GI Differential diagnosis

Question 1

What is scleroderma/systemic sclerosis

Answer 1

multi-system disease that affects the

body by hardening connective tissue

Question 2

What is gastritis

Answer 2

inflammation that is associated with mucosal injury

Question 3

Differential diagnosis of gastritis

Answer 3

• Peptic ulcer disease (PUD)
• GORD
• Non-ulcer dyspepsia
• Gastric lymphoma
• Gastric carcinoma

Question 4

What is Ulcerative Colitis

Answer 4

Relapsing and remitting inflammaotry disorder of the colonic mucosa

Question 5

Differential diagnosis fo UC

Answer 5

Alternative causes of diarrhoea should be excluded e.g. Salmonella spp,
Giardia intestinalis and rotavirus

Question 6

What is Crohns

Answer 6

Chronic inflammatory GI disease characterised by transmural (goes deep into
mucosa) granulomatous inflammation affecting ANY part of the gut from mouth to
anus (especially in TERMINAL ILEUM and PROXIMAL COLON)

Question 7

Differential diagnosis of Crohns

Answer 7

Alternative causes of diarrhoea should be excluded e.g. Salmonella spp,
Giardia intestinalis and rotavirus
Chronic diarrhoea

Question 8

Clinical presentation of Ischaemic colitis

Answer 8

• Sudden onset lower LOWER LEFT SIDE abdominal pain
• Passage of bright red blood with/without diarrhoea
• May be signs of shock (pale skin, weak rapid pulse, reduce urine output,
  confusion) and evidence of underlying cardiovascular disease

Question 9

Differential diagnosis of ischaemic colitis

Answer 9

Other causes of acute colitis e.g. IBD

Question 10

What are Haemorrhoids (piles)

Answer 10

Disrupted and dilated anal cushions (masses of spongy VASCULAR (veins and arteries) tissue due to swollen veins around the anus

Question 11

Clinical presentation of Haemorrhoids

Answer 11

• Bright red rectal bleeding (since blood from capillaries) that often coats
  stools, seen on tissue or drips into toilet
• Mucus discharge and pruritus ani (itchy bottom)
• Severe anaemia may occur
• Weight loss and change in bowel habit should prompt thoughts of pathology

Question 12

Differential diagnosis of Haemorrhoids

Answer 12

Perianal haematoma
Anal fissure
Abscess
Tumour

Question 13

Clinical presentation of IBS

Answer 13

A - Abdominal pain or discomfort
B - Bloating
C - Change in bowel habit
Urgency, Incomplete evacuation, Mucous in stool, Worsening symptoms after food

Question 14

Differential diagnosis of IBS

Answer 14

Coeliac disease (5% of IBS patients)
Lactose intolerance (especially in IBS-D
(diarrhoea)
Bile acid malabsorption
IBD
Colorectal cancer

Question 15

Differential diagnosis of Appendicitis

Answer 15

• Acute terminal ileitis due to Crohn’s
• Ectopic pregnancy
• UTI
• Diverticulitis
• Perforated ulcer
• Food poisoning

Question 16

Differential diagnosis of chronic pancreatits

Answer 16

Pancreatic malignancy - lots of common symptoms should be thought of
especially when there is a short history and pancreatic mass

Question 17

Differential diagnosis of Biliary colic disease

Answer 17

Irritable bowel syndrome
Carcinoma or the right side of the colon
Renal colic
Pancreatitis

Question 18

Differential diagnosis of Acute cholecystitis

Answer 18

Acute episodes of pancreatitis
Peptic ulceration
Basal pneumonia
An intrahepatic abscess

Question 19

Differential diagnosis of Hepatitis A

Answer 19

Other causes of jaundice

Other types of viral and drug-induced hepatitis

Question 20

Differential diagnosis of Primary Biliary Cholangitis

Answer 20

Autoimmune cholangitis

Extrahepatic biliary obstruction should be exclude by ultrasound

Question 21

Differential diagnosis of liver failure

Answer 21

• Structural/space occupying lesions in the brain
• Cerebral infection - bacterial or viral
• Drug or alcohol intoxication
• Hypoglycaemia, electrolyte imbalance or hypoxia

Question 22

What is volvulus

Answer 22

Complete twisting of a loop of intestine around its mesenteric attachment

Question 23

Differential diagnosis of volvulus

Answer 23

Other causes of acute obstruction
Appendicitis, cholecystitis, constipation, gastroenteritis, GORD, hepatitis,
peptic ulcer and pancreatitis

Question 24

Differential diagnosis of colorectal cancer

Answer 24

Anorectal pathology:
Haemorrhoids, anal fissure, anal prolapse

Colonic pathology:
Diverticular disease, IBD, ischaemic colitis

Small intestine and stomach pathology:
Massive upper GI bleed - haematochezia
Meckel’s diverticulum

Question 25

Differential diagnosis of pancreatic adenocarcinoma

Answer 25

- Diagnosis should NOT BE DIFFICULT in the presence of PAINLESS JAUNDICE or epigastric pain radiating into the back with progressive weight loss. However, many present with minor symptoms such as pain, changing bowel habit and weight loss - Abdominal CT should be done if pancreatic cancer is suspected - IgG4-related autoimmune pancreatitis

Question 26

Differential diagnosis of inguinal hernia

Answer 26

``` Femoral hernia Epididymitis Testicular torsion Groin abscess Aneurysm Hydrocele Undescended testes ```

Question 27

Differential diagnosis of femoral hernia

Answer 27

- Inguinal hernia - Lipoma - Femoral aneurysm - Psoas abscess - Saphena varix (dilation of saphenous vein at junction of femoral vein in groin)

Question 28

Differential diagnosis of infective diarrhoea

Answer 28

Appendicitis, volvulus, IBD, UTI, diabetes mellitus Pancreatic insufficiency, short bowel syndrome, coeliac disease Laxative abuse