Diverticulitis differential diagnosis: Difference between revisions

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Revision as of 17:40, 25 July 2017

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]

Overview

It is important to differentiate sigmoid diverticulitis from a lot of inflammatory and non-inflammatory diseases of the gastrointestinal tract and the urogenital system. Differential diagnosis of diverticulitis can be based on the diseases causing lower abdominal pain and fever, and the diseases causing peritonitis. Diverticulitis can be differentiated from other diseases that cause lower abdominal pain and fever like appendicitis, inflammatory bowel disease, cancer colon, cystitis and endometritis.

Differential Diagnosis

Differential diagnosis of diverticulitis can be based on the diseases causing lower abdominal pain and fever, and the diseases causing peritonitis.

Differentiating diverticulitis from diseases causing lower abdominal pain and fever

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

Diseases		Symptoms		Signs			Diagnosis		Comments
Diseases		Abdominal pain	Bowel habits	Rebound tenderness	Guarding	Genitourinary signs	Lab findings	Imaging	Comments
GI diseases	Diverticulitis	LLQ	Constipation Or Diarrhea	-	+	+	Leukocytosis	CT scan shows evidence of inflammation
	Appendicitis	LLQ / RRQ	Constipation	+	+	-	Leukocytosis	Ultrasound shows evidence of inflammation	Nausea & vomiting,decreased appetite
	Inflammatory bowel disease	LLQ	Bloody diarrhea	-	-	-	Leukocytosis		Colonoscopy and tissue sampling are recommended for differentiating between crohn's disease and ulcerative colitis.
	Colon carcinoma	LLQ	Constipation	-	-	-	Serum carcino-embryogenic antigen Low Vit b12 Hypercalcemia	CT scan, x ray and MRI used to show metastasis
	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	Pyuria Presence of nitrites and leukocyte estrase	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	Serum PSA elevated Leukocytosis Elevated CRP	CT scan shows edema and enlarged prostate Abscess may be observed
	Pelvic inflammatory disease	Bilateral	-	+	-	Purulent vaginal discharge	Nucleic acid amplification tests is the best laboratory test for PID.	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
Gynecological diseases	Salpingitis	LLQ/ RLQ		+/-	+/-		Leukocytosis	Pelvic ultrasound	Vaginal discharge

Differential diagnosis of diverticulitis with diseases causing peritonitis

Classification of acute abdomen based on etiology		Presentation	Symptoms			Signs			Diagnosis		Comments
Classification of acute abdomen based on etiology		Presentation	Fever	Abdominal Pain	Jaundice	Guarding	Rebound Tenderness	Bowel sounds	Lab Findings	Imaging	Comments
Common causes of Peritonitis	Primary Peritonitis	Spontaneous bacterial peritonitis	+	Diffuse	-	-	-	Hypoactive	Ascitic fluid PMN>250 cells/mm³ Culture: Positive for single organism	Ultrasound for evaluation of liver cirrhosis	-
	Secondary Peritonitis	Perforated gastric and duodenal ulcer	+	Diffuse	-	+	+	N	Ascitic fluid LDH > serum LDH Glucose < 50mg/dl Total protein > 1g/dl	Air under diaphragm in upright CXR	Upper GI endoscopy for diagnosis
		Acute cholangitis	+	RUQ	+	-	-	N	Abnormal LFT	Ultrasound shows biliary dilatation	Biliary drainage (ERCP) + IV antibiotics
		Acute cholecystitis	+	RUQ	+	-	-	Hypoactive	Hyperbilirubinemia Leukocytosis	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
		Acute salpingitis	+	LLQ/ RLQ	-	+/-	+/-	N	Leukocytosis	Pelvic ultrasound	Vaginal discharge
Hollow Viscous Obstruction		Small intestine obstruction	-	Diffuse	-	+	+/-	Hyperactive then absent	Leukocytosis	Abdominal X ray	Nausea & vomiting associated with constipation, abdominal distention
		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
	Ischemic causes	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
	Hemorrhagic causes	Intra-abdominal or retroperitoneal hemorrhage	-	Diffuse	-	-	-	N	Anemia	CT scan	History of trauma
Gynaecological Causes	Ovarian Cyst Complications	Torsion of the cyst	-	RLQ / LLQ	-	+/-	+/-	N	Increased ESR and CRP	Ultrasound	Sudden onset sever pain with nausea and vomiting
	Ovarian Cyst Complications	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

References

↑ 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.
↑ Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
↑ Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.
↑ Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016
↑ Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016
↑ 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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[pmid17573742-1] 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

[pmid8596552-3] Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.

[hhh-4] Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016

[nlm-5] Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016

[pmid27107781-6] 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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 ==Overview==
-It is important to differentiate sigmoid diverticulitis from a lot of inflammatory and non-inflammatory diseases of the gastrointestinal tract and the urogenital system. Differential diagnosis of diverticulitis can be based on the diseases causing [[lower abdominal pain]] and [[fever]], and the diseases causing [[peritonitis]]. Diverticulitis can be differentiated from other diseases that cause lower abdominal pain and fever like [[appendicitis]], [[inflammatory bowel disease]], cancer colon, [[cystitis]] and [[endometritis]]
+It is important to differentiate sigmoid diverticulitis from a lot of inflammatory and non-inflammatory diseases of the gastrointestinal tract and the urogenital system. Differential diagnosis of diverticulitis can be based on the diseases causing [[lower abdominal pain]] and [[fever]], and the diseases causing [[peritonitis]]. Diverticulitis can be differentiated from other diseases that cause lower abdominal pain and fever like [[appendicitis]], [[inflammatory bowel disease]], cancer colon, [[cystitis]] and [[endometritis]].
 ==Differential Diagnosis==