Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ ABDOMINAL PAIN ++ FIGURE 4.4 Differential diagnosis for abdominal pain based on area of pain. Shown are the regions of the abdomen and the differential diagnosis for pain in each region. Of note, pain does not always localize precisely, so no matter the location of the pain, consider a broad differential diagnosis. Abbreviations: AAA, abdominal aortic aneurysm; IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; SBO, small bowl obstruction; MI, myocardial infarction; PUD, peptic ulcer disease; RUQ, right upper quadrant; RLQ, right lower quadrant; LUQ, left upper quadrant; LLQ, left lower quadrant. Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ NAUSEA/VOMITING ++ Differential diagnosis: ++ Neuropsychiatric: - Intracerebral: Increased intracranial pressure (ICP) due to malignancy, hemorrhage, abscess, hydrocephalus - Labyrinthine: Labyrinthitis, motion sickness, malignancy - Psychiatric: Anorexia, bulimia nervosa, depression (may be associated with delayed gastric emptying) Cardiopulmonary: Myocardial infarction, congestive heart failure (nausea/early satiety can be early symptoms), post-tussive emesis Gastrointestinal: - Obstructive: Pyloric obstruction, SBO, colonic obstruction, SMA syndrome - Inflammatory: Enteric infections (viral, bacterial), cholecystitis, cholangitis, pancreatitis, appendicitis, hepatitis - Altered function/functional: Gastroparesis, ileus, pseudo-obstruction, GERD, cyclic vomiting syndrome, cannabinoid hyperemesis syndrome Other: - Medications, pregnancy, uremia, DKA/HHS, thyroid disease +++ DIARRHEA ++ Definitions/mimics: - Diarrhea: Passage of abnormally liquid or unformed stools at an increased frequency from baseline - Pseudo-diarrhea: Frequent passage of small volumes of stool, often accompanied by tenesmus, sensation of incomplete evacuation, or rectal urgency; commonly associated with IBS or proctitis - Fecal incontinence: Involuntary fecal discharge, usually due to neuromuscular etiologies or anorectal structural etiologies; however, severe diarrhea may aggravate or result in fecal incontinence “Localizing” features: These features may be present, but are non-specific - Small intestine: Watery, large volume, associated with abdominal cramping, bloating, gas; fever, occult blood/inflammatory cells in stool are rare - Large intestine: Frequent, regular, small volume, often painful bowel movements; fever, bloody or mucoid stools, RBCs/inflammatory cells in stool are common Clinical features: See Table 4.3 ++Table Graphic Jump LocationTABLE 4.3Types of Chronic Diarrhea: Clinical Features, Diagnostics, and EtiologiesView Table||Download (.pdf) TABLE 4.3 Types of Chronic Diarrhea: Clinical Features, Diagnostics, and Etiologies Secretory Osmotic Malabsorptive Inflammatory Diarrheal type Watery* Watery* Fatty (excess flatulence, foul-smelling, floating) Blood/pus in stool Mechanism Increased secretion or decreased absorption of water/electrolytes Presence of poorly absorbed, osmotically active substance with resultant intraluminal water retention Impaired nutrient absorption and impaired digestive function Inflammation or invasive infections Effect of fasting No effect No effect Improves Improves Diagnostics Low fecal osm gap (<50 mOsm/kg)** High fecal osm gap (>125 mOsm/kg)** Fecal fat Fecal WBCs/RBCs, fecal calprotectin, colonoscopy with inflammation Examples Alcohol use Enterotoxins (e.g., cholera) Bile acid malabsorption SIBO Medications Nonosmotic laxatives Early Crohn’s Endocrine disorders (e.g., thyroid) Neuroendocrine tumors Vasculitis Lactose/fructose malabsorption Celiac disease Osmotic laxatives Sugar alcohols (e.g., mannitol, sorbitol) Lactose intolerance Noninvasive parasite ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.