Conditions - Differentials Flashcards
What are 3 differentials for epigastric pain, and ways to differentiate between them?
Differentials:
GORD, peptic ulcer and gastritis
GORD only - burning quality, aggravated by eating, lying down, bending over
Peptic ulcers - recurrent flares of several weeks over the course of months and years
Dyspepsia - GORD, peptic ulcers
Nausea and vomiting - peptic ulcers, gastritis
(note: stomach cancer can mimic symptoms of gastritis / peptic ulcers. haematemesis and weight loss a cause for concern)
What are the 4 differentials for right upper quadrant pain, and ways to differentiate between them?
Cirrhos, hepatitis, liver malignancy, cholecystitis / cholelithiasis / choledocholithiasis
Hepatitis, cirrhosis and liver malignancy - jaundice, fever, nausea, vomiting, anorexia, portal hypertension (ascites, caput medusa, varicose veins), maybe hepatomegaly / splenomegaly
Hepatitis only - diarrhea
Murphy’s sign - gall bladder pathology:
Cholecystitis (inflammation) / cholelithiasis (gall stones) / choledocholithiasis (impacted gall stone)
Choledocholithiasis - sudden onset / acute pain
What are the 2 differentials for left upper quadrant pain, and ways to differentiate between them?
Pancreatitis, splenic pathology
Pancreatitis - bloating, nausea, vomiting, fever, maybe referral to left scap
Splenic pathology - splenomegaly, ruptured spleen (traumatic onset)
What are the 6 differentials for right lower quadrant pain, and ways to differentiate between them?
Appendicitis, pelvic inflammatory disease, ectopic pregnancy, IBS, IBD, colorectal cancer
Appendicitis - distinct pattern of pain progression from dull visceral to acute severe somatic within 2-3 hours, McBurney’s point, altered bowel habits
PID only - discharge, pain urinating
IBS - pain relieved by defecation, nausea, flatus, borborygmi, abdo distension
Colorectal cancer - night pain, night sweats, malaise, palpable mass
Irregular bleeding - PID, ectopic pregnancy
Weight loss - IBS, IBD, colorectal cancer
Altered bowel habits (diarrhea, constipation) - IBD, IBS
IBD and IBS - cramping, anaemia
What are the differentials for left lower quadrant pain, and ways to differentiate between them?
Diverticulitis, IBS, IBD, colorectal cancer, pelvic inflammatory disease
PID - maybe discharge, irregular bleeding, pain urinating
IBS - pain relieved by defecation, nausea, flatus, borborygmi, abdo distension, cramping
Diverticulitis - acute onset and severe pain in left iliac fossa, guarding and rigidity
Colorectal cancer - night sweats, night pain, malaise, palpable mass
Altered bowel habits (constipation, diarrhea) - IBS, IBD, diverticulitis
Weight loss -IBS, IBD, colorectal cancer
Which conditions are associated with portal hypertension, and what are the signs associated with portal hypertension?
Conditions;
Cirrhosis, hepatitis, liver cancer
Signs and symptoms:
Ascites, caput medusa, varicose veins, splenomegaly (passive congestion)
Which 8 conditions present with fever, and what are ways to differentiate between them?
Appendicitis - McBurney’s point, progression from vague visceral to acute somatic RLQ pain within 2-3 hours
Hepatitis, cirrhosis, liver disease - jaundice, portal hypertension, maybe hepatomegaly / splenomegaly
Cholecystitis - acute onset RUQ pain, maybe referral to right shoulder, Murphy’s sign
Choledocholithiasis - acute onset RUQ pain, maybe referral to right shoulder, Murphy’s sign, jaundice
Pancreatitis - severe LUQ pain, maybe referral to left scap, bloating
Upper UTI - sudden onset loin pain with radiations to iliac fossa or groin, guarding in renal angle / Lx, nausea, vomiting
Which 3 conditions can present with haematemesis (blood in vomit)?
3 conditions affecting upper gastrointestinal tract:
Gastritis
Oeseophageal cancer
Stomach cancer
Which 4 conditions can present with blood in faeces?
Oesophageal cancer
Stomach cancer
Colorectal cancer
IBD
Which conditions can present with jaundice, and what is a brief description of each?
Hepatits - viral infection of the liver
Cirrhosis - pathological remodelling of the liver cytoarchitecture resulting from prolonged cycles of damage and remodelling (usually from alcoholic liver disease or hepatitis)
Liver malignancy - primary or secondary cancerous tumour in the liver
Which 5 conditions can present with dysuria, and how can you differentiate between them?
Lower UTI (urethritis, cystitis), Upper UTI (pyelitis, pyelonephritis), PID, endometriosis, uterine fibroids
Scalding dysuria - lower UTI (urethritis)
Suprapubic pain during / after urination - lower UTI (cystitis)
Upper UTI - sudden onset loin pain with potential radiations to iliac fossa / groin, guarding in renal angle and Lxfever, nausea, vomiting
Dysmenorrhea, menorrhagia, irregular bleeding - endometriosis, fibroids
PID - low abdo pain, mucoprurulent discharge, irregular bleeding
Endometriosis -cyclical IBS SSX, dyspareunia, dyschezia,
Uterine fibroids - maybe palpable mass, abdo heaviness, abdo bloating
Which 3 conditions can present with flank pain, and how can you differentiate between them?
Nephrolithiasis, AKI, kidney cancer
Nephrolithiasis - dull pain aggravated by urination; if ureters impacted: distress, pallor, vomiting, sweating, sharp pain radiations to groin / testes / labia
AKI - disturbance to renal dysfunction causing cramps, twitching, peripheral neuropathy, cognitive / behavioural disturbance
Kidney cancer - maybe haematuria, fever, weight loss, night sweats, palpable mass
Which 3 conditions can cause pelvic pain in women, and how can you differentiate between them?
Endometriosis, ovarian cancer, cervical cancer
Endometriosis only -cyclical IBS SSX, dysuria, dyschezia, dysmenorrhea, dyspareunia
Both cancers - malaise, unexplained weight loss, night sweats
Ovarian cancer only - urinary frequency and urgency, abdo bloating, dyspepsia, nausea, constipation
Which conditions can cause menstrual irregularities in women, and how can you differentiate between them?
PID, endometriosis, uterine fibroids, uterine cancer, cervical cancer
PID only - mucoprurulent discharge
Endometriosis only -cyclical IBS SSX, dyschezia
Uterine and cervical cancers - malaise, night sweats, night pain, unexplained weight loss
Dyspareunia, dysuria -endometriosis, PID
Menorrhagia - endometriosis, uterine fibroids
Urinary frequency and urgency - fibroids (if compressing organs), ovarian cancer
Which 4 conditions can present with haematuria, and how can you differentiate between them?
Bladder cancer, kidney cancer, UTIs (lower and upper), nephrolithiasis
Location of pain:
- nephrolithiasis: dull flank pain with radiation to groin, aggravated by urination
- upper UTI: sudden onset loin pain with radiations to iliac fossa / groin
- lower UTI (cystitis): suprapubic pain during / after urination
- lower UTI (urethritis): dysuria only
UTI:
- urinary frequency and urgency, cloudy and pungent urine, dysuria
Upper UTI - fever, nausea, vomiting, rigors, guarding in renal angle / Lx
Nephrolithiasis - if ureters impacted: distress, pallor, vomiting, crying, sweating; sharp severe pain with radiations to groin / testes / labia
