Gastric dumping syndrome differential diagnosis: Difference between revisions

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Revision as of 16:43, 18 December 2017

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

Overview

Dumping syndrome may often be confused with other similar diseases that cause upper abdominal pain, nausea, and fatigue.

Differentiating Dumping Syndrome from other Diseases

Diseases with similar symptoms

Post-gastrectomy complications:
- Post-vagotomy diarrhea
- Small capacity syndrome
- Short bowel syndrome
- Afferent loop syndrome
- Efferent loop syndrome
Peptic ulcer disease
Fistula
Adhesion
Stenosis
Ischemia
Gastritis
Internal Hernia
Insulinoma
Glucose-lowering medication abuse
Symptomatic gallstone disease
Postprandial Hypotension
Irritable bowel syndrome (IBS)

Differentials based on nausea, vomiting, diarrhea, fatigue and abdominal pain

Gastric dumping syndrome should be differentiated from other diseases presenting with nausea, vomiting, diarrhea, fatigue and abdominal pain. The differentials include the following:

Differential diagnosis of dumping syndrome based on post-vagotomy complications:

They are the following:^[1]


Differential Diagnosis for Postgastrectomy complications	Clinical features	Diagnosis

Short bowel syndrome	Upper abdominal pain, diarrhea, malnutrition, weight loss	LFTs, liver biopsy, Upper GI series, CT scan
Small-capacity syndrome	Early satiety, malnutrition, weight loss	Clinical diagnosis with a history of surgery
Afferent loop syndrome	Upper abdominal pain, early satiety, relief after vomiting	Ultrasound, Barium enema
Efferent loop syndrome	Upper abdominal pain, distention, vomiting	CT scan, Upper GI series
Postvagotomy diarrhea	Watery Diarrhea	Clinical diagnosis with a history of surgery

Differential diagnosis of dumping syndrome based on early dumping syndrome symptoms:

Early dumping syndrome should be differentiated from other diseases presenting with abdominal pain, vomiting, nausea and early satiety. The differentials include the following::


Differential Diagnosis for Early Dumping Syndrome symptoms	Clinical features	Diagnosis

Adhesions	Upper abdominal pain, vomiting, distention	CT scan, Upper GI series
Internal hernia	Upper abdominal pain, vomiting, early satiety	CT scan, Diagnostic laproscopy
Fistula	Upper abdominal pain, relief after vomiting, early satiety	Fistuloscopy, Endoscopy, Colonoscopy, Dye injection, CT scan
Ischemia	Upper abdominal pain, vomiting, diarrhea, distention	CT Angiography
Ulcer	Upper abdominal pain with food, nausea, acid reflux	Gastroscopy
Stenosis	Upper abdominal pain with food, nausea, acid reflux, dysphagia	Gastroscopy, Gastrografin swallow

Differential Diagnosis of dumping syndrome based on late dumping syndrome symptoms:

The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline.They are as follows:


Differential Diagnosis for Late Dumping Syndrome symptoms	Clinical features	Diagnosis

Insulinoma	Fasting hypoglycemia	After a 72 hour fast do labs: Serum Glucose, C-peptide, Insulin, Proinsulin
Glucose-lowering medication abuse	Hypoglycemia	Sulfonylurea and C-peptide assay
Postprandial Hypotension	Nausea, lightheadedness,	Blood pressure checked before and after a meal

↑ "Mastery of Surgery - Google Books".

[urlMastery_of_Surgery_-_Google_Books-1] "Mastery of Surgery - Google Books".

[1]

@@ Line 8: / Line 8: @@
 ==Differentiating Dumping Syndrome from other Diseases==
 ===Diseases with similar symptoms===
-* Post-[[gastrectomy]] complications:<ref name="urlPostgastrectomy complications">{{cite web |url=https://www.uptodate.com/contents/postgastrectomy-complications?source=search_result&search=dumping%20syndrome&selectedTitle=2~58#H8245424 |title=Postgastrectomy complications |format= |work= |accessdate=}}</ref>
+* Post-[[gastrectomy]] complications:
-** Post-[[vagotomy]] [[diarrhea]]<ref>{{cite journal|title=Explaining Diarrhea After Vagotomy|journal=JAMA: The Journal of the American Medical Association|volume=195|issue=13|year=1966|pages=37|issn=0098-7484|doi=10.1001/jama.1966.03100130023009}}</ref>
+** Post-[[vagotomy]] [[diarrhea]]
-** Small capacity syndrome<ref name="urlMastery of Surgery - Google Books">{{cite web |url=https://books.google.com/books?id=PgUFJg_-f4YC&pg=PA952&lpg=PA952&dq=small+capacity+syndrome&source=bl&ots=f0TebFuKK1&sig=CVIB44xCURFPi0CctG9-MWCsMnU&hl=en&sa=X&ved=0ahUKEwiU7IC0l-LXAhUB2oMKHQ4HBEEQ6AEIMjAC#v=onepage&q=small%20capacity%20syndrome&f=false |title=Mastery of Surgery - Google Books |format= |work= |accessdate=}}</ref>
+** Small capacity syndrome
-** [[Short bowel syndrome]]<ref name="pmid8359568">{{cite journal |vauthors=Farthing MJ |title=Octreotide in dumping and short bowel syndromes |journal=Digestion |volume=54 Suppl 1 |issue= |pages=47–52 |year=1993 |pmid=8359568 |doi= |url=}}</ref>
+** [[Short bowel syndrome]]
 ** [[Afferent loop syndrome]]
 ** Efferent loop syndrome
@@ Line 24: / Line 24: @@
 * [[Glucose]]-lowering [[medication]] abuse
 * [[Symptomatic]] [[gallstone disease]]
-* [[Postprandial]] [[Hypotension]]<ref name="van BeekEmous2017">{{cite journal|last1=van Beek|first1=A. P.|last2=Emous|first2=M.|last3=Laville|first3=M.|last4=Tack|first4=J.|title=Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management|journal=Obesity Reviews|volume=18|issue=1|year=2017|pages=68–85|issn=14677881|doi=10.1111/obr.12467}}</ref>
+* [[Postprandial]] [[Hypotension]]
 *[[Irritable bowel syndrome]] ([[Irritable bowel syndrome|IBS]])
+=== Differentials based on nausea, vomiting, diarrhea, fatigue and abdominal pain ===
+Gastric dumping syndrome should be differentiated from other diseases presenting with [[nausea]], [[vomiting]], [[diarrhea]], [[fatigue]] and [[abdominal pain]]. The differentials include the following:
 ===Differential diagnosis of dumping syndrome based on post-vagotomy complications:===
-They are the following:<ref name="urlShort-Bowel Syndrome Workup: Laboratory Studies, Imaging Studies, Other Tests">{{cite web |url=https://emedicine.medscape.com/article/193391-workup#c8 |title=Short-Bowel Syndrome Workup: Laboratory Studies, Imaging Studies, Other Tests |format= |work= |accessdate=}}</ref><ref name="urlThe Dictionary of Modern Medicine - J.C. Segen - Google Books">{{cite web |url=https://books.google.com/books?id=FbSlyyshjOoC&pg=PA183&lpg=PA183&dq=small+capacity+syndrome+dumping+-gut&source=bl&ots=jxTdlNDcwC&sig=opIV9WoEa6yCIY6udkil_Mq3rYE&hl=en&sa=X&ved=0ahUKEwjrz72gn-LXAhUK7YMKHTOXCZMQ6AEIYjAN#v=onepage&q=small%20capacity%20syndrome%20dumping%20-gut&f=false |title=The Dictionary of Modern Medicine - J.C. Segen - Google Books |format= |work= |accessdate=}}</ref><ref name="urlMastery of Surgery - Google Books">{{cite web |url=https://books.google.com/books?id=PgUFJg_-f4YC&pg=PA952&lpg=PA952&dq=small+capacity+syndrome&source=bl&ots=f0TebFuKK1&sig=CVIB44xCURFPi0CctG9-MWCsMnU&hl=en&sa=X&ved=0ahUKEwiU7IC0l-LXAhUB2oMKHQ4HBEEQ6AEIMjAC#v=onepage&q=small%20capacity%20syndrome&f=false |title=Mastery of Surgery - Google Books |format= |work= |accessdate=}}</ref>
+They are the following:<ref name="urlMastery of Surgery - Google Books">{{cite web |url=https://books.google.com/books?id=PgUFJg_-f4YC&pg=PA952&lpg=PA952&dq=small+capacity+syndrome&source=bl&ots=f0TebFuKK1&sig=CVIB44xCURFPi0CctG9-MWCsMnU&hl=en&sa=X&ved=0ahUKEwiU7IC0l-LXAhUB2oMKHQ4HBEEQ6AEIMjAC#v=onepage&q=small%20capacity%20syndrome&f=false |title=Mastery of Surgery - Google Books |format= |work= |accessdate=}}</ref>
 {| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
 | valign="top" |
@@ Line 70: / Line 73: @@
 ===Differential diagnosis of dumping syndrome based on early dumping syndrome symptoms:===
-Early dumping syndrome should be differentiated from other diseases presenting with [[abdominal pain]], [[vomiting]], [[nausea]] and [[Satiety|early satiety]]. The differentials include the following::<ref name="pmid14150594">{{cite journal |vauthors=DAHLGREN S |title=THE AFFERENT LOOP SYNDROME |journal=Acta Chir Scand Suppl |volume=19 |issue= |pages=SUPPL 327:1+ |year=1964 |pmid=14150594 |doi= |url=}}</ref>
+Early dumping syndrome should be differentiated from other diseases presenting with [[abdominal pain]], [[vomiting]], [[nausea]] and [[Satiety|early satiety]]. The differentials include the following::
 {| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
 | valign="top" |
@@ Line 117: / Line 120: @@
 |}
-=== '''Differential Diagnosis of Dumping Syndrome based on Late Dumping Syndrome symptoms:''' ===
+=== '''Differential Diagnosis of dumping syndrome based on late dumping syndrome symptoms:''' ===
-The differential diagnosis of [[Gastric dumping syndrome|dumping syndrome]] is based on the early [[Gastric dumping syndrome|dumping syndrome]] timeline.They are as follows:<ref name="pmid23430217">{{cite journal |vauthors=Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y, Kobayashi M, Hanazaki K |title=Diagnosis and management of insulinoma |journal=World J. Gastroenterol. |volume=19 |issue=6 |pages=829–37 |year=2013 |pmid=23430217 |pmc=3574879 |doi=10.3748/wjg.v19.i6.829 |url=}}</ref><ref name="pmid10995052">{{cite journal |vauthors=Puisieux F, Bulckaen H, Fauchais AL, Drumez S, Salomez-Granier F, Dewailly P |title=Ambulatory blood pressure monitoring and postprandial hypotension in elderly persons with falls or syncopes |journal=J. Gerontol. A Biol. Sci. Med. Sci. |volume=55 |issue=9 |pages=M535–40 |year=2000 |pmid=10995052 |doi= |url=}}</ref>
+The differential diagnosis of [[Gastric dumping syndrome|dumping syndrome]] is based on the early [[Gastric dumping syndrome|dumping syndrome]] timeline.They are as follows:
 {| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
@@ Line 147: / Line 150: @@
 * [[Blood pressure]] checked before and after a meal
 |}
-==Differential diagnosis of abdominal pain==
-The differential diagnosis based on [[abdominal pain]] are as follows:
 {| align="center"
 |-
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki/>
-{| 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
-on etiology
-! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Presentation
-! colspan="8" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Clinical findings
-! colspan="2" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Diagnosis
-! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" | Comments
-|-
-! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Fever
-! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and Chills
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal Pain
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Hypotension
-! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Guarding
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Rebound Tenderness
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel sounds
-! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Lab Findings
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
-|-
-| colspan="2" rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Common causes of
-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" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
-| 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" |Hypoactive
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Ascitic fluid [[PMN]]>250 cells/mm<small>³</small>
-* 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" |<nowiki>-</nowiki>
-|-
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Perforated [[Gastric ulcer|gastric]] and [[duodenal ulcer]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | Diffuse
-| 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" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Ascitic fluid
-**[[LDH]] > serum [[LDH]]
-** Glucose < 50mg/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" |Upper GI [[endoscopy]] for diagnosis
-|-
-| 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" |[[RUQ]]
-| 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" | +
-| 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" |
-|-
-| 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" | [[RUQ]]
-| 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" |N
-| 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" |Biliary drainage ([[Endoscopic retrograde cholangiopancreatography|ERCP]]) + IV antibiotics
-|-
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute Cholecystitis|Acute cholecystitis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | [[RUQ]]
-| 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" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* [[Hyperbilirubinemia]]
-* [[Leukocytosis]]
-| 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]]
-|-
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |  [[Acute pancreatitis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | [[Epigastric]]
-| 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" |−
-| 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" |Ultrasound shows evidence of [[inflammation]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Pain radiation to back
-|-
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute appendicitis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | RLQ
-| 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" | +
-| 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" |Ultrasound shows evidence of [[inflammation]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], [[decreased appetite]]
-|-
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Diverticulitis|Acute diverticulitis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | LLQ
-| 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" |−
-| 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" |CT scan and ultrasound shows evidence of inflammation
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
-| 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
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |−
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
-| 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" |±
-| 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" |[[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]]
-|-
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gall stone disease|Gall stone '''disease''']]/'''Cholelithiasis'''
-| 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" |
-| 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" |
-| 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: #DCDCDC;" align="center" |[[Volvulus]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
-| 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" |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: #DCDCDC;" align="center" |[[Biliary colic]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |RUQ
-| 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" | -
-| 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" |Ultrasound
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Renal colic]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Flank pain]]
-| 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" | -
-| 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" |CT scan and ultrasound
-| 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="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: #F5F5F5;" align="left" |±
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Periumbilical
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| 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" |CT scan
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], normal physical examination
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ischemic colitis|Acute ischemic colitis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |±
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
-| 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" |CT scan
-| 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
-| 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" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| 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" |CT scan
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Unstable hemodynamics
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intra-abdominal or [[retroperitoneal hemorrhage]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| 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" |CT scan
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of [[trauma]]
-|-
-| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gynaecological Causes
-| 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]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | LLQ/ RLQ
-| 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" |±
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Pelvic ultrasound]]
-| 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
-| 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" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| 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" |N
-| 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" |Sudden onset severe pain with [[nausea and vomiting]]
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Endometriosis
-| -
-|
-|RLQ/LLQ
-| -
-|
-| +/-
-| +/-
-|N
-|Normal
-|Laproscopy
-|Menstrual-associated symptoms, pelvic
-symptoms
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cyst rupture
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
-| 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" |Ultrasound
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset severe pain with [[nausea and vomiting]]
-|-
-| 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: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| 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" |Ultrasound
-| 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
-| 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" |Diffuse
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
-| align="left" style="padding: 5px 5px; background: #F5F5F5;" | -
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-[[Diagnosis|Clinical diagnosis]]
-* ROME III/IV criteria
-* [[Pharmacological|Pharmacologic]] studies based criteria
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* High [[dietary fiber]]
-* [[Osmotic]] [[laxatives]]
-* [[Antispasmodic]]<nowiki/>drugs
-|-
-|}
-The following is a list of diseases that present with acute onset severe lower [[abdominal pain]]:
-{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
-|+
-| style="background: #4479BA; width: 180px;" | {{fontcolor|#000|Disease}}
-| style="background: #4479BA; width: 650px;" | {{fontcolor|#000|Findings}}
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Ectopic pregnancy]]'''
-| style="padding: 7px 7px; background: #F5F5F5;" | History of missed [[Menstruation|menses]], positive [[pregnancy test]], [[ultrasound]] reveals an empty [[uterus]] and may show a mass in the [[fallopian tubes]].<ref name="pmid27720100">{{cite journal |vauthors=Morin L, Cargill YM, Glanc P |title=Ultrasound Evaluation of First Trimester Complications of Pregnancy |journal=J Obstet Gynaecol Can |volume=38 |issue=10 |pages=982–988 |year=2016 |pmid=27720100 |doi=10.1016/j.jogc.2016.06.001 |url=}}</ref>
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Appendicitis]]'''
-| style="padding: 7px 7px; background: #F5F5F5;" |[[Pain]] localized to the [[right iliac fossa]], [[vomiting]], [[Ultrasound|abdominal ultrasound]] [[Sensitivity (tests)|sensitivity]] for diagnosis of [[acute appendicitis]] is 75% to 90%.<ref name="pmid8259423">{{cite journal |vauthors=Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C |title=Acute appendicitis: CT and US correlation in 100 patients |journal=Radiology |volume=190 |issue=1 |pages=31–5 |year=1994 |pmid=8259423 |doi=10.1148/radiology.190.1.8259423 |url=}}</ref>
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" | '''Ruptured [[ ovarian cyst]]'''
-| style="padding: 7px 7px; background: #F5F5F5;" |Usually spontaneous, can follow history of trauma, mild chronic lower abdominal discomfort may suddenly intensify, [[ultrasound]] is diagnostic.<ref name="pmid19299205">{{cite journal |vauthors=Bottomley C, Bourne T |title=Diagnosis and management of ovarian cyst accidents |journal=Best Pract Res Clin Obstet Gynaecol |volume=23 |issue=5 |pages=711–24 |year=2009 |pmid=19299205 |doi=10.1016/j.bpobgyn.2009.02.001 |url=}}</ref>
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Ovarian cyst ]]torsion'''
-| style="padding: 7px 7px; background: #F5F5F5;" |Presents with acute severe unilateral [[Lower abdominal pain|lower quadrant abdominal pain]], [[nausea and vomiting]], tender adnexal mass palpated in 90%, [[ultrasound]] is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" | '''Hemorrhagic [[ovarian cyst]]'''
-| style="padding: 7px 7px; background: #F5F5F5;" |Presents with [[Abdominal pain|localized abdominal pain]], [[nausea and vomiting]]. [[Hypovolemic shock]] may be present, [[abdominal tenderness]] and [[Abdominal guarding|guarding]] are physical exam findings, [[ultrasound]] is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Endometriosis]]'''
-| style="padding: 7px 7px; background: #F5F5F5;" |Presents with cyclic pain that is exacerbated by onset of menses, [[dyspareunia]]. [[Laparoscopy|laparoscopic]] exploration is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Acute cystitis]]'''
-| style="padding: 7px 7px; background: #F5F5F5;" |Presents with features of increased urinary [[frequency]], [[urgency]], [[dysuria]], and suprapubic pain.<ref>{{Cite journal
-<nowiki> </nowiki><nowiki>|</nowiki> 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
-<nowiki> </nowiki><nowiki>|</nowiki> 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>
-|}
-==References==
-{{Reflist|2}}
-{{WH}}
-{{WS}}
 [[Category: (name of the system)]]
 |}
 <references />