSA]] elevated
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|-
|-
|[[Pelvic inflammatory disease]]
|[[Pelvic inflammatory disease]]
|Bilateral  
|[[Bilateral]]
| align="center" style="padding: 5px 5px; background: " | -
| align="center" style="padding: 5px 5px; background: " | -
| align="center" style="padding: 5px 5px; background: " | -
| align="center" style="padding: 5px 5px; background: " | -
| align="center" style="padding: 5px 5px; background: " | -
| align="center" style="padding: 5px 5px; background: " | -
|
|
* Purulent vaginal discharge
* [[Purulent]] [[vaginal]] discharge
|
|
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] is the best laboratory test for PID
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] is the best laboratory test for PID
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* No specific tests
* No specific tests
|
|
* [[Ultrasound]] is helpful to rule out other differential diagnosis such as pelvic abscess, thrombosis and masses  
* [[Ultrasound]] is helpful to rule out other differential diagnosis such as [[Abscess|pelvic abscess]], [[thrombosis]] and masses  
|
|
* [[Vaginal discharge]]
* [[Vaginal discharge]]


* Vaginal bleeding  
* [[Vaginal bleeding]]
|-
|-
|[[Salpingitis]]  
|[[Salpingitis]]  
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===Differentiating diverticulitis from diseases causing peritonitis===
===Differentiating diverticulitis from diseases causing peritonitis===
The following table differentiates diverticulitis from other diseases causing [[peritonitis]]:


{| align="center"
{| style="border: 0px; background: #F5F5F5; font-size: 90%; margin: 3px;" align="center"
|-
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" | Classification of acute abdomen based  
! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" | Classification of acute abdomen based  
on etiology
on etiology
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|-
|-
| colspan="2" rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Common causes of  
| colspan="2" rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Common causes of  
Peritonitis
[[Peritonitis]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Spontaneous bacterial peritonitis]]  
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Spontaneous bacterial peritonitis]]  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ascitic fluid [[PMN]]>250 cells/mm<small>³</small>
* [[Ascites|Ascitic]] fluid shows [[polymorphonuclear cells]] ([[PMN]]) >250 cells/mm<small>³</small>


* Culture: Positive for single organism  
* [[Culture medium|Culture]]: Positive for single organism  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound for evaluation of liver cirrhosis
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]] for evaluation of liver [[cirrhosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|-
|-
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* Ascitic fluid
* Ascitic fluid
**[[LDH]] > serum [[LDH]]
**[[LDH]] > serum [[LDH]]
** Glucose < 50mg/dl
** [[Glucose]] < 50mg/dl
** Total protein > 1g/dl  
** Total [[protein]] > 1g/dl  


| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Air under [[diaphragm]] in upright [[CXR]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Air under [[diaphragm]] in upright chest x- ray ([[CXR]])
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Upper GI [[endoscopy]] for diagnosis
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Upper GI [[endoscopy]] for diagnosis
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Acute suppurative cholangitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Acute suppurative [[cholangitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Acute cholangitis  
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Acute [[cholangitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|−
|−
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Abnormal [[LFT]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Abnormal [[LFT]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[biliary]] dilatation
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]] shows [[biliary]] dilatation
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Biliary drainage ([[Endoscopic retrograde cholangiopancreatography|ERCP]]) + IV antibiotics
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Biliary drainage ([[Endoscopic retrograde cholangiopancreatography|ERCP]]) + [[intravenous]] ([[Intravenous|IV]]) [[antibiotics]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute Cholecystitis|Acute cholecystitis]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute Cholecystitis|Acute cholecystitis]]
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* [[Hyperbilirubinemia]]
* [[Hyperbilirubinemia]]
* [[Leukocytosis]]
* [[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows gallstone and evidence of inflammation
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]] shows gallstone and evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]]
|-
|-
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[amylase]] / [[lipase]]  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[amylase]] / [[lipase]]  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]] shows evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Pain radiation to back
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Pain radiation to back
|-
|-
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]] shows evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], [[decreased appetite]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], [[decreased appetite]]
|-
|-
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound shows evidence of inflammation
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Computed tomography|CT scan]] and [[ultrasound]] shows evidence of [[inflammation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
| colspan="2" rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Hollow Viscous Obstruction  
| colspan="2" rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Hollow Viscous Obstruction  
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Small intestine obstruction
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Intestinal obstruction|Small intestine obstruction]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and [[Abdominal x-ray|abdominal X ray]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Computed tomography|CT scan]] and [[Abdominal x-ray|abdominal X ray]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]]
|-
|-
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[bilirubin]] and [[alkaline phosphatase]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[bilirubin]] and [[alkaline phosphatase]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
|-
|-
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Hematuria]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Hematuria]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Computed tomography|CT scan]] and [[ultrasound]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Colicky [[abdominal pain]] associated with [[Nausea and vomiting|nausea & vomiting]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Colicky [[abdominal pain]] associated with [[Nausea and vomiting|nausea & vomiting]]
|-
|-
| rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Vascular Disorders
| rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Vascular Disorders
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ischemic causes  
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ischemic]] causes  
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |±
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]] and [[lactic acidosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]] and [[lactic acidosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Computed tomography|CT scan]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], normal physical examination
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], normal physical examination
|-
|-
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Computed tomography|CT scan]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
|-
|-
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hemorrhagic causes
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hemorrhagic]] causes
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ruptured abdominal aortic aneurysm]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ruptured abdominal aortic aneurysm]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Computed tomography|CT scan]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Unstable hemodynamics
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Unstable hemodynamics
|-
|-
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Anemia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Anemia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Computed tomography|CT scan]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of [[trauma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of [[trauma]]
|-
|-
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gynaecological Causes
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gynaecological Causes
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Fallopian tube
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Fallopian tube]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Salpingitis|Acute salpingitis]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Salpingitis|Acute salpingitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Vaginal discharge]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Vaginal discharge]]
|-
|-
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ovarian cyst]] complications and endometrial disease
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ovarian cyst]] complications and [[endometrial]] disease
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Torsion of the cyst
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Torsion of the cyst
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Endometriosis
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Endometriosis]]
| -
| -
|
|
Line 473: Line 471:
|Normal
|Normal
|Laproscopy
|Laproscopy
|Menstrual-associated symptoms, pelvic
|[[Menstrual cycle|Menstrual]]-associated [[symptoms]], pelvic
symptoms
[[symptoms]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cyst rupture
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cyst rupture
Line 486: Line 484:
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pregnancy
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pregnancy]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ruptured [[ectopic pregnancy]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ruptured [[ectopic pregnancy]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
Line 500: Line 498:
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Positive [[pregnancy test]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Positive [[pregnancy test]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ultrasound]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of missed period and [[vaginal bleeding]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of missed period and [[vaginal bleeding]]
|-
|-
| rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Functional
| rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Functional
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Irritable Bowel Syndrome
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Irritable bowel syndrome]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
Line 525: Line 523:
|-
|-
|}
|}
<br><br>


===Differentiating diverticulitis from diseases causing chronic diarrhea===
==References==
{{Reflist|2}}


The following diseases must be differentiated from diverticulitis presenting with chronic diarrhea.<ref name="pmid8209928">{{cite journal| author=Konvolinka CW| title=Acute diverticulitis under age forty. | journal=Am J Surg | year= 1994 | volume= 167 | issue= 6 | pages= 562-5 | pmid=8209928 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8209928  }} </ref><ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue=  | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544  }} </ref><ref name="pmid16698746">{{cite journal| author=Satsangi J, Silverberg MS, Vermeire S, Colombel JF| title=The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. | journal=Gut | year= 2006 | volume= 55 | issue= 6 | pages= 749-53 | pmid=16698746 | doi=10.1136/gut.2005.082909 | pmc=1856208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16698746  }} </ref><ref name="pmid12700377">{{cite journal| author=Haque R, Huston CD, Hughes M, Houpt E, Petri WA| title=Amebiasis. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 16 | pages= 1565-73 | pmid=12700377 | doi=10.1056/NEJMra022710 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700377  }} </ref><ref name="pmid12700377">{{cite journal| author=Haque R, Huston CD, Hughes M, Houpt E, Petri WA| title=Amebiasis. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 16 | pages= 1565-73 | pmid=12700377 | doi=10.1056/NEJMra022710 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700377  }} </ref>
{{WH}}
 
{{WS}}
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Cause
! align="center" style="background:#4479BA; color: #FFFFFF;" + |History
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnosis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Treatment
|-
|[[Diverticulitis]]
|
* [[Bloody diarrhea]]
* Left lower quadrant [[abdominal pain]]
* [[Abdominal tenderness]] on [[physical examination]]
* Low grade [[fever]]
|
* [[Leukocytosis]]
* Elevated serum [[amylase]] and [[lipase]]
* [[Sterile]] [[pyuria]] on [[urinalysis]]
|Abdominal [[CT scan]] with oral and intravenous [[Contrast medium|(IV) contrast]]
Bowel rest, [[Intravenous fluids|IV fluid]] resuscitation, and [[Broad-spectrum antibiotic|broad-spectrum antimicrobial therapy]] that covers [[Anaerobic organism|anaerobic]] [[bacteria]] and [[gram-negative]] [[Bacteria|rods]]
|
*A 7-10 day course of oral, broad-spectrum [[antibiotic]] therapy is the first line of therapy for acute uncomplicated diverticulitis.<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 978-0-443-06839-3 | pages =  }}</ref>
*Hospital admission is indicated for elderly patients and patients with multiple comorbidities, [[Immunocompromised|compromised immune systems]], inability to tolerate oral [[hydration]], or failure to improve despite appropriate [[antibiotic therapy]].
*Hospitalized patients often require bowel rest, [[nasogastric tube]] placement, and [[parenteral]] [[antibiotics]].<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 978-0-443-06839-3 | pages =  }}</ref>
*Outpatients should be advised to follow a liquid diet for 2-3 days, after which a regular diet may be resumed slowly.
|-
|[[Ulcerative colitis]]
|
* [[Diarrhea]] mixed with [[blood]] and [[mucus]], of gradual onset.
* Signs of [[weight loss]]
* [[Rectal pain|Rectal urgency]]
* [[Tenesmus]]
* [[Blood]] is often noticed on underwear
* Different degrees of [[abdominal pain]]
|
* [[Anemia]]
* [[Thrombocytosis]]
* A high [[platelet]] count
 
* Elevated [[ESR]] (>30mm/hr)
* Low [[albumin]]
|[[Endoscopy]]
|
* Induction of  [[Remission (medicine)|remission]] with [[mesalamine]] and [[corticosteroids]] followed by the administration of [[sulfasalazine]] and [[Mercaptopurine|6-Mercaptopurine]] depending on the severity of the [[disease]].
|-
|[[Amoebiasis]]
|
* [[Abdominal cramps]]
* [[Diarrhea]]
** Passage of 3 - 8 semiformed [[stools]] per day
** Passage of soft [[stools]] with [[mucus]] and occasional [[blood]]
* [[Fatigue]]
* [[Intestinal]] gas (excessive [[flatus]])
* [[Rectal pain]] while having a [[bowel movement]] ([[tenesmus]])
* Unintentional [[weight loss]]
|Cysts shed with the stool
|Detects [[amoeba]] [[DNA]] in feces
|[[Amebic dysentery]]
* [[Metronidazole]] 500-750mg three times a day for 5-10 days
* [[Tinidazole]] 2g once a day for 3 days is an alternative to [[metronidazole]]
Luminal amebicides for ''[[E. histolytica]]'' in the [[colon]]:
* [[Paromomycin]] 500mg three times a day for 10 days
* [[Diloxanide furoate]] 500mg three times a day for 10 days
* [[Iodoquinol]] 650mg three times a day for 20 days
For [[Amoebiasis|amebic liver abscess]]:
* [[Metronidazole]] 400mg three times a day for 10 days
* [[Tinidazole]] 2g once a day for 6 days is an alternative to [[metronidazole]]
* [[Diloxanide furoate]] 500mg three times a day for 10 days must always be given afterwards.
|}
|}
==References==
{{Reflist|2}}


[[Category:Surgery]]
[[Category:Surgery]]
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[[Category:Gastroenterology]]
[[Category:Needs overview]]
[[Category:Needs overview]]
 
[[Category:Emergency medicine]]
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{{WS}}
|}[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Primary care]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Gastroenterology]]
[[Category:Surgery]]

Latest revision as of 21:26, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2],Seyedmahdi Pahlavani, M.D. [3], Omodamola Aje B.Sc, M.D. [4], Ahmed Elsaiey, MBBCH [5]

Overview

Diverticulitis must be differentiated from other diseases that cause lower abdominal pain and fever like appendicitis, inflammatory bowel disease, colon cancer, cystitis, and endometritis. Diverticulitis must be also differentiated from diseases causing peritonitis.

Differentiating Diverticulitis from other Diseases

Diverticulitis must be differentiated from other diseases that cause lower abdominal pain and fever. Diverticulitis must be also differentiated from diseases causing peritonitis.

Differentiating diverticulitis from diseases causing lower abdominal pain and fever

Diverticulitis must be differentiated from other diseases that cause lower abdominal pain and fever like appendicitis, inflammatory bowel disease, colon cancer, cystitis, and endometritis.[1][2][3][4][5][6]

Diseases Symptoms Signs Diagnosis Other Features
Location of abdominal pain Bowel habits Rebound tenderness Guarding Genitourinary signs Lab findings Imaging
GI diseases Diverticulitis Left lower quadrant (LLQ) Constipation

or

Diarrhea

- + +
Appendicitis LLQ / RRQ Constipation + + -
Inflammatory bowel disease LLQ Bloody diarrhea - - -
Colon carcinoma LLQ Constipation - - -
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 - + -
Prostatitis LLQ

Groin pain

- - -
Pelvic inflammatory disease Bilateral - - -
Gynecological diseases Endometritis LLQ - + - +
  • No specific tests
Salpingitis LLQ/ RLQ +/- +/-
  • Pelvic ultrasound

Differentiating diverticulitis from diseases causing peritonitis

The following table differentiates diverticulitis from other diseases causing peritonitis:

Classification of acute abdomen based

on etiology

Presentation Clinical findings Diagnosis Comments
Fever Rigors and Chills Abdominal Pain Jaundice Hypotension Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Common causes of

Peritonitis

Spontaneous bacterial peritonitis + Diffuse Hypoactive
  • Culture: Positive for single organism
Ultrasound for evaluation of liver cirrhosis -
Perforated gastric and duodenal ulcer + Diffuse + + + N Air under diaphragm in upright chest x- ray (CXR) Upper GI endoscopy for diagnosis
Acute suppurative cholangitis + + RUQ + + + + ±
Acute cholangitis + RUQ + N Abnormal LFT Ultrasound shows biliary dilatation Biliary drainage (ERCP) + intravenous (IV) antibiotics
Acute cholecystitis + RUQ + Hypoactive Ultrasound shows gallstone and evidence of inflammation Murphy’s sign
Acute pancreatitis + Epigastric ± N Increased amylase / lipase Ultrasound shows evidence of inflammation Pain radiation to back
Acute appendicitis + RLQ + + Hypoactive Leukocytosis Ultrasound shows evidence of inflammation Nausea & vomiting, decreased appetite
Acute diverticulitis + LLQ ± + Hypoactive Leukocytosis CT scan and ultrasound shows evidence of inflammation
Hollow Viscous Obstruction Small intestine obstruction Diffuse + ± Hyperactive then absent Leukocytosis Abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Gall stone disease/Cholelithiasis ±
Volvulus - Diffuse - + - Hypoactive Leukocytosis CT scan and abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Biliary colic - RUQ + - - N Increased bilirubin and alkaline phosphatase Ultrasound Nausea & vomiting
Renal colic - Flank pain - - - N Hematuria CT scan and ultrasound Colicky abdominal pain associated with nausea & vomiting
Vascular Disorders Ischemic causes Mesenteric ischemia ± Periumbilical - - - Hyperactive Leukocytosis and lactic acidosis CT scan Nausea & vomiting, normal physical examination
Acute ischemic colitis ± Diffuse - + + Hyperactive then absent Leukocytosis CT scan Nausea & vomiting
Hemorrhagic causes Ruptured abdominal aortic aneurysm - Diffuse - - - N Normal CT scan Unstable hemodynamics
Intra-abdominal or retroperitoneal hemorrhage - Diffuse - - - N Anemia CT scan History of trauma
Gynaecological Causes Fallopian tube Acute salpingitis + LLQ/ RLQ ± ± N Leukocytosis Pelvic ultrasound Vaginal discharge
Ovarian cyst complications and endometrial disease Torsion of the cyst - RLQ / LLQ - ± ± N Increased ESR and CRP Ultrasound Sudden onset sever pain with nausea and vomiting
Endometriosis - RLQ/LLQ - +/- +/- N Normal Laproscopy Menstrual-associated symptoms, pelvic

symptoms

Cyst rupture - RLQ / LLQ - +/- +/- N Increased ESR and CRP Ultrasound Sudden onset sever pain with nausea and vomiting
Pregnancy Ruptured ectopic pregnancy - RLQ / LLQ - - - N Positive pregnancy test Ultrasound History of missed period and vaginal bleeding
Functional Irritable bowel syndrome - Diffuse - - - - N

Clinical diagnosis

-



References

  1. Laurell H, Hansson LE, Gunnarsson U (2007). "Acute diverticulitis--clinical presentation and differential diagnostics". Colorectal Dis. 9 (6): 496–501, discussion 501-2. doi:10.1111/j.1463-1318.2006.01162.x. PMID 17573742.
  2. Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
  3. Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.
  4. Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016
  5. Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016
  6. Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.

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