Sandbox:Zahir

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

Differentiating [Disease name] from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].

OR

As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].

Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].

Diseases Clinical manifestations Diagnosis Gold standard Additional findings Others
Symptoms Physical examination
Lab Findings Imaging
Abdominal pain Bowel habits Blood in stool Weight loss General appearance Abdominal exam Rectal exam Genitourinary exam CBC Tumor markers Stool test Colonoscopy Barium enema Ultrasound CT scan
Rectal carcinoma[1][2][3][4][5] LLQ Constipation/diarrhea + +
  • lethargy
  • pallor
  • confusion
  • emaciation
  • tendernes
  • hepatomegaly
  • ascites
  • absent bowel sounds
  • rectal mass
  • rectal bleeding
 NL Anmeia
  • ↑ CEA
  • ↑ CA19-9
 FOBT+ mass/polyp Apple core apearance endoscopic/trnasrectal US detects tumor extent determine tumor stage colonoscopy with biopsy DRE & proctoscopy detects tumor localization & extension
  • ↓ serum iron
  • ↓ vit: B12 & folate
Rectal polyp[6][7][8] + mucous diarrhea + + NL NL rectal mass/polyp NL NL/anemia NL FOBT+ Polyp N/A Polyp N/A colonoscopy with biopsy
  • hypoproteinemia
  • hypoalbuminemia
 N/A
Anal cancer[9][10][11][12] +/- constipation/diarrhea + +/- NL NL lump/mass at anal opening NL NL/anemia N/A FOBT+ N/A N/A determines anal cancer depth into sphincter hypoattenuated necrotic mass on contrast CT Biopsy PET/CT detects localization of small anal tumors <2cm sentinal lymph node biopsy detects lymph node metastases
Hemorrhoids[13][14][15][16] +/- fecal incontinence/mucous discharge + - NL/weakness,irritability NL
  • palpable perianal lump
  • bleeding PR
 NL iron deficiency anemia N/A blood on stool outer surface done if colorectal cancer suspected N/A N/A N/A DRE + anoscopy anoscopy shows bulging purplish hue veins or dark, pink, glistening mass None
Rectal prolapse[17][18][19][20] Abdominal discomfort constipation/diarrhea +/- - NL NL intermittent rectum protrusion seen NL NL/anemia N/A mucous/blood in stool may be used for screening N/A reveals asymmetry & any sphincter defect N/A history & physical examination DRE shows patulous anus, attenuated sphincter tone & mass anal manometry to assess sphincter function
Foreign body[21][22][23][24] Anorectal pain and abdominal pain Constipation + -
  • Palpable foreign body
  • Absent bowel sounds
  • Signs of peritonitis
 NL
  • Leucocytosis
  • Metabolic acidosis
 NL FOBT+ Foreign body Contraindicated Foreign body Foreign body Plain radiographs show presence of foreign body NL NL
Diseases Abdominal pain Bowel habits Blood in stool Weight loss General appearance Abdominal exam Rectal exam Genitourinary exam CBC Tumor markers Stool test Colonoscopy Barium enema Ultrasound CT scan Gold standard Additional findings Others
Prostatitis[25][26][27][28] LLQ/groin pain NL N/A - NL NL NL tender/enlarged prostate leukocytosis NL/↑ PSA N/A N/A N/A
  • focal hypoechoic regoin in peripheral prostate
  • fluid collection suggests abscess
 edematous/enlarged prostate N/A prostate biopsy & thermograms may also be done ↑ CRP
Fecal impaction[29][30][31][32] + constipation - +/-
  • agitation
  • confusion
  • worsening psychosis
  • abdominal distension with tympany
  • difuse abdominal tenderness with palpable malleable tubular structure indicating stool filled rectosigmoid
 DRE shows fecal impaction NL mild leukocytosis N/A N/A N/A used in softening of stool & stimulation of evacuation N/A presence of fecal matter in colon DRE to detect fecal impaction
  • dehydration
  • hyponatremia
  • hypokalemic metabolic alkalosis
 abdominal radiograph to detect fecal loading
Anal stenosis[33][34][35] + constipation + +/- NL NL visual inspection shows stenosis NL NL N/A NL contraindicated N/A N/A N/A visual inspection with DRE incomplete evacuation None
Hypertrophied anal papillae[36][37][38][39] - NL +/- - NL NL firm & palpable papillae on digital examination NL NL N/A mixed with blood N/A smooth polyp located inside anal verge N/A N/A visual inspection with digital examination associated with anal fissure & anal skin tag None
Endometriosis[40][41][42] +/-
  • Dull pelvic pain
 Constipation - - Fatigue Mild tenderness Nodules in posterior posterior fornix
  • Adnexal masses
  • Immobility
  • Lateral placement of the cervix or uterus
 Tenderness on vaginal exam Anemia - - N/A N/A Lesions can be detected on usg Not required N/A N/A N/A
Uterine malignancy[43][44][45] - NL - + Pallor
  • Fatigue
 NL Pelvic mass Vaginal bleeding
  • Enlarged uteru
  • Fixed uterus
 Anemia Hcg - N/A N/A Increased thickness of uterine wall >4mm N/A Endometrial biopsy N/A N/A
Diseases Abdominal pain Bowel habits Blood in stool Weight loss General appearance Abdominal exam Rectal exam Genitourinary exam CBC Tumor markers Stool test Colonoscopy Barium enema Ultrasound CT scan Gold standard Additional findings Others
Cervical malignancy[46] - Normal - + Pallor

Fatigue

NL Pelvic mass
  • Cervical growth
  • Bleeding
  • Cervical stenosis
  • Fixed uterus
 Anemia N/A FOBT - N/A N/A Cervical thickening detects metastasis Cone biopsy N/A N/A
Pelvic abscess[47][48] + Nil - +/-
  • Gaurdening
  • Generalized tenderness
 Fluctuating mass Vaginal discharge in females leucocytosis - Fobt - N/A N/A Location and consistency of abcess Location and consistency of abcess N/A N/A N/A
Pelvic sarcoma + NL/constipation +/- +/- NL/cachetic with fever presence of mass NL N/A leukocytosis
  • ↑LDH
  • ↑AFP
  • ↑b-hCG
 NL N/A N/A N/A well circusmscribed, multinodular/infiltrating mass of soft tissue attenuation CT/MRI/Biopsy PET with FDG used for staging None
Parasacral neurogenic tumor

References

  1. ↑ Chiara Molinari, Federica Matteucci, Paola Caroli & Alessandro Passardi (2015). "Biomarkers and Molecular Imaging as Predictors of Response to Neoadjuvant Chemoradiotherapy in Patients With Locally Advanced Rectal Cancer". Clinical colorectal cancer. 14 (4): 227–238. doi:10.1016/j.clcc.2015.05.014. PMID 26170142. Unknown parameter |month= ignored (help)
  2. ↑ William Hamilton & Deborah Sharp (2004). "Diagnosis of colorectal cancer in primary care: the evidence base for guidelines". Family practice. 21 (1): 99–106. PMID 14760054. Unknown parameter |month= ignored (help)
  3. ↑ Wolfgang B. Gaertner, Mary R. Kwaan, Robert D. Madoff & Genevieve B. Melton (2015). "Rectal cancer: An evidence-based update for primary care providers". World journal of gastroenterology. 21 (25): 7659–7671. doi:10.3748/wjg.v21.i25.7659. PMID 26167068. Unknown parameter |month= ignored (help)
  4. ↑ V. Raman Muthusamy & Kenneth J. Chang (2007). "Optimal methods for staging rectal cancer". Clinical cancer research : an official journal of the American Association for Cancer Research. 13 (22 Pt 2): 6877s–6884s. doi:10.1158/1078-0432.CCR-07-1137. PMID 18006793. Unknown parameter |month= ignored (help)
  5. ↑ Mohammad Sadegh Fazeli & Mohammad Reza Keramati (2015). "Rectal cancer: a review". Medical journal of the Islamic Republic of Iran. 29: 171. PMID 26034724.
  6. ↑ N. Oshitani, Y. Moriyama, T. Matsumoto, K. Kobayashi & A. Kitano (1995). "Protein-losing enteropathy from cap polyposis". Lancet (London, England). 346 (8989): 1567. PMID 7491082. Unknown parameter |month= ignored (help)
  7. ↑ Ioannis Papaconstantinou, Andreas Karakatsanis, Xanthi Benia, George Polymeneas & Evanthia Kostopoulou (2012). "Solitary rectal cap polyp: Case report and review of the literature". World journal of gastrointestinal surgery. 4 (6): 157–162. doi:10.4240/wjgs.v4.i6.157. PMID 22816031. Unknown parameter |month= ignored (help)
  8. ↑ Kheng-Hong Ng, Pawan Mathur, M. Priyanthi Kumarasinghe, Kong-Weng Eu & Francis Seow-Choen (2004). "Cap polyposis: further experience and review". Diseases of the colon and rectum. 47 (7): 1208–1215. doi:10.1007/s10350-004-0561-8. PMID 15164251. Unknown parameter |month= ignored (help)
  9. ↑ Thomas G. Trautmann & James H. Zuger (2005). "Positron Emission Tomography for pretreatment staging and posttreatment evaluation in cancer of the anal canal". Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging. 7 (4): 309–313. doi:10.1007/s11307-005-0003-6. PMID 16028002. Unknown parameter |month= ignored (help)
  10. ↑ D. R. Radin (1994). "Squamous cell carcinoma of the anus and rectum in homosexual men: CT findings". Journal of computer assisted tomography. 18 (6): 921–924. PMID 7962800. Unknown parameter |month= ignored (help)
  11. ↑ S. D. Otto, L. Lee, H. J. Buhr, B. Frericks, S. Hocht & A. J. Kroesen (2009). "Staging anal cancer: prospective comparison of transanal endoscopic ultrasound and magnetic resonance imaging". Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 13 (7): 1292–1298. doi:10.1007/s11605-009-0870-2. PMID 19365694. Unknown parameter |month= ignored (help)
  12. ↑ Sajad Ahmad Salati & Azzam Al Kadi (2012). "Anal cancer - a review". International journal of health sciences. 6 (2): 206–230. PMID 23580899. Unknown parameter |month= ignored (help)
  13. ↑ Varut Lohsiriwat (2012). "Hemorrhoids: from basic pathophysiology to clinical management". World journal of gastroenterology. 18 (17): 2009–2017. doi:10.3748/wjg.v18.i17.2009. PMID 22563187. Unknown parameter |month= ignored (help)
  14. ↑ Danny Jacobs (2014). "Clinical practice. Hemorrhoids". The New England journal of medicine. 371 (10): 944–951. doi:10.1056/NEJMcp1204188. PMID 25184866. Unknown parameter |month= ignored (help)
  15. ↑ Varut Lohsiriwat (2013). "Approach to hemorrhoids". Current gastroenterology reports. 15 (7): 332. doi:10.1007/s11894-013-0332-6. PMID 23715885. Unknown parameter |month= ignored (help)
  16. ↑ Varut Lohsiriwat (2015). "Treatment of hemorrhoids: A coloproctologist's view". World journal of gastroenterology. 21 (31): 9245–9252. doi:10.3748/wjg.v21.i31.9245. PMID 26309351. Unknown parameter |month= ignored (help)
  17. ↑ Julia Segal & Melissa M.. Tavarez (2018). "Rectal Prolapse". PMID 30335341. Unknown parameter |month= ignored (help)
  18. ↑ Bordeianou L, Hicks CW, Kaiser AM, Alavi K, Sudan R, Wise PE (2014). "Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies". J. Gastrointest. Surg. 18 (5): 1059–69. doi:10.1007/s11605-013-2427-7. PMID 24352613.
  19. ↑ Bordeianou L, Paquette I, Johnson E, Holubar SD, Gaertner W, Feingold DL, Steele SR (2017). "Clinical Practice Guidelines for the Treatment of Rectal Prolapse". Dis. Colon Rectum. 60 (11): 1121–1131. doi:10.1097/DCR.0000000000000889. PMID 28991074.
  20. ↑ K. M. Hiltunen, M. Matikainen, O. Auvinen & P. Hietanen (1986). "Clinical and manometric evaluation of anal sphincter function in patients with rectal prolapse". American journal of surgery. 151 (4): 489–492. PMID 3963307. Unknown parameter |month= ignored (help)
  21. ↑ Ooi BS, Ho YH, Eu KW, Nyam D, Leong A, Seow-Choen F (December 1998). "Management of anorectal foreign bodies: a cause of obscure anal pain". Aust N Z J Surg. 68 (12): 852–5. PMID 9885867.
  22. ↑ Lake JP, Essani R, Petrone P, Kaiser AM, Asensio J, Beart RW (October 2004). "Management of retained colorectal foreign bodies: predictors of operative intervention". Dis. Colon Rectum. 47 (10): 1694–8. PMID 15540301.
  23. ↑ Stack LB, Munter DW (August 1996). "Foreign bodies in the gastrointestinal tract". Emerg. Med. Clin. North Am. 14 (3): 493–521. PMID 8681881.
  24. ↑ Goldberg JE, Steele SR (February 2010). "Rectal foreign bodies". Surg. Clin. North Am. 90 (1): 173–84, Table of Contents. doi:10.1016/j.suc.2009.10.004. PMID 20109641.
  25. ↑ Prostatitis: Inflammation of the Prostate. NIDDK 2016. http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/prostate-problems/Pages/facts.aspx. Accessed on February 25, 2016
  26. ↑ Sharp VJ, Takacs EB, Powell CR (2010). "Prostatitis: diagnosis and treatment". Am Fam Physician. 82 (4): 397–406. PMID 20704171.
  27. ↑ Lipsky BA, Byren I, Hoey CT (2010). "Treatment of bacterial prostatitis". Clin Infect Dis. 50 (12): 1641–52. doi:10.1086/652861. PMID 20459324.
  28. ↑ Mark S. Litwin & Hung-Jui Tan (2017). "The Diagnosis and Treatment of Prostate Cancer: A Review". JAMA. 317 (24): 2532–2542. doi:10.1001/jama.2017.7248. PMID 28655021. Unknown parameter |month= ignored (help)
  29. ↑ Izi Obokhare (2012). "Fecal impaction: a cause for concern?". Clinics in colon and rectal surgery. 25 (1): 53–58. doi:10.1055/s-0032-1301760. PMID 23449376. Unknown parameter |month= ignored (help)
  30. ↑ N. Gurll & M. Steer (1975). "Diagnostic and therapeutic considerations for fecal impaction". Diseases of the colon and rectum. 18 (6): 507–511. PMID 1081034. Unknown parameter |month= ignored (help)
  31. ↑ Zilla H. Hussain, Diana A. Whitehead & Brian E. Lacy (2014). "Fecal impaction". Current gastroenterology reports. 16 (9): 404. doi:10.1007/s11894-014-0404-2. PMID 25119877. Unknown parameter |month= ignored (help)
  32. ↑ Farshid Araghizadeh (2005). "Fecal impaction". Clinics in colon and rectal surgery. 18 (2): 116–119. doi:10.1055/s-2005-870893. PMID 20011351. Unknown parameter |month= ignored (help)
  33. ↑ Mukta V. Katdare & Rocco Ricciardi (2010). "Anal stenosis". The Surgical clinics of North America. 90 (1): 137–145. doi:10.1016/j.suc.2009.10.002. PMID 20109638. Unknown parameter |month= ignored (help)
  34. ↑ Giuseppe Brisinda, Serafino Vanella, Federica Cadeddu, Gaia Marniga, Pasquale Mazzeo, Francesco Brandara & Giorgio Maria (2009). "Surgical treatment of anal stenosis". World journal of gastroenterology. 15 (16): 1921–1928. PMID 19399922. Unknown parameter |month= ignored (help)
  35. ↑ I. T. Khubchandani (1994). "Anal stenosis". The Surgical clinics of North America. 74 (6): 1353–1360. PMID 7985070. Unknown parameter |month= ignored (help)
  36. ↑ M. Miyazaki, M. Endoh, T. Suga, N. Yano, T. Kuramoto, Y. Matsumoto, K. Eguchi, M. Yagame, M. Miura & Y. Nomoto (1990). "Rheumatoid factors and glomerulonephritis". Clinical and experimental immunology. 81 (2): 250–255. PMID 2201469. Unknown parameter |month= ignored (help)
  37. ↑ J. P. Heiken, G. R. Zuckerman & D. M. Balfe (1984). "The hypertrophied anal papilla: recognition on air-contrast barium enema examinations". Radiology. 151 (2): 315–318. doi:10.1148/radiology.151.2.6709897. PMID 6709897. Unknown parameter |month= ignored (help)
  38. ↑ Pravin-J. Gupta (2004). "Hypertrophied anal papillae and fibrous anal polyps, should they be removed during anal fissure surgery?". World journal of gastroenterology. 10 (16): 2412–2414. PMID 15285031. Unknown parameter |month= ignored (help)
  39. ↑ M. Kusunoki, T. Horai, Y. Sakanoue, H. Yanagi, T. Yamamura & J. Utsunomiya (1991). "Giant hypertrophied anal papilla. Case report". The European journal of surgery = Acta chirurgica. 157 (8): 491–492. PMID 1681940. Unknown parameter |month= ignored (help)
  40. ↑ Vercellini P, Fedele L, Aimi G, Pietropaolo G, Consonni D, Crosignani PG (January 2007). "Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients". Hum. Reprod. 22 (1): 266–71. doi:10.1093/humrep/del339. PMID 16936305.
  41. ↑ Hickey M, Ballard K, Farquhar C (March 2014). "Endometriosis". BMJ. 348: g1752. doi:10.1136/bmj.g1752. PMID 24647161.
  42. ↑ Woodward PJ, Sohaey R, Mezzetti TP (2001). "Endometriosis: radiologic-pathologic correlation". Radiographics. 21 (1): 193–216, questionnaire 288–94. doi:10.1148/radiographics.21.1.g01ja14193. PMID 11158655.
  43. ↑ Ronghe R, Gaudoin M (March 2010). "Women with recurrent postmenopausal bleeding should be re-investigated but are not more likely to have endometrial cancer". Menopause Int. 16 (1): 9–11. doi:10.1258/mi.2010.010008. PMID 20424280.
  44. ↑ Twu NF, Chen SS (August 2000). "Five-year follow-up of patients with recurrent postmenopausal bleeding". Zhonghua Yi Xue Za Zhi (Taipei). 63 (8): 628–33. PMID 10969449.
  45. ↑ Reed SD, Newton KM, Clinton WL, Epplein M, Garcia R, Allison K, Voigt LF, Weiss NS (June 2009). "Incidence of endometrial hyperplasia". Am. J. Obstet. Gynecol. 200 (6): 678.e1–6. doi:10.1016/j.ajog.2009.02.032. PMID 19393600.
  46. ↑ Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S (September 2007). "Human papillomavirus and cervical cancer". Lancet. 370 (9590): 890–907. doi:10.1016/S0140-6736(07)61416-0. PMID 17826171.
  47. ↑ Landers DV, Sweet RL (1983). "Tubo-ovarian abscess: contemporary approach to management". Rev. Infect. Dis. 5 (5): 876–84. PMID 6635426.
  48. ↑ Benigno BB (December 1981). "Medical and surgical management of the pelvic abscess". Clin Obstet Gynecol. 24 (4): 1187–97. PMID 7333045.
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