Lower gastrointestinal bleeding differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Lower gastrointestinal bleeding}}
[[Image:Home_logo1.png|right|250px|link=[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Lower_gastrointestinal_bleeding]]
{{CMG}}; {{AE}} {{ADG}}
{{CMG}}; {{AE}} {{ADG}}
==Overview==
==Overview==
Several diseases present with lower gastrointestinal bleeding and must be differented from each other. The common diseases responsible for lower GI bleeding inlcude diverticulosis, angiodysplasia, hemorrhoids, anal fissures, mesenteric Ischemia, ischemic colitis, inflammatory bowel disease, and colo-rectal carcinoma.
Several diseases present with lower gastrointestinal bleeding and must be differented from each other. The common diseases responsible for lower GI bleeding inlcude [[diverticulosis]], [[angiodysplasia]], [[hemorrhoids]], [[anal fissures]], [[mesenteric Ischemia]], [[ischemic colitis]], [[inflammatory bowel disease]], and [[colorectal carcinoma]].


==Differentiating Lower gastrointestinal bleeding from other Diseases==
==Differentiating Lower gastrointestinal bleeding from other Diseases==
Several diseases present with lower gastrointestinal bleeding and must be differented from each other. The common diseases responsible for lower GI bleeding inlcude diverticulosis, angiodysplasia, hemorrhoids, anal fissures, mesenteric Ischemia, ischemic colitis, inflammatory bowel disease, and colo-rectal carcinoma.
Several diseases present with lower gastrointestinal bleeding and must be differented from each other. The common diseases responsible for lower GI bleeding inlcude [[diverticulosis]], [[angiodysplasia]], [[hemorrhoids]], [[anal fissures]], [[mesenteric Ischemia]], [[ischemic colitis]], [[inflammatory bowel disease]], and [[colorectal carcinoma]].
{| class="wikitable"
{| class="wikitable"
! rowspan="2" |Disease
! rowspan="2" |Disease
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!Radio-Imaging findings
!Radio-Imaging findings
|-
|-
|Diverticulosis
|[[Diverticulosis|'''Diverticulosis''']]
| -
| -
| -
| -
| -
| -
| -
| -
|Red or maroon-colored blood
|Red or maroon-colored [[blood]]
| -
| -
| +
| +
Line 37: Line 37:
|Normal
|Normal
|
|
Globular outpouchings on CT scan
Globular outpouchings on [[CT scan]]
|-
|-
|Angiodysplasia
|[[Angiodysplasia|'''Angiodysplasia''']]
| -
| -
| -
| -
| -
| -
| -
| -
|Frank blood
|Frank [[blood]]
| -
| -
| -
| -
|
|
* Painless bleeding
* Painless [[bleeding]]


* Iron deficiency anemia
* [[Iron deficiency anemia]]
|Normal
|Normal
|Normal
|Normal
|-
|-
|Hemorrhoids
|[[Hemorrhoids|'''Hemorrhoids''']]
| -
| -
| +
| +
| -
| -
| -
| -
|Blood on tissues
|[[Blood]] on [[tissues]]
| -
| -
| +
| +
|
|
* Pain during defecation
* [[Pain]] during [[defecation]]


* Anemia
* [[Anemia]]
| -
| -
|Tortuoeus dilated vessels on anoscopy
|Tortuous dilated vessels on [[anoscopy]]
|-
|-
|Anal fissures
|[[Anal fissures|'''Anal fissures''']]
| -
| -
| +
| +
| -
| -
| -
| -
|Blood on tissues
|[[Blood]] on [[tissues]]
| -
| -
| +
| +
|
|
* Pain during defecation
* [[Pain]] during [[defecation]]
* Pain recurs with every bowel movement
* [[Pain]] recurs with every [[bowel movement]]
|Normal expect mild leucocytosis
|Normal except mild [[leucocytosis]]
|Anoscopy
|[[Anoscopy]]
|-
|-
|Mesenteric Ischemia
|[[Mesenteric Ischemia|'''Mesenteric Ischemia''']]
| +
| +
| -
| -
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| -
| -
|
|
* Pain alters with eating habits
* [[Pain]] alters with eating habits


* Associated with other comorbid conditions
* Associated with other comorbid conditions
|
|
* Leukocytosis  
* [[Leukocytosis]]
* Increased hematocrit
* Increased [[hematocrit]]
* High anion gap metabolic acidosis
* [[High anion gap metabolic acidosis critical pathways|High anion gap metabolic acidosis]]
* Lactic acidosis
* [[Lactic acidosis]]
* High phosphate levels  
* [[Hyperphosphatemia|High phosphate levels]]
|
|
* Mesenteric edema
* [[Mesenteric]] [[edema]]
* Bowel dilatation
* [[Bowel]] dilatation
* Bowel wall thickening
* Bowel wall thickening
* Intramural gas
* Intramural gas
* Mesenteric stranding
* [[Mesenteric]] stranding
|-
|-
|Ischemic colitis
|[[Ischemic colitis|'''Ischemic colitis''']]
| +
| +
| -
| -
| -
| -
| +
| +
|
|Frank blood
| +
| +
| -
| -
|3 phases
|3 phases
* Hyperactive Phase
* [[Hyperactive]] phase


* Paralytic Phase(absent bowel sounds}
* [[Paralytic]] phase (absent bowel sounds)


* Shock Phase
* [[Shock]] phase
|
|
* [[Elevated white blood cell count]] more than 15,000/mm<sup>3</sup> in 20 patients (27%)
* [[Elevated white blood cell count]] more than 15,000/mm<sup>3</sup> in 20 patients (27%)
Line 127: Line 127:
|
|
* Mild moderate diffuse bowel wall thickening
* Mild moderate diffuse bowel wall thickening
* Marked hyperenhancement of the mucosa.
* Marked hyperenhancement of the [[mucosa]]
|-
|-
|Crohn's disease
|[[Crohn's disease|'''Crohn's disease''']]
| +
| +
| -
| -
| +
| +
| +
| +
|
|Blood mixed with stools
| +
| +
| +
| +
|Extra intestinal manifestations
|Extra intestinal manifestations
* :Uveitis
*[[Uveitis]]
* Sarcolitis
* [[Sacroiliitis]]
* Anemia
* [[Anemia]]
* Peripheral neuropathy
* [[Peripheral neuropathy]]
|
|
* [[Anemia]]
* [[Anemia]]
* [[Leucocytosis]]
* [[Leukocytosis]]
* [[Thrombocytosis]]
* [[Thrombocytosis]]
* + ASCA
* [[Anti saccharomyces cerevisiae antibodies|Anti-Saccharomyces cerevisiae antibodies]]
|
|
* Skip lesions
* Skip lesions
* Bowel wall thickening
* Bowel wall thickening
* Surrounding inflammation, abscess, and fistulae
* Surrounding [[inflammation]], [[abscess]], and [[fistulae]]
|-
|-
|Ulcerative colitis
|[[Ulcerative colitis|'''Ulcerative colitis''']]
| +
| +
| +
| +
| +
| +
| +
| +
|
|Blood mixed with stools
| +
| +
| +
| +
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* Loss of the vascular appearance of the [[colon]]
* Loss of the vascular appearance of the [[colon]]
* [[Erythema]] (or redness of the [[mucosa]]) and friability of the [[mucosa]]
* [[Erythema]] (or redness of the [[mucosa]]) and friability of the [[mucosa]]
* Superficial ulceration, which may be confluent
* Superficial [[ulceration]], which may be confluent
* [[Polyp (medicine)|Pseudopolyps]]
* [[Polyp (medicine)|Pseudopolyps]]
|-
|-
|Colon carcinoma
|[[Colon carcinoma|'''Colon carcinoma''']]
| +
| +
| -†
| -†
| +
| +
| +
| +
|Occult bleeding
|[[Fecal occult blood|Occult bleeding]]
| +
| +
| +†
| +†
|
|
| + FOBT
| + [[FOBT]] (fecal occult blood test)
↑ [[CEA]] and CA 19-9
↑ [[CEA]]( and CA 19-9


Hypercalcemia 
[[Hypercalcemia]] 
| +Biopsy
|
* [[Biopsy]]
|}
|}


The following table differentiates all the diseases presenting with abdominal pain and lower gastrointestinal bleeding.


<span style="font-size:85%">'''Abbreviations:'''
<span style="font-size:85%">'''Abbreviations:'''
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! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Lab Findings
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Lab Findings
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
|-
| 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" |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" | <nowiki>+</nowiki>
| 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" |
* Gastric ulcer- [[melena]] and [[hematemesis]]
* Duodenal ulcer- [[melena]] and [[hematochezia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if perforated
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if perforated
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive if perforated
| 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" |[[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" | <nowiki>+</nowiki>
| 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" | Positive 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="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[H.pylori infection diagnostic tests]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Endoscopy]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[H.pylori gastritis guideline recommendation]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastrointestinal perforation]]
| 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" |<nowiki>-</nowiki>
| 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" |Hyperactive/hypoactive
| 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" |
* [[Hamman's sign]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diverticulitis|Acute diverticulitis]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diverticulitis|Acute diverticulitis]]
Line 389: Line 323:
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* PILLCAM 2: A colon capsule for CRC screening may be used in patients with an incomplete colonoscopy who lacks obstruction
* PILLCAM 2: A colon capsule for CRC screening may be used in patients with an incomplete colonoscopy who lacks obstruction
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" |Disease
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain
! 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" |Nausea or vomiting
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo-
tension
! 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
! style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" |Comments
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Budd-Chiari syndrome|Budd-Chiari syndrome]]
| 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="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive 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: #DCDCDC;" align="center" |[[Hemochromatosis]]
Line 460: Line 345:
* Ultrasound shows evidence of cirrhosis
* Ultrasound shows evidence of cirrhosis
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Extra intestinal findings:
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Extra intestinal findings:
* Hyperpigmentation
* [[Hyperpigmentation]]
* Diabetes mellitus
* [[Diabetes mellitus]]
* Arthralgia
* [[Arthralgia]]
* Impotence in males
* [[Erectile dysfunction|Impotence]] in males
* Cardiomyopathy
* [[Cardiomyopathy]]
* Atherosclerosis
* [[Atherosclerosis]]
* Hypopituitarism
* [[Hypopituitarism]]
* Hypothyroidism
* [[Hypothyroidism]]
* Extrahepatic cancer
* Extrahepatic cancer
* Prone to specific infections
* Prone to specific infections
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cirrhosis|Cirrhosis]]
| 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="center" |<nowiki>+</nowiki>
| 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" |
* [[Hypoalbuminemia]]
* Prolonged PT
* Abnormal LFTs
* [[Hyponatremia]]
* [[Thrombocytopenia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |US
* Nodular, shrunken liver
* [[Ascites]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Stigmata of liver disease
* Cruveilhier- Baumgarten murmur
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia]]

Latest revision as of 22:13, 7 February 2019

[[Image:Home_logo1.png|right|250px|link=

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

Overview

Several diseases present with lower gastrointestinal bleeding and must be differented from each other. The common diseases responsible for lower GI bleeding inlcude diverticulosis, angiodysplasia, hemorrhoids, anal fissures, mesenteric Ischemia, ischemic colitis, inflammatory bowel disease, and colorectal carcinoma.

Differentiating Lower gastrointestinal bleeding from other Diseases

Several diseases present with lower gastrointestinal bleeding and must be differented from each other. The common diseases responsible for lower GI bleeding inlcude diverticulosis, angiodysplasia, hemorrhoids, anal fissures, mesenteric Ischemia, ischemic colitis, inflammatory bowel disease, and colorectal carcinoma.

Disease Symptoms Other features Diagnosis
Abdominal pain Rectal pain Weightloss Fever Type of GI bleeding Diarrhea Constipation Laboratory findings Radio-Imaging findings
Diverticulosis - - - - Red or maroon-colored blood - +
  • Self limiting
  • Seen in elderly
Normal

Globular outpouchings on CT scan

Angiodysplasia - - - - Frank blood - - Normal Normal
Hemorrhoids - + - - Blood on tissues - + - Tortuous dilated vessels on anoscopy
Anal fissures - + - - Blood on tissues - + Normal except mild leucocytosis Anoscopy
Mesenteric Ischemia + - + + Frank blood + -
  • Pain alters with eating habits
  • Associated with other comorbid conditions
Ischemic colitis + - - + Frank blood + - 3 phases
  • Mild moderate diffuse bowel wall thickening
  • Marked hyperenhancement of the mucosa
Crohn's disease + - + + Blood mixed with stools + + Extra intestinal manifestations
Ulcerative colitis + + + + Blood mixed with stools + +
Colon carcinoma + -† + + Occult bleeding + +† + FOBT (fecal occult blood test)

↑ CEA( and CA 19-9

Hypercalcemia 

The following table differentiates all the diseases presenting with abdominal pain and lower gastrointestinal bleeding.

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, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Acute diverticulitis LLQ + ± + + ± + Positive in perforated diverticulitis + + Hypoactive
  • CT scan
  • Ultrasound
Inflammatory bowel disease Diffuse ± ± + + + Normal or hyperactive

Extra intestinal findings:

Infective colitis Diffuse + ± + + Positive in fulminant colitis ± ± Hyperactive CT scan
  • Bowel wall thickening
  • Edema
Colon carcinoma Diffuse/localized ± ± + + ±
  • Normal or hyperactive if obstruction present
  • CBC
  • Carcinoembryonic antigen (CEA)
  • Colonoscopy
  • Flexible sigmoidoscopy
  • Barium enema
  • CT colonography 
  • PILLCAM 2: A colon capsule for CRC screening may be used in patients with an incomplete colonoscopy who lacks obstruction
Hemochromatosis RUQ Positive in cirrhotic patients N
  • >60% TS
  • >240 μg/L SF
  • Raised LFT
    Hyperglycemia
  • Ultrasound shows evidence of cirrhosis
Extra intestinal findings:
Mesenteric ischemia Periumbilical Positive if bowel becomes gangrenous + + + + Positive if bowel becomes gangrenous Positive if bowel becomes gangrenous Hyperactive to absent CT angiography
  • SMA or SMV thrombosis
  • Also known as abdominal angina that worsens with eating
Acute ischemic colitis Diffuse + ± + + + + + + + Hyperactive then absent Abdominal x-ray
  • Distension and pneumatosis

CT scan

  • Double halo appearance, thumbprinting
  • Thickening of bowel
  • May lead to shock
Ruptured abdominal aortic aneurysm Diffuse ± + + + + N
  • Focused Assessment with Sonography in Trauma (FAST) 
  • Unstable hemodynamics
Intra-abdominal or retroperitoneal hemorrhage Diffuse ± ± + + N
  • ↓ Hb
  • ↓ Hct
  • CT scan

References

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