Irritable bowel syndrome differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Template:Irritable bowel syndrome}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Irritable_bowel_syndrome]]
{{CMG}}; {{AE}} {{Cherry}}
{{IBS T}}
==Overview==
[[Irritable bowel syndrome]] must be differentiated from other diseases that cause [[diarrhea]], [[constipation]], and [[abdominal pain]], such as [[Celiac disease]], [[Inflammatory bowel disease]]([[Crohn's disease]] and [[Ulcerative colitis]]) [[Thyroid disease]] (Hyper or [[Hypothyroidism]]), [[Stenosis|strictures]] due to [[ischemia]], [[diverticulitis]] or [[ischemia]], among others.


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The differential diagnosis for [[Irritable bowel syndrome]] can be listed based on predominant symptoms, such as [[constipation]] predominant, [[diarrhea]] predominant and [[pain]] predominant diseases.
 
==Differentiating Irritable Bowel Syndrome from other Diseases==
===Diseases with similar symptoms===
* [[Celiac disease]]
* [[Crohn's disease]]
* [[Zollinger-Ellison syndrome]]
* [[VIPoma]]
* [[Diverticulitis]]
* [[Endometriosis]]
* [[Gallstones]]
* [[Gastroesophageal reflux disease]] (GERD)
* [[Inflammatory bowel disease]]
* [[Lactose intolerance]]
* [[Thyroid disease]]- [[Hyperthyroidism]]/[[Hypothyroidism]]
* [[Chronic pancreatitis]]
* Small [[Bacteria|bacterial]] overgrowth
* [[Small bowel obstruction|Intermittent small bowel obstruction]]
 
==Differential diagnosis based on predominant symptom(s)==
===Differential diagnosis based on abdominal pain===
 
The differential diagnosis of IBS based on abdominal pain is as follows:
 
<span style="font-size:85%">'''Abbreviations:'''
'''[[RUQ]]'''= Right upper quadrant of the abdomen, '''LUQ'''= Left upper quadrant, '''LLQ'''= Left lower quadrant, '''RLQ'''= Right lower quadrant, '''LFT'''= Liver function test, SIRS= [[Systemic inflammatory response syndrome]], '''[[ERCP]]'''= [[Endoscopic retrograde cholangiopancreatography]], '''IV'''= Intravenous, '''N'''= Normal, '''AMA'''= Anti mitochondrial antibodies, '''[[LDH]]'''= [[Lactate dehydrogenase]], '''GI'''= Gastrointestinal, '''CXR'''= Chest X ray, '''IgA'''= [[Immunoglobulin A]], '''IgG'''= [[Immunoglobulin G]], '''IgM'''= [[Immunoglobulin M]], '''CT'''= [[Computed tomography]], '''[[PMN]]'''= Polymorphonuclear cells, '''[[ESR]]'''= [[Erythrocyte sedimentation rate]], '''[[CRP]]'''= [[C-reactive protein]], TS= [[Transferrin saturation]], SF= Serum [[Ferritin]]
</span>
{| align="center"
|-
|
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! colspan="3" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Classification of pain in the abdomen based on etiology
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease
! colspan="10" style="background:#4479BA; color: #FFFFFF;" align="center" |Clinical manifestations
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diagnosis
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Comments
|-
! colspan="6" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Symptoms
! colspan="4" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Signs
|-
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Fever
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
! style="background:#4479BA; color: #FFFFFF;" align="center" |Melena/ hematochezia/ hemtemesis
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo-
tension
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Guarding
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Lab Findings
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
|-
! rowspan="40" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal causes
! colspan="1" rowspan="28" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Inflammatory causes
! rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pancreato-biliary disorders
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Acute suppurative cholangitis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Abnormal [[LFT]]
* WBC >10,000
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[biliary]] dilatation/stents/tumor
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Septic shock occurs with features of [[SIRS]]
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Cholangitis|Acute cholangitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| 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/stents/tumor
| 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="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| 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="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| 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" |[[Primary biliary cirrhosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]/[[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Increased AMA level, abnormal [[LFTs]]
| 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" |[[Primary sclerosing cholangitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Increased liver enzymes
* Increased [[IgM]], [[IgG]]4
* [[Anti-neutrophil cytoplasmic antibody]]&nbsp;([[p-ANCA]])
* [[Anti-nuclear antibody]]&nbsp;([[ANA]])
* [[Anti-smooth muscle antibody]]&nbsp;(Anti-Sm)
* Anti-endothelial antibody
* Anti-cardiolipin antibody
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |ERCP and MRCP shows
* Multiple segmental&nbsp;[[strictures]]
* Mural irregularities
* [[Biliary]]&nbsp;dilatation and diverticula
* Distortion of biliary tree
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |The risk of&nbsp;[[cholangiocarcinoma]]&nbsp;in patients with primary sclerosing cholangitis is 400 times higher than the risk in the general population.
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cholelithiasis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]/[[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N to hyperactive for dislodged stone
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Leukocytosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[gallstone]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]]
|-
! colspan="1" rowspan="6" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Gastric causes
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Peptic Ulcer Disease|Peptic ulcer disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
* Gastric ulcer- [[melena]] and [[hematemesis]]
* Duodenal ulcer- [[melena]] and [[hematochezia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in perforated
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| 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
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastritis|Gastritis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in chronic gastritis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| 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" |[[Gastroesophageal reflux disease|Gastroesophageal reflux disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| 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" |[[Gastric outlet obstruction|Gastric outlet obstruction]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive
| 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" |[[Gastrointestinal perforation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +, depends on site
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* WBC> 10,000
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Air under [[diaphragm]] in upright [[CXR]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Dumping syndrome]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Lower and then diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| 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" |
|-
! rowspan="9" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intestinal causes
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute appendicitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +in pyogenic appendicitis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Starts in [[epigastrium]], migrates to RLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in perforated appendicitis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| 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="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |LLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[Hematochezia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| 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" |
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Inflammatory bowel disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[Hematochezia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| 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" |[[Irritable bowel syndrome]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Tests done to exclude other diseases as it diagnosis of exclusion
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Tests done to exclude other diseases as it diagnosis of exclusion
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Symptomatic treatment
* High&nbsp;[[dietary fiber]]
 
* [[Osmotic]]&nbsp;[[laxatives]]
* [[Antispasmodic]] drugs
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Whipple's disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Thrombocytopenia]]
* [[Hypoalbuminemia]]
* [[Small intestinal]] [[biopsy]] for [[Tropheryma whipplei]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |*[[Whipple's disease other diagnostic studies|Endoscopy]] is used to confirm diagnosis.
Images used to find complications
*[[Whipple's disease x ray|Chest and joint x-ray]]
*[[Whipple's disease CT|CT]]
*[[Whipple's disease MRI|MRI]]
*[[Whipple's disease ultrasound|Echocardiography]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Extra intestinal findings:
* [[Uveitis]]
* [[Endocarditis]]
* [[Encephalitis]]
* [[Dementia]]
* [[Hepatosplenomegaly]]
* [[Arthritis]]
* [[Ascites]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Toxic megacolon]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Anemia]]
*[[Leukocytosis]] especially in patients with [[Clostridium difficile infection|''Clostridium difficile'' infection]]
*[[Hypoalbuminemia]]
*[[Metabolic alkalosis]] associated with a poor [[prognosis]]
*[[Metabolic acidosis]] secondary to [[ischemic colitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan shows:
*Dilated [[transverse colon]]
*Loss of colonic haustrations
*Segmental parietal thinning
*[[Intraluminal]] soft-tissue masses
[[Ultrasound]] shows:
*Loss of haustra coli of the colon
*Hypoechoic and thickened bowel walls with irregular internal margins in the [[sigmoid]] and descending colon
*Prominent dilation of the transverse colon (>6 cm)
 
* Insignificant dilation of ileal bowel loops (diameter >18 mm) with increased intraluminal gas and fluid
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tropical sprue]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| 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" |[[Celiac disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±, also [[dermatitis herpetiformis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive (increased sounds)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[IgA]]&nbsp;endomysial antibody
* [[IgA]]&nbsp;[[tissue transglutaminase]] antibody
* [[Anti-gliadin antibodies|Anti-gliadin antibody]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Infective colitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| 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" |
|-
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatic causes
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis|Viral hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| 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" |[[Liver mass|Liver masses]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in [[Liver abscess]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in sepsis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| 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" |[[Budd-Chiari syndrome|Budd-Chiari syndrome]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in liver failure leading to varices
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Elevated [[Aspartate aminotransferase|serum aspartate aminotransferase]] and [[alanine aminotransferase]] levels may be more than five times the upper limit of the normal range.
*Elevated serum [[alkaline phosphatase]] and [[Bilirubin|bilirubin levels]], decreased [[Albumin|serum albumin level]].
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|-
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Findings on [[CT scan]] suggestive of Budd-Chiari syndrome include:
*Early enhancement of the [[caudate lobe]] and [[central liver]] around the [[Inferior vena cavae|inferior vena cava]]
*Delayed enhancement of the peripheral [[liver]] with accompanying central low density (flip-flop appearance)
*Peripheral zones of the [[liver]] show reversed [[portal]] [[venous]] [[blood flow]]
*In the [[chronic]] phase, there is [[caudate lobe]] enlargement and [[atrophy]] of the [[Liver|peripheral liver]] in affected areas
|}
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Ascitic tap|Ascitic fluid examination]] shows:
*[[Total protein]] more than 2.5 g per deciliter
*[[White blood cells]] are usually less than 500/μL.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hemochromatosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Dull / aching
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + with infections and GI involvement
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in cirrhotic patients
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |may be in cardicmyopathy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
* >60% TS
* >240 μg/L SF
* Raised LFT <br>Hyperglycemia
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Ultrasound shows evidence of cirrhosis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Extra intestinal findings:
* hyperpigmentation
* Diabetes mellitus
* Arthralgia
* Impotence in males
* Cardiomyopathy
* Atherosclerosis
* Hypopituitarism
* Hypothyroidism
* Extrahepatic cancer
* Prone to specific infections
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cirrhosis|Cirrhosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[varices]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''−'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| 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" | Peritoneal causes
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Spontaneous bacterial peritonitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in cirrhotic patients
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| 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" |
|-
! colspan="2" rowspan="4" 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="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| 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]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Volvulus]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| 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="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| 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="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Flank pain]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| 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="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Periumbilical
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hematochezia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| 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="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Massive
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<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="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Massive
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| 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="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Massive
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| 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="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gynaecological Causes
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Tubal causes
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Torsion of the cyst
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RLQ / LLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| 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 sever pain with [[nausea and vomiting]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Salpingitis|Acute salpingitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RLQ / LLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| 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]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cyst rupture
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RLQ / LLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| 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 sever 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="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RLQ / LLQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| 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="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra-abdominal causes
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pulmonary disorders
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pleural empyema]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]/[[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| 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" |Cardiovascular disorders
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Myocardial Infarction]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + in cardiogenic shock
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|}
|}
 
===Differential diagnosis based on constipation===
The differential diagnosis of irritable bowel syndrome based on [[constipation]] as the predominant [[symptom]] is as follows:<ref name="pmid16678566">{{cite journal |vauthors=Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS |title=Childhood functional gastrointestinal disorders: child/adolescent |journal=Gastroenterology |volume=130 |issue=5 |pages=1527–37 |year=2006 |pmid=16678566 |doi=10.1053/j.gastro.2005.08.063 |url=}}</ref><ref name="pmid12425553">{{cite journal |vauthors=Cash BD, Schoenfeld P, Chey WD |title=The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review |journal=Am. J. Gastroenterol. |volume=97 |issue=11 |pages=2812–9 |year=2002 |pmid=12425553 |doi=10.1111/j.1572-0241.2002.07027.x |url=}}</ref><ref name="pmid10235207">{{cite journal |vauthors=Hamm LR, Sorrells SC, Harding JP, Northcutt AR, Heath AT, Kapke GF, Hunt CM, Mangel AW |title=Additional investigations fail to alter the diagnosis of irritable bowel syndrome in subjects fulfilling the Rome criteria |journal=Am. J. Gastroenterol. |volume=94 |issue=5 |pages=1279–82 |year=1999 |pmid=10235207 |doi=10.1111/j.1572-0241.1999.01077.x |url=}}</ref><ref name="pmid20456760">{{cite journal |vauthors=Prott G, Shim L, Hansen R, Kellow J, Malcolm A |title=Relationships between pelvic floor symptoms and function in irritable bowel syndrome |journal=Neurogastroenterol. Motil. |volume=22 |issue=7 |pages=764–9 |year=2010 |pmid=20456760 |doi=10.1111/j.1365-2982.2010.01503.x |url=}}</ref><ref name="pmid8995945">{{cite journal |vauthors=Voderholzer WA, Schatke W, Mühldorfer BE, Klauser AG, Birkner B, Müller-Lissner SA |title=Clinical response to dietary fiber treatment of chronic constipation |journal=Am. J. Gastroenterol. |volume=92 |issue=1 |pages=95–8 |year=1997 |pmid=8995945 |doi= |url=}}</ref><ref name="pmid20152787">{{cite journal |vauthors=Spiller R, Camilleri M, Longstreth GF |title=Do the symptom-based, Rome criteria of irritable bowel syndrome lead to better diagnosis and treatment outcomes? |journal=Clin. Gastroenterol. Hepatol. |volume=8 |issue=2 |pages=125–9; discussion 129–36 |year=2010 |pmid=20152787 |doi=10.1016/j.cgh.2009.12.018 |url=}}</ref><ref name="pmid20179692">{{cite journal |vauthors=Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K |title=Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial |journal=Am. J. Gastroenterol. |volume=105 |issue=4 |pages=890–6 |year=2010 |pmid=20179692 |pmc=3910270 |doi=10.1038/ajg.2010.53 |url=}}</ref><ref name="pmid20179696">{{cite journal |vauthors=Chey WD, Nojkov B, Rubenstein JH, Dobhan RR, Greenson JK, Cash BD |title=The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: results from a prospective, controlled US trial |journal=Am. J. Gastroenterol. |volume=105 |issue=4 |pages=859–65 |year=2010 |pmid=20179696 |pmc=2887227 |doi=10.1038/ajg.2010.55 |url=}}</ref><ref name="pmid23357491">{{cite journal |vauthors=Begtrup LM, Engsbro AL, Kjeldsen J, Larsen PV, Schaffalitzky de Muckadell O, Bytzer P, Jarbøl DE |title=A positive diagnostic strategy is noninferior to a strategy of exclusion for patients with irritable bowel syndrome |journal=Clin. Gastroenterol. Hepatol. |volume=11 |issue=8 |pages=956–62.e1 |year=2013 |pmid=23357491 |doi=10.1016/j.cgh.2012.12.038 |url=}}</ref><ref name="pmid23826010">{{cite journal |vauthors=Mehdi Z, Sakineh E, Mohammad F, Mansour R, Alireza A |title=Celiac disease: Serologic prevalence in patients with irritable bowel syndrome |journal=J Res Med Sci |volume=17 |issue=9 |pages=839–42 |year=2012 |pmid=23826010 |pmc=3697208 |doi= |url=}}</ref>
{|
|-
 
|}
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis for Constipation predominant symptoms}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Clinical features}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Diagnosis}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Strictures]] due to [[diverticultis]],[[inflammatory bowel disease]], [[ischemia]] or [[cancer]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Obstipation]], [[constipation]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Barium enema]], [[flexible sigmoidoscopy]], [[colonoscopy]], [[CT scan]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Hypothyroidism]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Fatigue]], increased sensitivity to cold, [[dry skin]], [[constipation]], [[weight gain]], puffy face, [[muscle weakness]], [[hoarseness]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Serum]] [[Thyroid-stimulating hormone|thyroid stimulating hormone]] levels
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Medication
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Opiates]], [[cholestyramine]], [[calcium-channel blockers]], [[anticholinergic]] medications
| style="padding: 5px 5px; background: #F5F5F5;" |
* Medication history.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Neurologic disease
| style="padding: 5px 5px; background: #F5F5F5;" |
* Concurrent [[multiple sclerosis]], [[Parkinson disease]], autonomic dysfunction ([[Shy-Drager syndrome|Shy-Drager]])
| style="padding: 5px 5px; background: #F5F5F5;" |
* History and [[Neurological|neurologic]] examination
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Pelvic floor dysfunction
| style="padding: 5px 5px; background: #F5F5F5;" |
* Straining, self digitation
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Rectal examination]], defecography, anorectal manometry, [[balloon expulsion study]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Colonic inertia]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Infrequent [[Bowel movement|bowel movements]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Radiopaque markers]], [[scintigraphy]], wireless pH and motility capsule
|}
 
 
=== Differential Diagnosis based on abdominal pain and diarrhea ===
 
Below is a table that overviews the differential based on type of diarrhea. A more detailed table follows.
 
[[Diarrhea]] with [[abdominal pain]]/cramping may be caused by [[infectious diseases]], [[celiac disease]],<ref>{{cite journal |author=Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS |title=Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis |journal=Gastroenterology |volume=126 |issue=7 |pages=1721-32 |year=2004 |pmid=15188167 |doi=}}</ref> [[parasites]],<ref>{{cite journal |author=Stark D, van Hal S, Marriott D, Ellis J, Harkness J. |title=Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and diagnosis. |journal=Int J Parasitol. |volume= 31 |issue=1 |pages=11-20|year=2007 |pmid=17070814 |doi=}}</ref> [[food allergies]]<ref>{{cite journal |author=Drisko ''et al'' |title=Treating Irritable Bowel Syndrome with a Food Elimination Diet Followed by Food Challenge and Probiotics |journal=Journal of the American College of Nutrition |volume=25 |issue=6 |pages=514-22 |year=2006 |pmid=17229899 |doi=}}</ref> and [[lactose intolerance]].<ref>{{cite journal |author=Vernia P, Ricciardi MR, Frandina C, Bilotta T, Frieri G |title=Lactose malabsorption and irritable bowel syndrome. Effect of a long-term lactose-free diet |journal=The Italian journal of gastroenterology |volume=27 |issue=3 |pages=117-21 |year=1995 |pmid=7548919 |doi=}}</ref>  See the [[list of causes of diarrhea]] for other conditions which can cause [[diarrhea]]. [[Coeliac disease|Celiac disease]] in particular is most often misdiagnosed as IBS.<ref>http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/ - The United States National Institutes of Health Celiac Disease Page</ref>
The differential diagnosis of irritable bowel syndrome based on abdominal pain and [[diarrhea]] is as follows:<ref name="pmid26913568">{{cite journal |vauthors=Guagnozzi D, Arias Á, Lucendo AJ |title=Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders |journal=Aliment. Pharmacol. Ther. |volume=43 |issue=8 |pages=851–862 |year=2016 |pmid=26913568 |doi=10.1111/apt.13573 |url=}}</ref><ref name="pmid27796144">{{cite journal |vauthors=Hilpüsch F, Johnsen PH, Goll R, Valle PC, Sørbye SW, Abelsen B |title=Microscopic colitis: a missed diagnosis among patients with moderate to severe irritable bowel syndrome |journal=Scand. J. Gastroenterol. |volume=52 |issue=2 |pages=173–177 |year=2017 |pmid=27796144 |doi=10.1080/00365521.2016.1242025 |url=}}</ref><ref name="pmid14201408">{{cite journal| author=SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA| title=EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME. | journal=Gastroenterology | year= 1964 | volume= 47 | issue=  | pages= 184-7 | pmid=14201408 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14201408  }} </ref><ref name="pmid15188167">{{cite journal |vauthors=Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS |title=Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis |journal=Gastroenterology |volume=126 |issue=7 |pages=1721–32 |year=2004 |pmid=15188167 |doi= |url=}}</ref><ref name="pmid27753436">{{cite journal |vauthors=Irvine AJ, Chey WD, Ford AC |title=Screening for Celiac Disease in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis |journal=Am. J. Gastroenterol. |volume=112 |issue=1 |pages=65–76 |year=2017 |pmid=27753436 |doi=10.1038/ajg.2016.466 |url=}}</ref><ref name="pmid20634346">{{cite journal |vauthors=van Rheenen PF, Van de Vijver E, Fidler V |title=Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis |journal=BMJ |volume=341 |issue= |pages=c3369 |year=2010 |pmid=20634346 |pmc=2904879 |doi= |url=}}</ref><ref name="pmid25913530">{{cite journal |vauthors=Slattery SA, Niaz O, Aziz Q, Ford AC, Farmer AD |title=Systematic review with meta-analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea |journal=Aliment. Pharmacol. Ther. |volume=42 |issue=1 |pages=3–11 |year=2015 |pmid=25913530 |doi=10.1111/apt.13227 |url=}}</ref><ref name="pmid25238408">{{cite journal |vauthors=Canavan C, Card T, West J |title=The incidence of other gastroenterological disease following diagnosis of irritable bowel syndrome in the UK: a cohort study |journal=PLoS ONE |volume=9 |issue=9 |pages=e106478 |year=2014 |pmid=25238408 |pmc=4169512 |doi=10.1371/journal.pone.0106478 |url=}}</ref><ref name="pmid19364994">{{cite journal |vauthors=Ford AC, Chey WD, Talley NJ, Malhotra A, Spiegel BM, Moayyedi P |title=Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis |journal=Arch. Intern. Med. |volume=169 |issue=7 |pages=651–8 |year=2009 |pmid=19364994 |doi=10.1001/archinternmed.2009.22 |url=}}</ref><ref name="pmid19602448">{{cite journal |vauthors=Ford AC, Spiegel BM, Talley NJ, Moayyedi P |title=Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis |journal=Clin. Gastroenterol. Hepatol. |volume=7 |issue=12 |pages=1279–86 |year=2009 |pmid=19602448 |doi=10.1016/j.cgh.2009.06.031 |url=}}</ref>
 
====Overview based on type of diarrhea====
 
{| class="wikitable"
! colspan="3" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Cause
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Osmotic gap
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |History
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical exam
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Gold standard
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Treatment
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |< 50 mOsm per kg
! align="center" style="background:#4479BA; color: #FFFFFF;" + |> 50 mOsm per kg*
|-
| rowspan="7" |Watery
| rowspan="4" |Secretory
|[[Crohns disease|Crohns]]
| +
| -
|
* [[Abdominal pain]]&nbsp;followed by&nbsp;[[diarrhea]]
|
* [[Abdominal]] [[Tenderness|tenderness when]]<nowiki/> palpated in severe&nbsp;[[disease]]
* Blood seen on&nbsp;[[rectal exam]]
* [[Fever]]
* [[Tachycardia]]
* [[Hypotension]]
|
* [[Colonoscopy]]&nbsp;with&nbsp;[[biopsy]]
|
* Topical mucosamine and&nbsp;[[corticosteroids]]<nowiki/> are preferred
* [[Mesalamine]]<nowiki/>and&nbsp;[[sulfasalazine]]<nowiki/> are used for remission
|-
|[[Zollinger-Ellison syndrome]]
| +
| -
|
* [[Abdominal pain]]&nbsp;and&nbsp;[[diarrhea]]
* [[Dyspepsia]]
* Upper or lower [[gastrointestinal bleeding]]
|
* [[Abdominal]][[Tenderness|tenderness when]]<nowiki/>palpated in severe&nbsp;[[disease]]
* Blood seen on&nbsp;[[rectal exam]], Hematochezia
* Hematemesis
* [[Tachycardia]]
* [[Hypotension]]
|
* Gastrin levels
|
* Proton pump inhibitors
* Octreotide
|-
|[[Hyperthyroidism]]
| +
| -
|
* [[Abdominal pain]]&nbsp;and&nbsp;[[diarrhea]]
* [[Dyspepsia]]
* Upper or lower [[gastrointestinal bleeding]]
|
* Lump in the neck
* [[Proptosis]]
* [[Tremors]]
* Increased DTR
|
* [[TSH]]&nbsp;with&nbsp;[[T3]]&nbsp;and&nbsp;[[T4]]
|
* [[Carbimazole]]<nowiki/> and&nbsp;[[methimazole]]
* [[Beta blockers]]<nowiki/> like&nbsp;[[propylthiouracil]]
* [[Iodine-131]]
|-
|[[VIPoma]]
| +
| -
|
* Watery&nbsp;[[diarrhea]]
* [[Dehydration]]([[thirst]],&nbsp;[[dry skin]],&nbsp;[[dry mouth]],&nbsp;[[tiredness]],&nbsp;[[headaches]], and&nbsp;[[dizziness]])
* [[Lethargy]],&nbsp;[[muscle weakness]]
* [[Nausea]],&nbsp;[[vomiting]]
* Crampy&nbsp;[[abdominal pain]]
* [[Weight loss]]
* [[Flushing]]
|
* Lump in the neck
* [[Proptosis]]
* [[Tremors]]
* Increased DTR
|
* Elevated&nbsp;[[VIP]]<nowiki/>levels
* Followed by imaging
|
* [[Sandostatin]]&nbsp;or&nbsp;[[chemotherapy]]&nbsp;for&nbsp;[[malignant tumors]]
* Surgical removal of the&nbsp;[[tumor]]
|-
| rowspan="2" |Osmotic
|Lactose intolerance
| -
| +
|
* [[Abdominal pain]]
* [[Bloating]]
* [[Diarrhea]]
* [[Flatulence]]
|
* [[Abdominal tenderness]]
|
* Intestinal&nbsp;[[biopsy]]
|
* Avoidance of dietary&nbsp;[[lactose]]
* Substitution to maintain nutrient intake
* Regulation of&nbsp;[[calcium]]&nbsp;intake
* Use of&nbsp;[[enzyme]][[lactase]]
|-
|[[Celiac disease (patient information)|Celiac disease]]
| -
| +
|
* May be [[asymptomatic]]
* Vague&nbsp;[[abdominal pain]]
* [[Diarrhea]]
* [[Weight loss]]
* [[Malabsorption]]/&nbsp;[[steatorrhea]]
* [[Bloating]]
|
** [[Abdominal pain]]&nbsp;and&nbsp;[[cramping]]
** [[Abdominal distention]]
** [[Tetany]]
** [[Mouth ulcers]]
** [[Dermatitis herpetiformis]]
** Signs of the fat-soluble&nbsp;[[Vitamin A|vitamins A]], [[Vitamin D|D]], [[Vitamin E|E]], and [[Vitamin K|K]] deficiency
|
* [[IgA]]&nbsp;tissue&nbsp;[[transglutaminase]] [[antibody]]
|
* [[Gluten-free diet]]
|-
|Functional
|[[Irritable bowel syndrome]]
| -
| -
|[[Abdominal pain]] or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following:
* Improvement with&nbsp;[[defecation]]
 
* Onset associated with change in frequency of&nbsp;[[stool]]
 
* Onset associated with change in consistency or form of [[stool]]
* Straining during [[defecation]], [[dyspepsia]], [[bloating]] and [[flatulence]] may be present
|
* [[Abdominal tenderness]]
* Hard [[stool]] in the [[rectal]] vault
|[[Diagnosis|Clinical diagnosis]]
* ROME IV criteria
* Exclusion of organic causes based on laboratory investigations and imaging
|
* Low FODMAP diet ([[fructose]] -when&nbsp;in excess of [[glucose]], [[fructans]], galacto-[[oligosaccharides]], [[lactose]] and [[polyols]] (eg. [[sorbitol]] and [[mannitol]]), high&nbsp;[[dietary fiber]], physical exercise
* [[Osmotic]] [[laxatives]]&nbsp;such as&nbsp;[[polyethylene glycol]],&nbsp;[[sorbitol]], and&nbsp;[[lactulose]] for [[constipation]] predominant IBS
*[[Opioids]] such as [[loperamide]] and chloride channel activators such as linactolide and lubipristone for diarrhea predominant IBS
* [[Antispasmodic]]<nowiki/>drugs (e.g.&nbsp;[[Anticholinergic|anticholinergics]]<nowiki/> such as&nbsp;[[hyoscyamine]]<nowiki/> or&nbsp;[[dicyclomine]]), [[antidepressants]] and [[anxiolytics]] for pain predominant IBS
|}
 
 
==== Details based on pathology====
 
Irritable bowel syndrome must be diifferentiated from other causes of abdominal pain and diarrhea.
 
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="2" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="9" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
|
|
|
! colspan="10" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
|
|
|
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
!
!
!
|-
!
!
!
!
!
!
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
!
!
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Abdominal pain]]
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Diarrhea]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Flushing]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Dyspnea]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Palpitations]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Wheezing]]
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Telangiectasia]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Hypotension]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Tachycardia]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Systolic murmurs|Systolic murmur]] of [[tricuspid regurgitation]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other physical findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinary 5-hydroxyindoleacetic acid (5-HIAA)
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Serum [[Chromogranin]] A (CgA)
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other markers
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Computed tomography|Abdominal computed tomography]] (CT)
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Mri|Abdominal MRI]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Somatostatin receptor scintigraphy [SRS], or Octreoscan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Metaiodobenzylguanidine (MIBG) scintigraphy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other diagnostic studies
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Transthoracic echocardiography
|-
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Carcinoid Syndrome<ref name="pmid30133565">{{cite journal |vauthors=Rubin de Celis Ferrari AC, Glasberg J, Riechelmann RP |title=Carcinoid syndrome: update on the pathophysiology and treatment |journal=Clinics (Sao Paulo) |volume=73 |issue=suppl 1 |pages=e490s |date=August 2018 |pmid=30133565 |pmc=6096975 |doi=10.6061/clinics/2018/e490s |url=}}</ref><ref name="pmid14693013">{{cite journal |vauthors=Hegyi J, Schwartz RA, Hegyi V |title=Pellagra: dermatitis, dementia, and diarrhea |journal=Int. J. Dermatol. |volume=43 |issue=1 |pages=1–5 |date=January 2004 |pmid=14693013 |doi= |url=}}</ref><ref name="pmid15100502">{{cite journal |vauthors=Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E |title=Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours |journal=Nucl Med Commun |volume=25 |issue=5 |pages=445–9 |date=May 2004 |pmid=15100502 |doi= |url=}}</ref><ref name="pmid151005022">{{cite journal |vauthors=Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E |title=Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours |journal=Nucl Med Commun |volume=25 |issue=5 |pages=445–9 |date=May 2004 |pmid=15100502 |doi= |url=}}</ref><ref name="BoraVithiavathi2012">{{cite journal|last1=Bora|first1=ManashKumar|last2=Vithiavathi|first2=S|title=Primary bronchial carcinoid: A rare differential diagnosis of pulmonary koch in young adult patient|journal=Lung India|volume=29|issue=1|year=2012|pages=59|issn=0970-2113|doi=10.4103/0970-2113.92366}}</ref><ref name="pmid25207053">{{cite journal |vauthors=Yazıcıoğlu A, Yekeler E, Bıcakcıoğlu P, Ozaydın E, Karaoğlanoğlu N |title=Synchronous bilateral multiple typical pulmonary carcinoid tumors: a unique case with 10 typical carcinoids |journal=Balkan Med J |volume=29 |issue=4 |pages=450–2 |date=December 2012 |pmid=25207053 |pmc=4115868 |doi=10.5152/balkanmedj.2012.081 |url=}}</ref><ref name="pmid14616879">{{cite journal |vauthors=Krausz Y, Keidar Z, Kogan I, Even-Sapir E, Bar-Shalom R, Engel A, Rubinstein R, Sachs J, Bocher M, Agranovicz S, Chisin R, Israel O |title=SPECT/CT hybrid imaging with 111In-pentetreotide in assessment of neuroendocrine tumours |journal=Clin. Endocrinol. (Oxf) |volume=59 |issue=5 |pages=565–73 |date=November 2003 |pmid=14616879 |doi= |url=}}</ref><ref name="van der LelyHerder2005">{{cite journal|last1=van der Lely|first1=Aart J.|last2=Herder|first2=Wouter W. de|title=Carcinoid syndrome: diagnosis and medical management|journal=Arquivos Brasileiros de Endocrinologia & Metabologia|volume=49|issue=5|year=2005|pages=850–860|issn=0004-2730|doi=10.1590/S0004-27302005000500028}}</ref><ref name="pmid28238592">{{cite journal |vauthors=Halperin DM, Shen C, Dasari A, Xu Y, Chu Y, Zhou S, Shih YT, Yao JC |title=Frequency of carcinoid syndrome at neuroendocrine tumour diagnosis: a population-based study |journal=Lancet Oncol. |volume=18 |issue=4 |pages=525–534 |date=April 2017 |pmid=28238592 |pmc=6066284 |doi=10.1016/S1470-2045(17)30110-9 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neuroendocrine tumor]] of [[midgut]] <ref name="pmid3227292">{{cite journal |vauthors=Sjöblom SM |title=Clinical presentation and prognosis of gastrointestinal carcinoid tumours |journal=Scand. J. Gastroenterol. |volume=23 |issue=7 |pages=779–87 |date=September 1988 |pmid=3227292 |doi= |url=}}</ref><ref name="pmid24059366">{{cite journal |vauthors=Ganeshan D, Bhosale P, Yang T, Kundra V |title=Imaging features of carcinoid tumors of the gastrointestinal tract |journal=AJR Am J Roentgenol |volume=201 |issue=4 |pages=773–86 |date=October 2013 |pmid=24059366 |doi=10.2214/AJR.12.9758 |url=}}</ref><ref name="symptoms">Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq</ref><ref name="pmid15887161">{{cite journal |vauthors=Modlin IM, Kidd M, Latich I, Zikusoka MN, Shapiro MD |title=Current status of gastrointestinal carcinoids |journal=Gastroenterology |volume=128 |issue=6 |pages=1717–51 |date=May 2005 |pmid=15887161 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | +
Mild
| style="background: #F5F5F5; padding: 5px;" | +
* Intermittent
* Secretory [[diarrhea]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Pellagra]]
[[Dermatitis]]
 
[[Diarrhea]]
 
[[Dementia]]
 
[[Metastatic]] [[tumors]] in the [[Liver (2)|liver]]: [[Right upper quadrant]] pain, [[Hepatomegaly (new)|hepatomegaly]], and early [[satiety]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[NT-proBNP]]
** [[Screening]] of [[Carcinoid disease|carcinoid heart disease]]
** Blood [[Serotonin]] levels
| style="background: #F5F5F5; padding: 5px;" |
* [[Neuroendocrine tumor]] of [[midgut]] are difficult to identify on [[CT]] because of their small size.
 
* Findings: [[Mass|mass-]]<nowiki/>like process with soft tissue "spokes" radiating into the [[mesenteric]] [[fat]] toward the [[small bowel]] causing retraction.
* [[Liver]] [[metastases]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Sensitivity|Sensitive]] for detection of [[Liver (2)|liver]] [[metastases]]
| style="background: #F5F5F5; padding: 5px;" | +
* Localization of [[carcinoid tumor]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* 68-Ga DOTATATE [[PET scan]]
 
* [[Positron emission tomography-computed tomography]] ([[PET-CT]]) using 18[[-fluoro-dihydroxyphenylalanine]]
* Ki-67 labeling index
* [[Endoscopy]] for [[metastatic]] [[Neuroendocrine tumour]] with an unknown primary site.
|
* Valve thickening with retraction and reduction in the mobility of the [[Tricuspid valves|tricuspid valve]]
*
| style="background: #F5F5F5; padding: 5px;" |
* [[Enterochromaffin cells|Enterochromaffin]] [[cells]] stain with [[Potassium chromate|potassium chromate (chromaffin]]).
 
*On [[electron microscopy]] ,the [[cells]] in [[tumors]] are found to contain [[membrane]]-bound [[Granules|secretory granules]] with dense-core [[granules]] in the [[cytoplasm]].
| style="background: #F5F5F5; padding: 5px;" |
* Somatostatin receptor scintigraphy [SRS], or [[Octreoscan]]
* [[Biopsy]] and [[histopathology]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Mesenteric]] [[fibrosis]]
Pathognomonic radiological sign of [[midgut]] [[Neuroendocrine tumor|NET]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neuroendocrine tumor]] of [[lung]]<ref name="pmid18473355">{{cite journal |vauthors=Gustafsson BI, Kidd M, Chan A, Malfertheiner MV, Modlin IM |title=Bronchopulmonary neuroendocrine tumors |journal=Cancer |volume=113 |issue=1 |pages=5–21 |date=July 2008 |pmid=18473355 |doi=10.1002/cncr.23542 |url=}}</ref><ref name="JeungGasser2002">{{cite journal|last1=Jeung|first1=Mi-Young|last2=Gasser|first2=Bernard|last3=Gangi|first3=Afshin|last4=Charneau|first4=Dominique|last5=Ducroq|first5=Xavier|last6=Kessler|first6=Romain|last7=Quoix|first7=Elisabeth|last8=Roy|first8=Catherine|title=Bronchial Carcinoid Tumors of the Thorax: Spectrum of Radiologic Findings|journal=RadioGraphics|volume=22|issue=2|year=2002|pages=351–365|issn=0271-5333|doi=10.1148/radiographics.22.2.g02mr01351}}</ref><ref name="pmid1649924">{{cite journal |vauthors=Nessi R, Basso Ricci P, Basso Ricci S, Bosco M, Blanc M, Uslenghi C |title=Bronchial carcinoid tumors: radiologic observations in 49 cases |journal=J Thorac Imaging |volume=6 |issue=2 |pages=47–53 |date=April 1991 |pmid=1649924 |doi= |url=}}</ref><ref name="pmid5831899">{{cite journal |vauthors=Melmon KL, Sjoerdsma A, Mason DT |title=Distinctive clinical and therapeutic aspects of the syndrome associated with bronchial carcinoid tumors |journal=Am. J. Med. |volume=39 |issue=4 |pages=568–81 |date=October 1965 |pmid=5831899 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Cough]]
* [[Hemoptysis]]
* [[Chest pain]]
* [[Fever]] due to [[Pneumonia|post -obstructuve pneuomnia]]
 
*
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Immunohistochemical  stains]]:
* [[Synaptophysin]]
* [[Neuron-specific enolase]]
 
* [[NT-proBNP]]
* Low [[serotonin]] content as compared to [[midgut]] [[Tumors|tumors.]]
| style="background: #F5F5F5; padding: 5px;" |
* Atypical [[neuroendocrine tumors]] have a greater tendency to [[metastasize]] to [[Liver|liver,]][[hypervascular]], and becomies isodense relative to th[[Liver|e liver]] [[parenchyma]] after [[contrast]] administration.
 
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Sensitivity (tests)|Sensitive]] for detection o[[Liver (2)|f liver]] [[metastases]] if present
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Chest X ray]]: round or oval [[Opacity|opacities]] from 2-5cm with sharp and notched margins
* [[Chest]] [[CT]] : [[Hilar]] or Perihilar Masses, Endobronchial [[Nodules]],Related to [[Bronchial|bronchial Obstruction]]:peripheral [[atelectasis]] and postobstructive [[pneumonia]]
* [[PFTs|Pulmonary funcation test]]
* [[Bronchoscopy]]
* [[68-Ga DOTATATE PET scan]]
* Fluorodeoxyglucose [[PET scan|PET scans]] for atypical [[lung]] [[Neuroendocrine|NETs]] .
| -
| style="background: #F5F5F5; padding: 5px;" |Typical low-grade:bland cells containing regular round [[nuclei]] with finely dispersed [[chromatin]] and inconspicuous small [[nucleoli]].Mitotic figures are scarce and [[necrosis]] is absent.
 
Intermediate-grade atypical: presence of [[Neuroendocrine]] morphology and either [[necrosis]] or 2 to 10 [[mitoses]] per 10 HPF
 
|
* [[Biopsy]] and [[histopathology]]
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Irritable Bowel Syndrome]]<ref name="pmid18371141">{{cite journal |vauthors=Ford AC, Forman D, Bailey AG, Axon AT, Moayyedi P |title=Irritable bowel syndrome: a 10-yr natural history of symptoms and factors that influence consultation behavior |journal=Am. J. Gastroenterol. |volume=103 |issue=5 |pages=1229–39; quiz 1240 |date=May 2008 |pmid=18371141 |doi=10.1111/j.1572-0241.2007.01740.x |url=}}</ref><ref name="pmid28374308">{{cite journal |vauthors=Simren M, Palsson OS, Whitehead WE |title=Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice |journal=Curr Gastroenterol Rep |volume=19 |issue=4 |pages=15 |date=April 2017 |pmid=28374308 |pmc=5378729 |doi=10.1007/s11894-017-0554-0 |url=}}</ref><ref name="pmid12454865">{{cite journal |vauthors= |title=American Gastroenterological Association medical position statement: irritable bowel syndrome |journal=Gastroenterology |volume=123 |issue=6 |pages=2105–7 |date=December 2002 |pmid=12454865 |doi=10.1053/gast.2002.37095b |url=}}</ref><ref name="pmid27144627">{{cite journal |vauthors=Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R |title=Bowel Disorders |journal=Gastroenterology |volume= |issue= |pages= |date=February 2016 |pmid=27144627 |doi=10.1053/j.gastro.2016.02.031 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | +
 
Perioidic
| style="background: #F5F5F5; padding: 5px;" |
* Intermittent
* Chronic history of [[Diarrhea|diarhea]] alternating with [[constipation]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*
* [[Fibromyalgia]]
* [[Chronic fatigue syndrome]]
* [[Gastroesophageal reflux disease]],
* [[Functional dyspepsia]]
* [[Non-cardiac chest pain]],
* [[Major depression]]
* ,[[Anxiety Disorder|Anxiety]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
|
* [[Bristol stool]] form scale should to record [[stool]] consistency
* [[Abdominal|Abdomina]]<nowiki/>l [[Radiographic|radiograph]] to assess for [[Stool|stoo]]<nowiki/>l accumulation and determine the severity.
* Age-appropriate [[colorectal cancer]] [[screening]] in all [[patients]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Rome IV criteria]]
* Recurrent [[abdominal pain]],  at least 1day/week in the last 3 months, a/s with 2 or more of the following criteria:
•Related to [[defecation]]
 
•Associated with a change in [[stool]] frequency
 
•Associated with a change in [[stool]] form (appearance)
| style="background: #F5F5F5; padding: 5px;" |
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Small intestine cancer|Malignant neoplasms of small intestine]]<ref name="pmid23789703">{{cite journal |vauthors=McLaughlin PD, Maher MM |title=Primary malignant diseases of the small intestine |journal=AJR Am J Roentgenol |volume=201 |issue=1 |pages=W9–14 |date=July 2013 |pmid=23789703 |doi=10.2214/AJR.12.8492 |url=}}</ref><ref name="pmid17372046">{{cite journal |vauthors=Hatzaras I, Palesty JA, Abir F, Sullivan P, Kozol RA, Dudrick SJ, Longo WE |title=Small-bowel tumors: epidemiologic and clinical characteristics of 1260 cases from the connecticut tumor registry |journal=Arch Surg |volume=142 |issue=3 |pages=229–35 |date=March 2007 |pmid=17372046 |doi=10.1001/archsurg.142.3.229 |url=}}</ref><ref name="pmid17026561">{{cite journal |vauthors=Lepage C, Bouvier AM, Manfredi S, Dancourt V, Faivre J |title=Incidence and management of primary malignant small bowel cancers: a well-defined French population study |journal=Am. J. Gastroenterol. |volume=101 |issue=12 |pages=2826–32 |date=December 2006 |pmid=17026561 |doi=10.1111/j.1572-0241.2006.00854.x |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
* [[Constipation]]
* [[Fatigue]]
* Early [[satiety]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |* [[Abdominal mass]]
* [[Ascites]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Abdominal]] [[CT scan]] may be diagnostic of [[Small intestine cancer|small intestine cancer.]] Findings on [[CT scan]] suggestive of [[Small intestine cancer CT|small intestine cancer]] include intrinsic [[mass]] with a short segment of [[Bowel|bowel wall]] thickening
| style="background: #F5F5F5; padding: 5px;" |[[MRI]] and [[MRI enteroscopy]] are other advance modalities to [[diagnose]] and [[Staging (pathology)|stage]] [[Small intestine cancer|small intestinal cancers]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Endoscopy|Enteroscopy]], [[capsule endoscopy]] and double balloon [[enteroscopy]]
|
| style="background: #F5F5F5; padding: 5px;" |
*[[Adenocarcinoma|Adenocarcinomas]] may be polypoid, infiltrating, or as annular constricting lesions is [[small intestine]].
*[[Polyps]] and [[adenomas]] of [[small intestine]] are considered precursor lesions of [[adenocarcinoma]].
*[[Lymphoma|Lymphomas]] of [[small intestine]] present with suspicious growths in [[submucosa]] with normal appearing [[muscosa]].
*[[Endoscopy|Endoscopic]] evaluation may show multifocal involvement and large [[biopsies]] are required for diagnoses
|[[Biopsy]] and [[histopathology]]
|
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Crohn disease]]<ref name="pmid18649092">{{cite journal |vauthors=Hara AK, Swartz PG |title=CT enterography of Crohn's disease |journal=Abdom Imaging |volume=34 |issue=3 |pages=289–95 |date=2009 |pmid=18649092 |doi=10.1007/s00261-008-9443-1 |url=}}</ref><ref name="BaumgartSandborn2012">{{cite journal|last1=Baumgart|first1=Daniel C|last2=Sandborn|first2=William J|title=Crohn's disease|journal=The Lancet|volume=380|issue=9853|year=2012|pages=1590–1605|issn=01406736|doi=10.1016/S0140-6736(12)60026-9}}</ref><ref name="FeuersteinCheifetz2017">{{cite journal|last1=Feuerstein|first1=Joseph D.|last2=Cheifetz|first2=Adam S.|title=Crohn Disease: Epidemiology, Diagnosis, and Management|journal=Mayo Clinic Proceedings|volume=92|issue=7|year=2017|pages=1088–1103|issn=00256196|doi=10.1016/j.mayocp.2017.04.010}}</ref><ref name="García-BoschOrdás2016">{{cite journal|last1=García-Bosch|first1=O.|last2=Ordás|first2=I.|last3=Aceituno|first3=M.|last4=Rodríguez|first4=S.|last5=Ramírez|first5=A. M.|last6=Gallego|first6=M.|last7=Ricart|first7=E.|last8=Rimola|first8=J.|last9=Panes|first9=J.|title=Comparison of Diagnostic Accuracy and Impact of Magnetic Resonance Imaging and Colonoscopy for the Management of Crohn’s Disease|journal=Journal of Crohn's and Colitis|volume=10|issue=6|year=2016|pages=663–669|issn=1873-9946|doi=10.1093/ecco-jcc/jjw015}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Right lower quadrant abdominal pain resident survival guide|Right lower quadrant]] [[pain]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Gross [[bloody diarrhea]] +/-
* [[Weight loss]]
* [[Fatigue (physical)|Fatigue]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*
* [[Weight loss]]
* [[Pallor]]
* [[Oral lesions]]
* [[Odynophagia]]
* [[Dysphagia]]
* Perianal skin tags
* [[Sinus tracts]]
* [[Gallstones]]
* Extraintestinal manifestations
* [[Arthritis]]
* [[Uveitis]], [[Iritis]], and [[Episcleritis]]
* [[Erythema nodosum]] and [[Pyoderma gangrenosum]]
* [[Primary sclerosing cholangitis]]
* Secondary [[amyloidosis]]
* [[Thromboembolism]]
* [[Renal stones]]
* [[Osteoporosis]]
* [[Vitamin B12 deficiency]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* [[CRP]]  may be high
* [[p-ANCA]] and [[Anti saccharomyces cerevisiae antibodies|ASCA]]
*
| style="background: #F5F5F5; padding: 5px;" |
* CT enterography [[:Small bowel]] [[inflammation]] by displaying mural hyperenhancement and thickening; engorged [[vasa recta]]; and [[perienteric]] [[inflammatory]] changes.
|
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
|
* [[CBC]]
 
* [[Blood chemistry tests|Blood chemistry]] including [[Electrolyte|electrolytes]]
 
* [[Kidney function|Renal function tests]]
* [[liver enzymes]]
* [[Blood glucose]]
 
* [[ESR]]
 
* [[CRP]]
 
* [[Serum iron]]
* [[Vitamin D]] & [[vitamin B12 levels]]
* [[Stool D/R]] and [[Culture media|culture]] for [[ova]] and [[parasites]],
* [[Clostridium difficile|''C. difficile'' toxin]]
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
* Focal ulcerations and acute and chronic inflammation
 
* [[Granulomas]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Colonoscopic|Colonoscop]]<nowiki/>y:focal ulcerations adjacent to areas of normal appearing [[mucosa]] along with polypoid mucosa[[Skip lesion|l,skip lesion]]<nowiki/>s,[[pseudopolyps]],
| style="background: #F5F5F5; padding: 5px;" |
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Benign cutaneous flushing]]<ref name="IziksonEnglish2006">{{cite journal|last1=Izikson|first1=Leonid|last2=English|first2=Joseph C.|last3=Zirwas|first3=Matthew J.|title=The flushing patient: Differential diagnosis, workup, and treatment|journal=Journal of the American Academy of Dermatology|volume=55|issue=2|year=2006|pages=193–208|issn=01909622|doi=10.1016/j.jaad.2005.07.057}}</ref>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
|
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mastocytosis|Systemic mastocytosis]]<ref name="HartmannEscribano2016">{{cite journal|last1=Hartmann|first1=Karin|last2=Escribano|first2=Luis|last3=Grattan|first3=Clive|last4=Brockow|first4=Knut|last5=Carter|first5=Melody C.|last6=Alvarez-Twose|first6=Ivan|last7=Matito|first7=Almudena|last8=Broesby-Olsen|first8=Sigurd|last9=Siebenhaar|first9=Frank|last10=Lange|first10=Magdalena|last11=Niedoszytko|first11=Marek|last12=Castells|first12=Mariana|last13=Oude Elberink|first13=Joanna N.G.|last14=Bonadonna|first14=Patrizia|last15=Zanotti|first15=Roberta|last16=Hornick|first16=Jason L.|last17=Torrelo|first17=Antonio|last18=Grabbe|first18=Jürgen|last19=Rabenhorst|first19=Anja|last20=Nedoszytko|first20=Boguslaw|last21=Butterfield|first21=Joseph H.|last22=Gotlib|first22=Jason|last23=Reiter|first23=Andreas|last24=Radia|first24=Deepti|last25=Hermine|first25=Olivier|last26=Sotlar|first26=Karl|last27=George|first27=Tracy I.|last28=Kristensen|first28=Thomas K.|last29=Kluin-Nelemans|first29=Hanneke C.|last30=Yavuz|first30=Selim|last31=Hägglund|first31=Hans|last32=Sperr|first32=Wolfgang R.|last33=Schwartz|first33=Lawrence B.|last34=Triggiani|first34=Massimo|last35=Maurer|first35=Marcus|last36=Nilsson|first36=Gunnar|last37=Horny|first37=Hans-Peter|last38=Arock|first38=Michel|last39=Orfao|first39=Alberto|last40=Metcalfe|first40=Dean D.|last41=Akin|first41=Cem|last42=Valent|first42=Peter|title=Cutaneous manifestations in patients with mastocytosis: Consensus report of the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology|journal=Journal of Allergy and Clinical Immunology|volume=137|issue=1|year=2016|pages=35–45|issn=00916749|doi=10.1016/j.jaci.2015.08.034}}</ref><ref name="LeeWhittaker2008">{{cite journal|last1=Lee|first1=Jason K|last2=Whittaker|first2=Scott J|last3=Enns|first3=Robert A|last4=Zetler|first4=Peter|title=Gastrointestinal manifestations of systemic mastocytosis|journal=World Journal of Gastroenterology|volume=14|issue=45|year=2008|pages=7005|issn=1007-9327|doi=10.3748/wjg.14.7005}}</ref><ref name="pmid2002264">{{cite journal |vauthors=Horan RF, Austen KF |title=Systemic mastocytosis: retrospective review of a decade's clinical experience at the Brigham and Women's Hospital |journal=J. Invest. Dermatol. |volume=96 |issue=3 |pages=5S–13S; discussion 13S–14S |date=March 1991 |pmid=2002264 |doi= |url=}}</ref><ref name="SokolGeorgin-Lavialle2010">{{cite journal|last1=Sokol|first1=Harry|last2=Georgin-Lavialle|first2=Sophie|last3=Grandpeix-Guyodo|first3=Catherine|last4=Canioni|first4=Danielle|last5=Barete|first5=Stéphane|last6=Dubreuil|first6=Patrice|last7=Lortholary|first7=Olivier|last8=Beaugerie|first8=Laurent|last9=Hermine|first9=Olivier|title=Gastrointestinal involvement and manifestations in systemic mastocytosis|journal=Inflammatory Bowel Diseases|volume=16|issue=7|year=2010|pages=1247–1253|issn=1078-0998|doi=10.1002/ibd.21218}}</ref><ref name="pmid17063092">{{cite journal |vauthors=Bedeir A, Jukic DM, Wang L, Mullady DK, Regueiro M, Krasinskas AM |title=Systemic mastocytosis mimicking inflammatory bowel disease: A case report and discussion of gastrointestinal pathology in systemic mastocytosis |journal=Am. J. Surg. Pathol. |volume=30 |issue=11 |pages=1478–82 |date=November 2006 |pmid=17063092 |doi=10.1097/01.pas.0000213310.51553.d7 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* [[Maculopapular rash]]
* [[Pruritus]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Diffuse [[musculoskeletal pain]]
* [[Neuropsychiatric symptoms]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Activating [[mutations]] of ''[[KIT]]''
* Serum [[Tryptase]] levels
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Asthma]] exacerbation<ref name="pmid22386508">{{cite journal |vauthors=Fuhlbrigge A, Peden D, Apter AJ, Boushey HA, Camargo CA, Gern J, Heymann PW, Martinez FD, Mauger D, Teague WG, Blaisdell C |title=Asthma outcomes: exacerbations |journal=J. Allergy Clin. Immunol. |volume=129 |issue=3 Suppl |pages=S34–48 |date=March 2012 |pmid=22386508 |pmc=3595577 |doi=10.1016/j.jaci.2011.12.983 |url=}}</ref><ref name="pmid16337448">{{cite journal |vauthors=Limb SL, Brown KC, Wood RA, Wise RA, Eggleston PA, Tonascia J, Adkinson NF |title=Irreversible lung function deficits in young adults with a history of childhood asthma |journal=J. Allergy Clin. Immunol. |volume=116 |issue=6 |pages=1213–9 |date=December 2005 |pmid=16337448 |doi=10.1016/j.jaci.2005.09.024 |url=}}</ref><ref name="pmid17468458">{{cite journal |vauthors=Aldington S, Beasley R |title=Asthma exacerbations. 5: assessment and management of severe asthma in adults in hospital |journal=Thorax |volume=62 |issue=5 |pages=447–58 |date=May 2007 |pmid=17468458 |pmc=2117186 |doi=10.1136/thx.2005.045203 |url=}}</ref><ref name="pmid19187331">{{cite journal |vauthors=Dougherty RH, Fahy JV |title=Acute exacerbations of asthma: epidemiology, biology and the exacerbation-prone phenotype |journal=Clin. Exp. Allergy |volume=39 |issue=2 |pages=193–202 |date=February 2009 |pmid=19187331 |pmc=2730743 |doi=10.1111/j.1365-2222.2008.03157.x |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Tachypnea
* Prolonged expiratory phase of respiration (decreased I:E ratio)
* Seated position with use of extended arms to support the upper chest (tripod position)
* +/- Pulsus paradoxus
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | --
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
|[[Chest X ray]]
| -
| style="background: #F5F5F5; padding: 5px;" |
* Loss of the normal pseudostratified structure of airway epithelium
* Increase in the proportion of goblet cells
* Fibrotic thickening of the sub-epithelial reticular basement membrane
* Increased numbers of myofibroblasts
* Increased vascularity
* Increased airway smooth muscle mass
* Increased extracellular matrix
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Anaphylaxis]]<ref name="pmid18596587">{{cite journal |vauthors=Peavy RD, Metcalfe DD |title=Understanding the mechanisms of anaphylaxis |journal=Curr Opin Allergy Clin Immunol |volume=8 |issue=4 |pages=310–5 |date=August 2008 |pmid=18596587 |pmc=2683407 |doi=10.1097/ACI.0b013e3283036a90 |url=}}</ref><ref name="pmid20944042">{{cite journal |vauthors=Tupper J, Visser S |title=Anaphylaxis: A review and update |journal=Can Fam Physician |volume=56 |issue=10 |pages=1009–11 |date=October 2010 |pmid=20944042 |pmc=2954079 |doi= |url=}}</ref><ref name="pmid12209078">{{cite journal |vauthors=Kemp SF, Lockey RF |title=Anaphylaxis: a review of causes and mechanisms |journal=J. Allergy Clin. Immunol. |volume=110 |issue=3 |pages=341–8 |date=September 2002 |pmid=12209078 |doi= |url=}}</ref><ref name="pmid21293765">{{cite journal |vauthors=Bjornsson HM, Graffeo CS |title=Improving diagnostic accuracy of anaphylaxis in the acute care setting |journal=West J Emerg Med |volume=11 |issue=5 |pages=456–61 |date=December 2010 |pmid=21293765 |pmc=3027438 |doi= |url=}}</ref><ref name="urlUsefulness and Limitations of Sequential Serum Tryptase for the Diagnosis of Anaphylaxis in 102 Patients - FullText - International Archives of Allergy and Immunology 2013, Vol. 160, No. 2 - Karger Publishers">{{cite web |url=https://www.karger.com/Article/Fulltext/339749 |title=Usefulness and Limitations of Sequential Serum Tryptase for the Diagnosis of Anaphylaxis in 102 Patients - FullText - International Archives of Allergy and Immunology 2013, Vol. 160, No. 2 - Karger Publishers |format= |work= |accessdate=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Vomiting]]
* [[Hives|Generalized hives]],
* [[Pruritus]]
* [[Itching]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Swollen [[lips]]-[[tongue]]-[[uvula]]
* [[Periorbital edema]],
* [[Conjunctival|Conjunctival swelling]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* plasma [[tryptase]]
* Plasm[[Histamine|a histamine]] levels
* Take proper clinical history and medication history specially [[beta blockers]],[[Angiotensin Converting Enzyme Inhibitor|ACE-inhibitors,]][[opioids]]
* [[Skin testing]] with [[Allergens|allergen extracts]]
* [[Enzyme linked immunosorbent assay (ELISA)|enzyme-linked immunosorbent assays (ELISAs)]] for quantification of allergen-specific [[IgE]] levels
*
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
|History of exposure to [[Insect allergy|insect]] stings,food alllergy,rubber latex,food [[Additives|additives,]],allergy to medications,physical factors such s excercise and cold
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Histaminergic [[Angioedema]]<ref name="pmid28687103">{{cite journal |vauthors=Busse PJ, Smith T |title=Histaminergic Angioedema |journal=Immunol Allergy Clin North Am |volume=37 |issue=3 |pages=467–481 |date=August 2017 |pmid=28687103 |doi=10.1016/j.iac.2017.03.001 |url=}}</ref><ref name="pmid28818177">{{cite journal |vauthors=Hahn J, Hoffmann TK, Bock B, Nordmann-Kleiner M, Trainotti S, Greve J |title=Angioedema |journal=Dtsch Arztebl Int |volume=114 |issue=29-30 |pages=489–496 |date=July 2017 |pmid=28818177 |pmc=5569554 |doi=10.3238/arztebl.2017.0489 |url=}}</ref><ref name="pmid28405953">{{cite journal |vauthors=Bernstein JA, Cremonesi P, Hoffmann TK, Hollingsworth J |title=Angioedema in the emergency department: a practical guide to differential diagnosis and management |journal=Int J Emerg Med |volume=10 |issue=1 |pages=15 |date=December 2017 |pmid=28405953 |pmc=5389952 |doi=10.1186/s12245-017-0141-z |url=}}</ref><ref name="pmid23131076">{{cite journal |vauthors=Bernstein JA, Moellman J |title=Emerging concepts in the diagnosis and treatment of patients with undifferentiated angioedema |journal=Int J Emerg Med |volume=5 |issue=1 |pages=39 |date=November 2012 |pmid=23131076 |pmc=3518251 |doi=10.1186/1865-1380-5-39 |url=}}</ref><ref name="pmid23282406">{{cite journal |vauthors=Kaplan AP |title=Angioedema |journal=World Allergy Organ J |volume=1 |issue=6 |pages=103–13 |date=June 2008 |pmid=23282406 |pmc=3651192 |doi=10.1097/WOX.0b013e31817aecbe |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Generalized [[pruritus]]
* [[Throat]] tightness
* [[Hoarse voice]]
* [[Difficulty swallowing]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* [[Urticaria]]
* Localized [[swelling]] of [[skin]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* [[Bowel|Bowel wall]] edema
* Circumferential thickening of the [[Small bowel|small bowel wall]] with [[ascites]] or incomplete [[obstruction]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* [[CBC|CBC with differential,]]
* [[Electrolyte|Electrolytes]]
* [[Liver function tests]]
* [[C-reactive protein (CRP)|C-reactive protein]]
* [[ESR|Erythrocyte sedimentation rate]]
* Levels of the [[Complement System|complement protein C4]]
* Serum tota[[Tryptase|l tryptase]]
* Allergen-specific [[IgE immunoassay|IgE immunoassays]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Take proper clinical history of previous similar episodes
* Medication history
* Any allergy to insects stings , foods or any ingestion within previous 24 hours
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Medullary carcinoma of thyroid|Medullary Thyroid Carcinoma]]<ref name="pmid20627492">{{cite journal |vauthors=Pacini F, Castagna MG, Cipri C, Schlumberger M |title=Medullary thyroid carcinoma |journal=Clin Oncol (R Coll Radiol) |volume=22 |issue=6 |pages=475–85 |date=August 2010 |pmid=20627492 |doi=10.1016/j.clon.2010.05.002 |url=}}</ref><ref name="pmid24037980">{{cite journal |vauthors=Roy M, Chen H, Sippel RS |title=Current understanding and management of medullary thyroid cancer |journal=Oncologist |volume=18 |issue=10 |pages=1093–100 |date=2013 |pmid=24037980 |pmc=3805151 |doi=10.1634/theoncologist.2013-0053 |url=}}</ref><ref name="pmid24552221">{{cite journal |vauthors=Mian C, Perrino M, Colombo C, Cavedon E, Pennelli G, Ferrero S, De Leo S, Sarais C, Cacciatore C, Manfredi GI, Verga U, Iacobone M, De Pasquale L, Pelizzo MR, Vicentini L, Persani L, Fugazzola L |title=Refining calcium test for the diagnosis of medullary thyroid cancer: cutoffs, procedures, and safety |journal=J. Clin. Endocrinol. Metab. |volume=99 |issue=5 |pages=1656–64 |date=May 2014 |pmid=24552221 |doi=10.1210/jc.2013-4088 |url=}}</ref><ref name="pmid26494386">{{cite journal |vauthors=Bae YJ, Schaab M, Kratzsch J |title=Calcitonin as Biomarker for the Medullary Thyroid Carcinoma |journal=Recent Results Cancer Res. |volume=204 |issue= |pages=117–37 |date=2015 |pmid=26494386 |doi=10.1007/978-3-319-22542-5_5 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* [[Neck pain]]
* [[Hoarseness]]
* [[Cough]]
* [[Difficulty swallowing]]
* [[Difficulty breathing]]
* [[Lethargy]]
* [[Bone pain]] from [[metastasis]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* [[Solitary thyroid nodule]]
* [[Cervical lymph nodes|Cervical lymph node involvement]]
* [[Weight loss]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Basal serum [[calcitonin]] concentrations
* [[Carcinoembryonic antigen peptide-1|Carcinoembryonic antigen (CEA) concentration]]
* [[Thyroid function tests]]: normal
* [[Germline]] ''[[RET gene|RET]]'' testing
* [[Calcium|Serum calcium]]
* Plasma fractionated [[Metanephrine|metanephrines]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* [[Ultrasonography]] of the [[neck]]
Fo[[Metastasis|r metastasis]]
* [[Chest]] [[computed tomography]]
* [[Neck]] [[CT]]
* Three-phase contrast-enhanced [[Liver (2)|liver]] [[CT-scans|CT]]
* Axial [[MRI]]
* Bone [[scintigraphy]].
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* [[Immunohistochemical staining]] for [[calcitonin]]
* [[Spindle cells|Spindle]]-shaped and frequently [[Pleomorphic|pleomorphic cells]] without follicle development
| style="background: #F5F5F5; padding: 5px;" |
* [[Fine-needle aspiration|Fine-needle aspiration (FNA) biopsy]]
* [[TNM staging system|TNM staging]]
* American Thyroid Association (ATA) Guidelines for Management and evaluation of [[Medullary carcinoma of the thyroid|Medullary Thyroid Cancer]]
|
|}
 
=== Differential diagnosis based on diarrhea ===
The following table outlines the major differential diagnoses based on [[diarrhea]] as the major presenting [[symptom]]
 
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis for Diarrhea predominant symptoms}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Clinical features}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Diagnosis}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Crohn's disease]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Diarrhea]], [[abdominal pain]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Colonoscopy]], [[small bowel barium radiograph]], [[CT enterography]], [[magnetic resonance enterography]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Ulcerative colitis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Present with [[abdominal pain]], [[tenesmus]], have [[diarrhea]] and [[rectal bleeding]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Colonoscopy]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Microscopic colitis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Watery diarrhea]] with nocturnal [[Symptom|symptoms]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Colonoscopy]], [[flexible sigmoidoscopy]] and [[biopsy]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Celiac disease]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Diarrhea]], [[steatorrhea]], [[anemia]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Endoscopy]] with [[small bowel]] biopsy, [[tissue transglutaminase]] [[antibody]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Neuroendocrine tumor]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Gastrinoma]], [[carcinoid]] and [[VIPoma|VIP producing tumor]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Urine 5HIAA]], fasting [[gastrin]] levels (followed by [[secretin]] stimulation test), [[serum]] [[VIP]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Hyperthyroidism]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Increased [[appetite]], [[insomnia]], [[diarrhea]], [[palpitations]], heat intolerance, increased [[sweating]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Serum [[TSH]] levels
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Lactose intolerance]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Flatulence]], [[bloating]] with [[lactose]] consumption
| style="padding: 5px 5px; background: #F5F5F5;" |
* Avoidance trial, lactose breath test
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Infectious]] causes
| style="padding: 5px 5px; background: #F5F5F5;" |
* Abdominal discomfort, [[diarrhea]] especially in the setting of recent travel
| style="padding: 5px 5px; background: #F5F5F5;" |
* Stool for ova and [[parasites]], stool Giardia antigen, stool culture, trial of [[metronidazole]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Small bowel bacterial overgrowth]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Bloating]], [[diarrhea]], [[abdominal distension]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Jejunum|Jejunal]] aspirate, [[lactulose]] breath hydrogen test, [[antibiotic]] trial
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Clostridium difficile]] [[infection]]([[Pseudomembranous enterocolitis|Psuedomembranous colitis]])
| style="padding: 5px 5px; background: #F5F5F5;" |
* Recent [[antibiotic]] [[treatment]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Stool]] [[polymerase chain reaction]]
|}
==References==
==References==
{{Reflist|2}}


{{reflist|2}}
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<references />

Latest revision as of 02:40, 20 January 2022

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

Content

Overview

Differentiating Irritable Bowel Syndrome from other Diseases

Differential diagnosis based on the predominant symptom(s)

References

Overview

Irritable bowel syndrome must be differentiated from other diseases that cause diarrhea, constipation, and abdominal pain, such as Celiac disease, Inflammatory bowel disease(Crohn's disease and Ulcerative colitis) Thyroid disease (Hyper or Hypothyroidism), strictures due to ischemia, diverticulitis or ischemia, among others.

The differential diagnosis for Irritable bowel syndrome can be listed based on predominant symptoms, such as constipation predominant, diarrhea predominant and pain predominant diseases.

Differentiating Irritable Bowel Syndrome from other Diseases

Diseases with similar symptoms

Differential diagnosis based on predominant symptom(s)

Differential diagnosis based on abdominal pain

The differential diagnosis of IBS based on abdominal pain is as follows:

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin

Classification of pain in the abdomen based on etiology Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Fever Rigors and chills Abdominal Pain Jaundice Diarrhea Melena/ hematochezia/ hemtemesis Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Abdominal causes Inflammatory causes Pancreato-biliary disorders Acute suppurative cholangitis + + RUQ + + + + N
  • Abnormal LFT
  • WBC >10,000
Ultrasound shows biliary dilatation/stents/tumor Septic shock occurs with features of SIRS
Acute cholangitis + RUQ + N Ultrasound shows biliary dilatation/stents/tumor Biliary drainage (ERCP) + IV antibiotics
Acute cholecystitis + RUQ + Hypoactive Ultrasound shows gallstone and evidence of inflammation Murphy’s sign
Acute pancreatitis + Epigastric ± ± N Ultrasound shows evidence of inflammation Pain radiation to back
Primary biliary cirrhosis RUQ/Epigastric + N
  • Increased AMA level, abnormal LFTs
Primary sclerosing cholangitis + RUQ + N ERCP and MRCP shows
  • Multiple segmental strictures
  • Mural irregularities
  • Biliary dilatation and diverticula
  • Distortion of biliary tree
The risk of cholangiocarcinoma in patients with primary sclerosing cholangitis is 400 times higher than the risk in the general population.
Cholelithiasis ± RUQ/Epigastric ± + + N to hyperactive for dislodged stone Ultrasound shows gallstone Murphy’s sign
Gastric causes Peptic ulcer disease ± Diffuse + in perforated + + N
  • Ascitic fluid
    • LDH > serum LDH
    • Glucose < 50mg/dl
    • Total protein > 1g/dl
Air under diaphragm in upright CXR Upper GI endoscopy for diagnosis
Gastritis ± Epigastric + in chronic gastritis
Gastroesophageal reflux disease Epigastric
Gastric outlet obstruction Epigastric ± Hyperactive
Gastrointestinal perforation + ± Diffuse ± +, depends on site + + ±
  • WBC> 10,000
Air under diaphragm in upright CXR
Dumping syndrome Lower and then diffuse
Intestinal causes Acute appendicitis + +in pyogenic appendicitis Starts in epigastrium, migrates to RLQ + in perforated appendicitis + + Hypoactive Ultrasound shows evidence of inflammation Nausea & vomiting, decreased appetite
Acute diverticulitis + ± LLQ Hematochezia + Hypoactive CT scan and ultrasound shows evidence of inflammation
Inflammatory bowel disease ± Diffuse ± Hematochezia
Irritable bowel syndrome ± Diffuse + N Tests done to exclude other diseases as it diagnosis of exclusion Tests done to exclude other diseases as it diagnosis of exclusion Symptomatic treatment
Whipple's disease ± Diffuse ± ± N *Endoscopy is used to confirm diagnosis.

Images used to find complications

Extra intestinal findings:
Toxic megacolon + Diffuse + + ± Hypoactive CT scan shows:

Ultrasound shows:

  • Loss of haustra coli of the colon
  • Hypoechoic and thickened bowel walls with irregular internal margins in the sigmoid and descending colon
  • Prominent dilation of the transverse colon (>6 cm)
  • Insignificant dilation of ileal bowel loops (diameter >18 mm) with increased intraluminal gas and fluid
Tropical sprue + Diffuse +
Celiac disease Diffuse ±, also dermatitis herpetiformis + Hyperactive (increased sounds)
Infective colitis +
Hepatic causes Viral hepatitis + RUQ + +
Liver masses + + in Liver abscess RUQ ± + in sepsis
Budd-Chiari syndrome ± RUQ ± + in liver failure leading to varices N
Findings on CT scan suggestive of Budd-Chiari syndrome include:
Ascitic fluid examination shows:
Hemochromatosis RUQ Dull / aching + with infections and GI involvement + in cirrhotic patients may be in cardicmyopathy
  • >60% TS
  • >240 μg/L SF
  • Raised LFT
    Hyperglycemia
Ultrasound shows evidence of cirrhosis Extra intestinal findings:
  • hyperpigmentation
  • Diabetes mellitus
  • Arthralgia
  • Impotence in males
  • Cardiomyopathy
  • Atherosclerosis
  • Hypopituitarism
  • Hypothyroidism
  • Extrahepatic cancer
  • Prone to specific infections
Cirrhosis + RUQ + varices
Peritoneal causes Spontaneous bacterial peritonitis + Diffuse + in cirrhotic patients ± Hypoactive
  • Ascitic fluid PMN>250 cells/mm³
  • Culture: Positive for single organism
Ultrasound for evaluation of liver cirrhosis
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 + Hematochezia ± Hyperactive Leukocytosis and lactic acidosis CT scan Nausea & vomiting, normal physical examination
Acute ischemic colitis ± ± Diffuse + Massive + + Hyperactive then absent Leukocytosis CT scan Nausea & vomiting
Hemorrhagic causes Ruptured abdominal aortic aneurysm Diffuse Massive + N Normal CT scan Unstable hemodynamics
Intra-abdominal or retroperitoneal hemorrhage Diffuse Massive + N Anemia CT scan History of trauma
Gynaecological Causes Tubal causes Torsion of the cyst RLQ / LLQ ± ± N Increased ESR and CRP Ultrasound Sudden onset sever pain with nausea and vomiting
Acute salpingitis + ± RLQ / LLQ ± ± N Leukocytosis Pelvic ultrasound Vaginal discharge
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
Extra-abdominal causes Pulmonary disorders Pleural empyema + ± RUQ/Epigastric N
Cardiovascular disorders Myocardial Infarction Epigastric + in cardiogenic shock N

Differential diagnosis based on constipation

The differential diagnosis of irritable bowel syndrome based on constipation as the predominant symptom is as follows:[1][2][3][4][5][6][7][8][9][10]

Differential Diagnosis for Constipation predominant symptoms Clinical features Diagnosis
Strictures due to diverticultis,inflammatory bowel disease, ischemia or cancer
Hypothyroidism
Medication
  • Medication history.
Neurologic disease
Pelvic floor dysfunction
  • Straining, self digitation
Colonic inertia


Differential Diagnosis based on abdominal pain and diarrhea

Below is a table that overviews the differential based on type of diarrhea. A more detailed table follows.

Diarrhea with abdominal pain/cramping may be caused by infectious diseases, celiac disease,[11] parasites,[12] food allergies[13] and lactose intolerance.[14] See the list of causes of diarrhea for other conditions which can cause diarrhea. Celiac disease in particular is most often misdiagnosed as IBS.[15] The differential diagnosis of irritable bowel syndrome based on abdominal pain and diarrhea is as follows:[16][17][18][19][20][21][22][23][24][25]

Overview based on type of diarrhea

Cause Osmotic gap History Physical exam Gold standard Treatment
< 50 mOsm per kg > 50 mOsm per kg*
Watery Secretory Crohns + -
Zollinger-Ellison syndrome + -
  • Gastrin levels
  • Proton pump inhibitors
  • Octreotide
Hyperthyroidism + -
VIPoma + -
  • Elevated VIPlevels
  • Followed by imaging
Osmotic Lactose intolerance - +
Celiac disease - +
Functional Irritable bowel syndrome - - Abdominal pain or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following:
  • Onset associated with change in frequency of stool
Clinical diagnosis
  • ROME IV criteria
  • Exclusion of organic causes based on laboratory investigations and imaging


Details based on pathology

Irritable bowel syndrome must be diifferentiated from other causes of abdominal pain and diarrhea.

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Abdominal pain Diarrhea Flushing Dyspnea Palpitations Other symptoms Wheezing Telangiectasia Hypotension Tachycardia Systolic murmur of tricuspid regurgitation Other physical findings Urinary 5-hydroxyindoleacetic acid (5-HIAA) Serum Chromogranin A (CgA) Other markers Abdominal computed tomography (CT) Abdominal MRI Somatostatin receptor scintigraphy [SRS], or Octreoscan Metaiodobenzylguanidine (MIBG) scintigraphy Other diagnostic studies Transthoracic echocardiography
Carcinoid Syndrome[26][27][28][29][30][31][32][33][34] Neuroendocrine tumor of midgut [35][36][37][38] +

Mild

+ + + +

Dermatitis

Diarrhea

Dementia

Metastatic tumors in the liver: Right upper quadrant pain, hepatomegaly, and early satiety

+ +/- +/- + + - + + + +
  • Valve thickening with retraction and reduction in the mobility of the tricuspid valve

Pathognomonic radiological sign of midgut NET.

Neuroendocrine tumor of lung[39][40][41][42] + + + + +
+ +/- +/- + + - + + Sensitive for detection of liver metastases if present + + - Typical low-grade:bland cells containing regular round nuclei with finely dispersed chromatin and inconspicuous small nucleoli.Mitotic figures are scarce and necrosis is absent.

Intermediate-grade atypical: presence of Neuroendocrine morphology and either necrosis or 2 to 10 mitoses per 10 HPF

Irritable Bowel Syndrome[43][44][45][46] +

Perioidic

- - - - - - - - - - - - - - - - Rome IV criteria
  • Recurrent abdominal pain, at least 1day/week in the last 3 months, a/s with 2 or more of the following criteria:

•Related to defecation

•Associated with a change in stool frequency

•Associated with a change in stool form (appearance)

Malignant neoplasms of small intestine[47][48][49] +/- +/- - - +/- - - +/- - * Abdominal mass - + Abdominal CT scan may be diagnostic of small intestine cancer. Findings on CT scan suggestive of small intestine cancer include intrinsic mass with a short segment of bowel wall thickening MRI and MRI enteroscopy are other advance modalities to diagnose and stage small intestinal cancers - - Enteroscopy, capsule endoscopy and double balloon enteroscopy Biopsy and histopathology
Crohn disease[50][51][52][53] +/- - - - - - - - - - - - - -
  • Focal ulcerations and acute and chronic inflammation
Benign cutaneous flushing[54] - - + - - - - - - - - - - - - - - - - - - -
Systemic mastocytosis[55][56][57][58][59] + + + + - +/- +/- + - - - - - -
Asthma exacerbation[60][61][62][63] - - - + + + - - + -
  • Tachypnea
  • Prolonged expiratory phase of respiration (decreased I:E ratio)
  • Seated position with use of extended arms to support the upper chest (tripod position)
  • +/- Pulsus paradoxus
- - - -- - - - Chest X ray -
  • Loss of the normal pseudostratified structure of airway epithelium
  • Increase in the proportion of goblet cells
  • Fibrotic thickening of the sub-epithelial reticular basement membrane
  • Increased numbers of myofibroblasts
  • Increased vascularity
  • Increased airway smooth muscle mass
  • Increased extracellular matrix
Anaphylaxis[64][65][66][67][68] + -/+ + + + +/- - + + - - - - - - - - - - History of exposure to insect stings,food alllergy,rubber latex,food additives,,allergy to medications,physical factors such s excercise and cold
Histaminergic Angioedema[69][70][71][72][73] +/- +/- + + + + - + + - - - - - - - - - -
  • Take proper clinical history of previous similar episodes
  • Medication history
  • Any allergy to insects stings , foods or any ingestion within previous 24 hours
Medullary Thyroid Carcinoma[74][75][76][77] - +/- +/- +/- - - - - - - - - - - - -

For metastasis

-

Differential diagnosis based on diarrhea

The following table outlines the major differential diagnoses based on diarrhea as the major presenting symptom

Differential Diagnosis for Diarrhea predominant symptoms Clinical features Diagnosis
Crohn's disease
Ulcerative colitis
Microscopic colitis
Celiac disease
Neuroendocrine tumor
Hyperthyroidism
  • Serum TSH levels
Lactose intolerance
  • Avoidance trial, lactose breath test
Infectious causes
  • Abdominal discomfort, diarrhea especially in the setting of recent travel
Small bowel bacterial overgrowth
Clostridium difficile infection(Psuedomembranous colitis)

References

  1. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS (2006). "Childhood functional gastrointestinal disorders: child/adolescent". Gastroenterology. 130 (5): 1527–37. doi:10.1053/j.gastro.2005.08.063. PMID 16678566.
  2. Cash BD, Schoenfeld P, Chey WD (2002). "The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review". Am. J. Gastroenterol. 97 (11): 2812–9. doi:10.1111/j.1572-0241.2002.07027.x. PMID 12425553.
  3. Hamm LR, Sorrells SC, Harding JP, Northcutt AR, Heath AT, Kapke GF, Hunt CM, Mangel AW (1999). "Additional investigations fail to alter the diagnosis of irritable bowel syndrome in subjects fulfilling the Rome criteria". Am. J. Gastroenterol. 94 (5): 1279–82. doi:10.1111/j.1572-0241.1999.01077.x. PMID 10235207.
  4. Prott G, Shim L, Hansen R, Kellow J, Malcolm A (2010). "Relationships between pelvic floor symptoms and function in irritable bowel syndrome". Neurogastroenterol. Motil. 22 (7): 764–9. doi:10.1111/j.1365-2982.2010.01503.x. PMID 20456760.
  5. Voderholzer WA, Schatke W, Mühldorfer BE, Klauser AG, Birkner B, Müller-Lissner SA (1997). "Clinical response to dietary fiber treatment of chronic constipation". Am. J. Gastroenterol. 92 (1): 95–8. PMID 8995945.
  6. Spiller R, Camilleri M, Longstreth GF (2010). "Do the symptom-based, Rome criteria of irritable bowel syndrome lead to better diagnosis and treatment outcomes?". Clin. Gastroenterol. Hepatol. 8 (2): 125–9, discussion 129–36. doi:10.1016/j.cgh.2009.12.018. PMID 20152787.
  7. Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K (2010). "Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial". Am. J. Gastroenterol. 105 (4): 890–6. doi:10.1038/ajg.2010.53. PMC 3910270. PMID 20179692.
  8. Chey WD, Nojkov B, Rubenstein JH, Dobhan RR, Greenson JK, Cash BD (2010). "The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: results from a prospective, controlled US trial". Am. J. Gastroenterol. 105 (4): 859–65. doi:10.1038/ajg.2010.55. PMC 2887227. PMID 20179696.
  9. Begtrup LM, Engsbro AL, Kjeldsen J, Larsen PV, Schaffalitzky de Muckadell O, Bytzer P, Jarbøl DE (2013). "A positive diagnostic strategy is noninferior to a strategy of exclusion for patients with irritable bowel syndrome". Clin. Gastroenterol. Hepatol. 11 (8): 956–62.e1. doi:10.1016/j.cgh.2012.12.038. PMID 23357491.
  10. Mehdi Z, Sakineh E, Mohammad F, Mansour R, Alireza A (2012). "Celiac disease: Serologic prevalence in patients with irritable bowel syndrome". J Res Med Sci. 17 (9): 839–42. PMC 3697208. PMID 23826010.
  11. Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS (2004). "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology. 126 (7): 1721–32. PMID 15188167.
  12. Stark D, van Hal S, Marriott D, Ellis J, Harkness J. (2007). "Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and diagnosis". Int J Parasitol. 31 (1): 11–20. PMID 17070814.
  13. Drisko; et al. (2006). "Treating Irritable Bowel Syndrome with a Food Elimination Diet Followed by Food Challenge and Probiotics". Journal of the American College of Nutrition. 25 (6): 514–22. PMID 17229899.
  14. Vernia P, Ricciardi MR, Frandina C, Bilotta T, Frieri G (1995). "Lactose malabsorption and irritable bowel syndrome. Effect of a long-term lactose-free diet". The Italian journal of gastroenterology. 27 (3): 117–21. PMID 7548919.
  15. http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/ - The United States National Institutes of Health Celiac Disease Page
  16. Guagnozzi D, Arias Á, Lucendo AJ (2016). "Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders". Aliment. Pharmacol. Ther. 43 (8): 851–862. doi:10.1111/apt.13573. PMID 26913568.
  17. Hilpüsch F, Johnsen PH, Goll R, Valle PC, Sørbye SW, Abelsen B (2017). "Microscopic colitis: a missed diagnosis among patients with moderate to severe irritable bowel syndrome". Scand. J. Gastroenterol. 52 (2): 173–177. doi:10.1080/00365521.2016.1242025. PMID 27796144.
  18. SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA (1964). "EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME". Gastroenterology. 47: 184–7. PMID 14201408.
  19. Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS (2004). "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology. 126 (7): 1721–32. PMID 15188167.
  20. Irvine AJ, Chey WD, Ford AC (2017). "Screening for Celiac Disease in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis". Am. J. Gastroenterol. 112 (1): 65–76. doi:10.1038/ajg.2016.466. PMID 27753436.
  21. van Rheenen PF, Van de Vijver E, Fidler V (2010). "Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis". BMJ. 341: c3369. PMC 2904879. PMID 20634346.
  22. Slattery SA, Niaz O, Aziz Q, Ford AC, Farmer AD (2015). "Systematic review with meta-analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea". Aliment. Pharmacol. Ther. 42 (1): 3–11. doi:10.1111/apt.13227. PMID 25913530.
  23. Canavan C, Card T, West J (2014). "The incidence of other gastroenterological disease following diagnosis of irritable bowel syndrome in the UK: a cohort study". PLoS ONE. 9 (9): e106478. doi:10.1371/journal.pone.0106478. PMC 4169512. PMID 25238408.
  24. Ford AC, Chey WD, Talley NJ, Malhotra A, Spiegel BM, Moayyedi P (2009). "Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis". Arch. Intern. Med. 169 (7): 651–8. doi:10.1001/archinternmed.2009.22. PMID 19364994.
  25. Ford AC, Spiegel BM, Talley NJ, Moayyedi P (2009). "Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis". Clin. Gastroenterol. Hepatol. 7 (12): 1279–86. doi:10.1016/j.cgh.2009.06.031. PMID 19602448.
  26. Rubin de Celis Ferrari AC, Glasberg J, Riechelmann RP (August 2018). "Carcinoid syndrome: update on the pathophysiology and treatment". Clinics (Sao Paulo). 73 (suppl 1): e490s. doi:10.6061/clinics/2018/e490s. PMC 6096975. PMID 30133565.
  27. Hegyi J, Schwartz RA, Hegyi V (January 2004). "Pellagra: dermatitis, dementia, and diarrhea". Int. J. Dermatol. 43 (1): 1–5. PMID 14693013.
  28. Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E (May 2004). "Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours". Nucl Med Commun. 25 (5): 445–9. PMID 15100502.
  29. Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E (May 2004). "Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours". Nucl Med Commun. 25 (5): 445–9. PMID 15100502.
  30. Bora, ManashKumar; Vithiavathi, S (2012). "Primary bronchial carcinoid: A rare differential diagnosis of pulmonary koch in young adult patient". Lung India. 29 (1): 59. doi:10.4103/0970-2113.92366. ISSN 0970-2113.
  31. Yazıcıoğlu A, Yekeler E, Bıcakcıoğlu P, Ozaydın E, Karaoğlanoğlu N (December 2012). "Synchronous bilateral multiple typical pulmonary carcinoid tumors: a unique case with 10 typical carcinoids". Balkan Med J. 29 (4): 450–2. doi:10.5152/balkanmedj.2012.081. PMC 4115868. PMID 25207053.
  32. Krausz Y, Keidar Z, Kogan I, Even-Sapir E, Bar-Shalom R, Engel A, Rubinstein R, Sachs J, Bocher M, Agranovicz S, Chisin R, Israel O (November 2003). "SPECT/CT hybrid imaging with 111In-pentetreotide in assessment of neuroendocrine tumours". Clin. Endocrinol. (Oxf). 59 (5): 565–73. PMID 14616879.
  33. van der Lely, Aart J.; Herder, Wouter W. de (2005). "Carcinoid syndrome: diagnosis and medical management". Arquivos Brasileiros de Endocrinologia & Metabologia. 49 (5): 850–860. doi:10.1590/S0004-27302005000500028. ISSN 0004-2730.
  34. Halperin DM, Shen C, Dasari A, Xu Y, Chu Y, Zhou S, Shih YT, Yao JC (April 2017). "Frequency of carcinoid syndrome at neuroendocrine tumour diagnosis: a population-based study". Lancet Oncol. 18 (4): 525–534. doi:10.1016/S1470-2045(17)30110-9. PMC 6066284. PMID 28238592.
  35. Sjöblom SM (September 1988). "Clinical presentation and prognosis of gastrointestinal carcinoid tumours". Scand. J. Gastroenterol. 23 (7): 779–87. PMID 3227292.
  36. Ganeshan D, Bhosale P, Yang T, Kundra V (October 2013). "Imaging features of carcinoid tumors of the gastrointestinal tract". AJR Am J Roentgenol. 201 (4): 773–86. doi:10.2214/AJR.12.9758. PMID 24059366.
  37. Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq
  38. Modlin IM, Kidd M, Latich I, Zikusoka MN, Shapiro MD (May 2005). "Current status of gastrointestinal carcinoids". Gastroenterology. 128 (6): 1717–51. PMID 15887161.
  39. Gustafsson BI, Kidd M, Chan A, Malfertheiner MV, Modlin IM (July 2008). "Bronchopulmonary neuroendocrine tumors". Cancer. 113 (1): 5–21. doi:10.1002/cncr.23542. PMID 18473355.
  40. Jeung, Mi-Young; Gasser, Bernard; Gangi, Afshin; Charneau, Dominique; Ducroq, Xavier; Kessler, Romain; Quoix, Elisabeth; Roy, Catherine (2002). "Bronchial Carcinoid Tumors of the Thorax: Spectrum of Radiologic Findings". RadioGraphics. 22 (2): 351–365. doi:10.1148/radiographics.22.2.g02mr01351. ISSN 0271-5333.
  41. Nessi R, Basso Ricci P, Basso Ricci S, Bosco M, Blanc M, Uslenghi C (April 1991). "Bronchial carcinoid tumors: radiologic observations in 49 cases". J Thorac Imaging. 6 (2): 47–53. PMID 1649924.
  42. Melmon KL, Sjoerdsma A, Mason DT (October 1965). "Distinctive clinical and therapeutic aspects of the syndrome associated with bronchial carcinoid tumors". Am. J. Med. 39 (4): 568–81. PMID 5831899.
  43. Ford AC, Forman D, Bailey AG, Axon AT, Moayyedi P (May 2008). "Irritable bowel syndrome: a 10-yr natural history of symptoms and factors that influence consultation behavior". Am. J. Gastroenterol. 103 (5): 1229–39, quiz 1240. doi:10.1111/j.1572-0241.2007.01740.x. PMID 18371141.
  44. Simren M, Palsson OS, Whitehead WE (April 2017). "Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice". Curr Gastroenterol Rep. 19 (4): 15. doi:10.1007/s11894-017-0554-0. PMC 5378729. PMID 28374308.
  45. "American Gastroenterological Association medical position statement: irritable bowel syndrome". Gastroenterology. 123 (6): 2105–7. December 2002. doi:10.1053/gast.2002.37095b. PMID 12454865.
  46. Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R (February 2016). "Bowel Disorders". Gastroenterology. doi:10.1053/j.gastro.2016.02.031. PMID 27144627.
  47. McLaughlin PD, Maher MM (July 2013). "Primary malignant diseases of the small intestine". AJR Am J Roentgenol. 201 (1): W9–14. doi:10.2214/AJR.12.8492. PMID 23789703.
  48. Hatzaras I, Palesty JA, Abir F, Sullivan P, Kozol RA, Dudrick SJ, Longo WE (March 2007). "Small-bowel tumors: epidemiologic and clinical characteristics of 1260 cases from the connecticut tumor registry". Arch Surg. 142 (3): 229–35. doi:10.1001/archsurg.142.3.229. PMID 17372046.
  49. Lepage C, Bouvier AM, Manfredi S, Dancourt V, Faivre J (December 2006). "Incidence and management of primary malignant small bowel cancers: a well-defined French population study". Am. J. Gastroenterol. 101 (12): 2826–32. doi:10.1111/j.1572-0241.2006.00854.x. PMID 17026561.
  50. Hara AK, Swartz PG (2009). "CT enterography of Crohn's disease". Abdom Imaging. 34 (3): 289–95. doi:10.1007/s00261-008-9443-1. PMID 18649092.
  51. Baumgart, Daniel C; Sandborn, William J (2012). "Crohn's disease". The Lancet. 380 (9853): 1590–1605. doi:10.1016/S0140-6736(12)60026-9. ISSN 0140-6736.
  52. Feuerstein, Joseph D.; Cheifetz, Adam S. (2017). "Crohn Disease: Epidemiology, Diagnosis, and Management". Mayo Clinic Proceedings. 92 (7): 1088–1103. doi:10.1016/j.mayocp.2017.04.010. ISSN 0025-6196.
  53. García-Bosch, O.; Ordás, I.; Aceituno, M.; Rodríguez, S.; Ramírez, A. M.; Gallego, M.; Ricart, E.; Rimola, J.; Panes, J. (2016). "Comparison of Diagnostic Accuracy and Impact of Magnetic Resonance Imaging and Colonoscopy for the Management of Crohn's Disease". Journal of Crohn's and Colitis. 10 (6): 663–669. doi:10.1093/ecco-jcc/jjw015. ISSN 1873-9946.
  54. Izikson, Leonid; English, Joseph C.; Zirwas, Matthew J. (2006). "The flushing patient: Differential diagnosis, workup, and treatment". Journal of the American Academy of Dermatology. 55 (2): 193–208. doi:10.1016/j.jaad.2005.07.057. ISSN 0190-9622.
  55. Hartmann, Karin; Escribano, Luis; Grattan, Clive; Brockow, Knut; Carter, Melody C.; Alvarez-Twose, Ivan; Matito, Almudena; Broesby-Olsen, Sigurd; Siebenhaar, Frank; Lange, Magdalena; Niedoszytko, Marek; Castells, Mariana; Oude Elberink, Joanna N.G.; Bonadonna, Patrizia; Zanotti, Roberta; Hornick, Jason L.; Torrelo, Antonio; Grabbe, Jürgen; Rabenhorst, Anja; Nedoszytko, Boguslaw; Butterfield, Joseph H.; Gotlib, Jason; Reiter, Andreas; Radia, Deepti; Hermine, Olivier; Sotlar, Karl; George, Tracy I.; Kristensen, Thomas K.; Kluin-Nelemans, Hanneke C.; Yavuz, Selim; Hägglund, Hans; Sperr, Wolfgang R.; Schwartz, Lawrence B.; Triggiani, Massimo; Maurer, Marcus; Nilsson, Gunnar; Horny, Hans-Peter; Arock, Michel; Orfao, Alberto; Metcalfe, Dean D.; Akin, Cem; Valent, Peter (2016). "Cutaneous manifestations in patients with mastocytosis: Consensus report of the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology". Journal of Allergy and Clinical Immunology. 137 (1): 35–45. doi:10.1016/j.jaci.2015.08.034. ISSN 0091-6749.
  56. Lee, Jason K; Whittaker, Scott J; Enns, Robert A; Zetler, Peter (2008). "Gastrointestinal manifestations of systemic mastocytosis". World Journal of Gastroenterology. 14 (45): 7005. doi:10.3748/wjg.14.7005. ISSN 1007-9327.
  57. Horan RF, Austen KF (March 1991). "Systemic mastocytosis: retrospective review of a decade's clinical experience at the Brigham and Women's Hospital". J. Invest. Dermatol. 96 (3): 5S–13S, discussion 13S–14S. PMID 2002264.
  58. Sokol, Harry; Georgin-Lavialle, Sophie; Grandpeix-Guyodo, Catherine; Canioni, Danielle; Barete, Stéphane; Dubreuil, Patrice; Lortholary, Olivier; Beaugerie, Laurent; Hermine, Olivier (2010). "Gastrointestinal involvement and manifestations in systemic mastocytosis". Inflammatory Bowel Diseases. 16 (7): 1247–1253. doi:10.1002/ibd.21218. ISSN 1078-0998.
  59. Bedeir A, Jukic DM, Wang L, Mullady DK, Regueiro M, Krasinskas AM (November 2006). "Systemic mastocytosis mimicking inflammatory bowel disease: A case report and discussion of gastrointestinal pathology in systemic mastocytosis". Am. J. Surg. Pathol. 30 (11): 1478–82. doi:10.1097/01.pas.0000213310.51553.d7. PMID 17063092.
  60. Fuhlbrigge A, Peden D, Apter AJ, Boushey HA, Camargo CA, Gern J, Heymann PW, Martinez FD, Mauger D, Teague WG, Blaisdell C (March 2012). "Asthma outcomes: exacerbations". J. Allergy Clin. Immunol. 129 (3 Suppl): S34–48. doi:10.1016/j.jaci.2011.12.983. PMC 3595577. PMID 22386508.
  61. Limb SL, Brown KC, Wood RA, Wise RA, Eggleston PA, Tonascia J, Adkinson NF (December 2005). "Irreversible lung function deficits in young adults with a history of childhood asthma". J. Allergy Clin. Immunol. 116 (6): 1213–9. doi:10.1016/j.jaci.2005.09.024. PMID 16337448.
  62. Aldington S, Beasley R (May 2007). "Asthma exacerbations. 5: assessment and management of severe asthma in adults in hospital". Thorax. 62 (5): 447–58. doi:10.1136/thx.2005.045203. PMC 2117186. PMID 17468458.
  63. Dougherty RH, Fahy JV (February 2009). "Acute exacerbations of asthma: epidemiology, biology and the exacerbation-prone phenotype". Clin. Exp. Allergy. 39 (2): 193–202. doi:10.1111/j.1365-2222.2008.03157.x. PMC 2730743. PMID 19187331.
  64. Peavy RD, Metcalfe DD (August 2008). "Understanding the mechanisms of anaphylaxis". Curr Opin Allergy Clin Immunol. 8 (4): 310–5. doi:10.1097/ACI.0b013e3283036a90. PMC 2683407. PMID 18596587.
  65. Tupper J, Visser S (October 2010). "Anaphylaxis: A review and update". Can Fam Physician. 56 (10): 1009–11. PMC 2954079. PMID 20944042.
  66. Kemp SF, Lockey RF (September 2002). "Anaphylaxis: a review of causes and mechanisms". J. Allergy Clin. Immunol. 110 (3): 341–8. PMID 12209078.
  67. Bjornsson HM, Graffeo CS (December 2010). "Improving diagnostic accuracy of anaphylaxis in the acute care setting". West J Emerg Med. 11 (5): 456–61. PMC 3027438. PMID 21293765.
  68. "Usefulness and Limitations of Sequential Serum Tryptase for the Diagnosis of Anaphylaxis in 102 Patients - FullText - International Archives of Allergy and Immunology 2013, Vol. 160, No. 2 - Karger Publishers".
  69. Busse PJ, Smith T (August 2017). "Histaminergic Angioedema". Immunol Allergy Clin North Am. 37 (3): 467–481. doi:10.1016/j.iac.2017.03.001. PMID 28687103.
  70. Hahn J, Hoffmann TK, Bock B, Nordmann-Kleiner M, Trainotti S, Greve J (July 2017). "Angioedema". Dtsch Arztebl Int. 114 (29–30): 489–496. doi:10.3238/arztebl.2017.0489. PMC 5569554. PMID 28818177.
  71. Bernstein JA, Cremonesi P, Hoffmann TK, Hollingsworth J (December 2017). "Angioedema in the emergency department: a practical guide to differential diagnosis and management". Int J Emerg Med. 10 (1): 15. doi:10.1186/s12245-017-0141-z. PMC 5389952. PMID 28405953.
  72. Bernstein JA, Moellman J (November 2012). "Emerging concepts in the diagnosis and treatment of patients with undifferentiated angioedema". Int J Emerg Med. 5 (1): 39. doi:10.1186/1865-1380-5-39. PMC 3518251. PMID 23131076.
  73. Kaplan AP (June 2008). "Angioedema". World Allergy Organ J. 1 (6): 103–13. doi:10.1097/WOX.0b013e31817aecbe. PMC 3651192. PMID 23282406.
  74. Pacini F, Castagna MG, Cipri C, Schlumberger M (August 2010). "Medullary thyroid carcinoma". Clin Oncol (R Coll Radiol). 22 (6): 475–85. doi:10.1016/j.clon.2010.05.002. PMID 20627492.
  75. Roy M, Chen H, Sippel RS (2013). "Current understanding and management of medullary thyroid cancer". Oncologist. 18 (10): 1093–100. doi:10.1634/theoncologist.2013-0053. PMC 3805151. PMID 24037980.
  76. Mian C, Perrino M, Colombo C, Cavedon E, Pennelli G, Ferrero S, De Leo S, Sarais C, Cacciatore C, Manfredi GI, Verga U, Iacobone M, De Pasquale L, Pelizzo MR, Vicentini L, Persani L, Fugazzola L (May 2014). "Refining calcium test for the diagnosis of medullary thyroid cancer: cutoffs, procedures, and safety". J. Clin. Endocrinol. Metab. 99 (5): 1656–64. doi:10.1210/jc.2013-4088. PMID 24552221.
  77. Bae YJ, Schaab M, Kratzsch J (2015). "Calcitonin as Biomarker for the Medullary Thyroid Carcinoma". Recent Results Cancer Res. 204: 117–37. doi:10.1007/978-3-319-22542-5_5. PMID 26494386.

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