Read Differential Diagnosis of Common Complaints PDF Ebook by Andrew B. Symons MD plicanodfratran.gahed by Elsevier, ePUB/PDF Robert H Seller; Andrew B Symons. Provides you with practical coverage of the most common complaints you're likely to see in daily practice. Add tags for "Differential diagnosis of common complaints". Robert H. Seller and Andrew B. Symons, helps you quickly and efficiently diagnose the 36 most common symptoms reported by patients. Organized alphabetically by presenting symptom, each chapter mirrors the problem-solving process most physicians use to make a diagnosis.
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Robert H. Seller, Andrew B. Symons - Differential Diagnosis of Common Complaints (, Elsevier).pdf - Ebook download as PDF File .pdf), Text File . txt) or. (Download pdf) Differential Diagnosis of Common Complaints. Differential Diagnosis of Common Complaints. Title.: Differential Diagnosis of Common. Differential Diagnosis of Common Complaints 7th edition PDF eTextbook. ISBN: Logically organized around the 36 most.
Complete blood count. Chireau M. Ghazi S. Early laparoscopy for the evaluation of nonspecific abdominal Benson B. Sergi G. Purcell reviews other uncommon conditions simulating an acute abdomen. Why does the clinical diagnosis fail in suspected appendicitis? European Journal of Surgery. Inelmen E.
Osorio C. Cope Z. MRI evaluation of acute appendicitis in pregnancy. Diagnosis of chronic mesenteric ischemia in older patients: A structured review. Fratta S. Cardin F. Selected References Andersson R.
Pedrosa I. Manzato E. Journal of Clinical Gastroenterology Hugander A. Vega V.. Angiotensin converting enzyme inhibitor-induced gastrointestinal angioedema: A case series and literature review. Beddy P.. Vascular causes of abdominal pain include mesenteric thrombosis and acute mesenteric occlusion by embolism or torsion. Dewhurst C. The latter may have no associated signs or symptoms—only severe abdominal pain.
Sanabria A. Bastian L.
Aging Clinical and Experimental Research. Terranova C. Crochet J. Smith C. Does this woman have an ectopic pregnancy?: The rational clinical examination systematic review.. Dominguez L. Angelini D. Obstetric triage revisited: Update on non- obstetric surgical conditions in pregnancy Laczek J.
Aortic aneurysm may cause constant low back pain. Magnetic Resonance Imaging. Assessment and differential diagnosis of abdominal pain.. Seminars in Roentgenology. Gunnarsson U. Laurell H. Krajewski S. Surgical Endoscopy. Brown C. Imaging of abdominal pain in pregnancy. Hines J. Yamamura J. Wetherington A. Katz D. Tsui T. Ganson G. Imaging the patient with right upper quadrant pain. Berliner C. Laparoscopy for the management of acute lower abdominal pain in women of childbearing age. Pearls and pitfalls in the emergency department evaluation of abdominal pain..
Powers R. Radiologic Clinics of North America.. Phang P. Diagnosing the patient with abdominal pain and altered bowel habits: Is it irritable bowel syndrome? American Family Physician. Farquhar C.
Nurse Practitioner. Spiro H. Jeffrey R. A critical appraisal of the evidence. Courtney D.. Acute abdominal pain among elderly patients Emergency Medicine Clinics of North America. Alpert P.. Gaitan H. Raval M.. Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: A meta-analysis.
Martinez J.. Keller S. Nonsurgical and extraperitoneal causes of abdominal pain. Hansson L. Canadian Journal of Surgery. Karul M.. Reveiz L. Brown J. Nino-Murcia M. Abdominal pain in the elderly. Kamin R.. Cochrane Database of Systematic Reviews. Holten K. Purcell T. Miller S.
Mattu A. Nowicki T. Imaging of appendicitis in adults. Klein M. Gastroenteritis is the most common cause of acute abdominal pain in children. Whenever significant concern exists about the presence of a surgical condition. Accurate diagnosis is essential because abdominal pain may be a manifestation of a surgical emergency. Functional abdominal pain is defined as Other common nonsurgical causes of acute abdominal pain are mesenteric adenitis.
A small number of selected laboratory studies may also be required. Red flags for chronic abdominal pain in children include age less than 5 years. Abdominal pain in children has many potential causes. Table 2. It is quite common in children older than 5 years and usually has a psychosocial association Table 2. Irritable bowel syndrome IBS is similar. Symptoms most frequently measured in IBS studies are abdominal pain. Adolescents Table 2.
The most common surgical causes of acute abdominal pain are appendicitis. Sigalet DL. Patients between 5 and 12 years of age 3. Children younger than 5 years 2. Acute abdominal pain in children. Am Fam Physician. Nature of patient Presentation and causes of abdominal pain vary according to three age groups.
Differential diagnosis of common complaints
With the exception of infantile colic. Intussusception is likely when signs of intestinal obstruction are found in infants peak incidence. Physical examination is particularly important in this age group. When otherwise healthy and well-fed infants cry for more than 3 hours a day.
Appendicitis is uncommon in infants and children up to age 5 years. The cause of abdominal pain in very young children is difficult to determine unless abdominal tenderness.
In children between 5 and 12 years old. In one-third of cases of appendicitis in children. Because appendicitis is seldom considered. For example. Functional abdominal pain is one of the four functional gastrointestinal disorders described by the Rome IV criteria the others being functional dyspepsia. A gradual onset of cramping pain often suggests an intestinal cause.
In addition to observing the severity. In female adolescents with abdominal pain. Inflammatory bowel disease frequently begins during adolescence and can be a cause of acute or recurrent abdominal pain. Functional abdominal pain is usually central and nonradiating and rarely awakens the patient at night. Growth failure may also indicate gluten-sensitive enteropathy.
It is rarely associated with recurrent vomiting or diarrhea but is often associated with vagueness and multiple symptoms. Children with functional abdominal pain have a high incidence of behavioral and personality disorders.
Acute appendicitis is most common in children ages 5 to 15 years. Many have histories of colic and feeding problems in infancy and stressful family and school situations. These patients tend to be anxious and perfectionists and are often apprehensive. Nature of pain The timing of the first occurrence of abdominal pain in children may help identify psychological stress as the cause. Sickle cell crises occur almost exclusively in black patients but occasionally in people of Mediterranean descent.
In young children. This pattern is in contrast to that of appendicitis. The child has tenderness and guarding when the pain is present and usually shows no guarding when the pain is absent. Diffuse cramping abdominal pain that follows or coincides with the onset of diarrhea. This diagnosis should be accepted only when an enema yields a large amount of feces and relieves pain.
Guarding and abdominal tenderness are the symptoms most frequently associated with a surgical diagnosis. This spasmodic pain often recurs at The associated pain may be colicky in younger children and severe and episodic in older children. The pain of appendicitis classically precedes the development of vomiting and anorexia. Sudden onset of severe. The pain of mesenteric adenitis often mimics that of appendicitis. Because of frequent atypical presentations and a decreased incidence in young children.
When the abdominal pain is relatively constant. Hematuria may support this diagnosis. Cramping pain occurring primarily after meals. Abdominal pain associated with tenderness on percussion in the region of the costovertebral angle may indicate pyelonephritis. Mesenteric adenitis usually occurs after a viral or bacterial infection.
When abdominal pain is severe and colicky and radiates to the groin or flank. Hematuria may also be noted when an inflamed retrocecal appendix overlies the ureter. Recurrent episodes of severe abdominal pain suggest sickle cell disease. Epigastric pain can come from esophageal. The abdominal pain of diabetic acidosis is often generalized. Substernal pain usually emanates from the esophagus. The abdominal pain of a sickle cell crisis is severe and usually associated with ileus.
Left lower quadrant pain suggests proctitis. Location of pain Periumbilical pain is most common in functional abdominal pain. Associated symptoms A detailed evaluation of associated symptoms often helps establish the diagnosis. Subsequent to this localization of pain in the RLQ.
Increasing localized tenderness in the RLQ associated with rebound to the RLQ is the most helpful finding favoring the diagnosis of appendicitis. Some generally applicable rules concerning the differential diagnosis of acute abdominal pain are as follows: The presumed mechanism of RLQ pain in constipation involves gaseous distention of the cecum.
Classic findings often occur with the appendix in its usual location. It is critical for the physician to perform a rectal examination because pain in the right upper quadrant may be due to retrocecal appendicitis.
The pain of gastroenteritis is poorly localized. When abdominal distention. When significant diarrhea is associated with abdominal pain. When vomiting precedes abdominal pain. Viral diarrhea of the small bowel often manifests as midabdominal cramping. Some children with such findings also have nausea. Eating may also worsen midepigastric pain that is caused by gastritis from drugs or H. If lactose-containing foods cause pain. Precipitating and aggravating factors If a viral infection precedes abdominal pain.
Their pain is poorly localized. If eating precipitates crampy lower abdominal pain. When abdominal pain is diffuse and no localizing physical signs are found. A history of polyuria. A preceding upper respiratory infection e. Abdominal pain without systemic signs e. Other warning signs suggesting an organic cause of recurrent abdominal pain are weight loss.
Growth failure. With a retrocecal appendix. Physical findings Physical examination should include general observation of the child and inspection of the abdomen for distention. The following features of acute appendicitis apply distinctly to children: Patients with appendicitis have tenderness over the inflamed appendix.
The pain may be atypically located when the appendix is not The pain may be mild and discontinuous. The abdomen should be auscultated before palpation or percussion. Peritoneal inflammation. Diffuse and generalized hyperperistalsis suggests gastroenteritis. Other signs of peritonitis include shallow breathing. The child may lie quite still or may move cautiously and often prefers to lie on the left side with the right thigh flexed.
If triptan medication relieves abdominal pain. Symptoms most frequently measured in chronic idiopathic constipation studies include frequency of bowel movements.
Ameliorating factors When recurrent abdominal pain is relieved by defecation. When pain is relieved by eating or antacids. Serial examinations by the same doctor are often helpful. Surgery should be performed within 24 hours of symptom onset.
Patients with such processes may have no muscle guarding or rebound tenderness. A bulge in the inguinal area or the presence of an undescended testicle suggests an inguinal hernia.
Rectal Mesenteric adenitis may also follow viral gastroenteritis. Both mesenteric adenitis and nonspecific acute abdominal pain can mimic appendicitis. In mesenteric adenitis. When intussusception is ileocecal most common. There are currently no published clinical prediction rules that reliably rule in or rule out appendicitis.
Until the diagnosis is clear. A lump may be palpated either rectally or abdominally in infants with intussusception. When the temperature. It is very difficult for the physician to distinguish mesenteric adenitis from acute appendicitis by physical examination alone.
The value of serial abdominal examinations and serial laboratory tests. With early inflammatory processes. If the patient has a history of similar pain episodes and the current episode subsides within 24 hours. Continued pain. Studies useful in the differential diagnosis of abdominal pain include complete blood count with differential.
When chronic or recurrent abdominal pain is the chief complaint. CT scans are currently being used more frequently to evaluate abdominal With recurrent abdominal pain. This diagnosis is confirmed if an enema yields a large amount of stool and relieves the pain.
Frequent serial tests may be necessary with acute pain.
Every child should undergo a blood glucose test and urinalysis before abdominal surgery. Occasionally an enlarged kidney is detected by palpation. Although sonography is often the initial test in children. Diagnostic studies Many indications for diagnostic studies have already been reviewed.
All black patients should have their sickle cell status confirmed. Complex and invasive studies rarely influence the outcome. A barium enema not only may reveal the intussusception but also may alleviate it. A firm stool may be palpated rectally.
In special instances. Palpation of fecal material in the colon and tenderness over the course of the colon suggest pain from obstipation. If a Gram stain preparation of the vaginal secretion reveals gonococci. Laparoscopy has been helpful in instances of recurrent pain when the diagnosis is not apparent despite multiple studies.
Complete or incomplete intestinal obstruction resulting from adhesions should be considered as a cause of abdominal pain in any patient with an abdominal scar. The fever is usually higher than that observed with appendicitis. This pain is usually cramping and is typically accompanied by bilious vomiting.
Ultrasonography may help detect an ovarian cyst. A twisted ovarian cyst should be considered in cases of acute lower abdominal pain in girls. In older girls. For diagnosing appendicitis. Abdominal distention. A mass is usually palpable. A history of mittelschmerz also suggests that the pain may be due to an ovarian cyst. Less common diagnostic considerations Congenital intestinal obstruction. Laparoscopy is particularly helpful in children with recurrent RLQ pain and premenarchal girls with undiagnosed recurrent abdominal pain.
Many with duodenal atresia or midgut volvulus demonstrate visible gastric peristalsis. Physical examination may reveal abdominal distention. Peptic ulceration and perforation should be considered whenever children with abdominal symptoms have undergone major stress. Acute pancreatitis.
Abdominal pain may be the presenting complaint in children with lower lobe pneumonias. Peptic ulceration and occasional perforation may develop in children experiencing major stress as the result of serious physical trauma e. Lactose intolerance can cause recurrent abdominal pain in children and should be considered if the onset of pain coincides with heavy lactose ingestion.
In rare cases. Functional abdominal pain. Before invasive procedures are performed or a psychogenic origin is assumed. Children with migraine headaches may also complain of abdominal pain. Allergies to foods and drugs occasionally cause abdominal pain. Patients with this condition usually have marked nausea. In the early phase. Upright or decubitus radiographs may demonstrate free air in the peritoneal cavity.
If the obstruction continues. Gallstones are rare in children and are most likely to occur in those with hemolytic anemias. Lead poisoning should be suspected if the child has paroxysms of diffuse abdominal pain alternating with constipation. Children with ureteropelvic junction obstruction often have recurrent unilateral pain that commonly occurs at night after ingestion of large quantities of fluids.
A history of pica may or may not be obtained from the parents or patient. Urinary tract infections. Right lower quadrant. Selected References Macarthur C. McCollough M. Brown R. Chronic abdominal pain in childhood: Diagnosis and management. Appendicitis update.. Sharieff G. Emergency management of acute abdomen in children. Saunders N.
Lake A.. Pediatric Annals. Pediatric Surgery International. Recurrent abdominal pain and Helicobacter pylori. Abdominal pain in children.
Journal of Clinical Epidemiology. Endocrine Development.. Carson R. Differential diagnosis of recurrent abdominal pain: New considerations.
Park R.. Current Opinion in Pediatrics.. American Academy of Pediatrics. Journal of Pediatric Gastroenterology and Nutrition. Feldman W.. Bachur R. Chronic pelvic pain and recurrent abdominal pain in female adolescents. Hennelly K. Puzanovovna M.
Differential Diagnosis of Common Complaints
Lal S. Balachandran B. Chronic abdominal pain in children. Shulman R.
Kulik D. Walker L. McOmber M Measuring the symptoms of pediatric constipation and irritable bowel syndrome with constipation: Expert commentary and literature review. Nelson R. North American Society for Pediatric Gastroenterology.. Uleryk E. Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain. Kohli R. Pediatric Clinics of North America. Maguire J. Baber K..
Anderson J. Exploratory laparoscopy for recurrent right lower quadrant pain in a pediatric population.. Abetz-Webb L. Arbuckle R.. Indian Journal of Pediatrics.
Hewitt G. Singhi S. Kolts R. Abdominal migraine: Evidence for existence and treatment options. Stevenson R. Noe J. Pediatric Annals.. Wester T. Symon D. Imaging and the child with abdominal pain. Zeiter D. Recurrent abdominal pain in children. Russell G.. Abdominal pain unrelated to trauma. Functional abdominal pain: All roads lead to Rome criteria.
Infantile colic. Ostapchuk M. Abu-Arafeh I. The Surgical Clinics of North America. Hyams J. Singapore Medical Journal. Paediatric Drugs. Contemporary management of abdominal surgical emergencies in infants and children. Strouse P.. Pakarinen M. Navigating recurrent abdominal pain through clinical clues. Roberts D.
British Journal of Surgery. Current Opinion in Pediatrics. Yacob D. DiLorenzo C. Two percent of the population consults a physician each year because of back pain. Low back pain is the most common musculoskeletal complaint that results in a visit to the emergency department. On the other hand. To complicate matters even more.
It is the most common cause of disability in patients younger than age 45 years. Despite the frequency of low back syndrome. Acute lower back pain is defined as lasting less than 6 weeks. When lost productivity from work absence is considered. Some patients have local or radicular signs but no evidence of morphologic abnormalities.
Pain lasting more than 6 weeks usually merits deeper investigation. Low back pain most often has a mechanical origin. Nature of patient Backaches in patients younger than 20 years old or older than 50 years suggest a serious red flag problem. A sprained back is occasionally caused by trauma e.
Backache represents serious disease more often in young children than in adults. The pain is located in the midscapular region. Social and psychological factors are more pronounced in patients with chronic low back pain.
Spondylolisthesis is a deficit in the pars interarticularis. It sometimes results in the anterior translocation of the affected vertebra. Pain usually develops after strenuous athletic activity. Infection should be a strong diagnostic consideration. Mechanical causes include acute lumbosacral strain. This type of sprain usually results from participation in sports.
Other common causes are sciatica often associated with a herniated disc. Spondylolisthesis and spondylolysis occur more often in teenagers than in younger patients. Because low back pain may represent serious illness in children. Backaches in children are relatively uncommon. Disc syndromes are more common in men. Regardless of the cause.
It is then usually preceded by some traumatic incident. Even if the patient has spondylolisthesis. It occurs more often in people such as industrial workers and farmers.
Nature of symptoms and location of pain To determine the cause of backache. Postural backaches are more common in multigravida patients and individuals who are obese or otherwise in poor physical condition. When it is the chief complaint in patients older than 50 years. Everyone probably experiences some degenerative joint disease in the low back. Herniated discs occur in young adults but are relatively uncommon. In young adults who complain of persistent backache.
The number of backaches caused by disc disease rises as age increases from 25 to 50 years.. In older patients. In patients older than 50 years who present with backache without a significant history of prior backaches. The pain usually has a sudden onset and often radiates into the buttock. Can Med J. Radiation of pain to the knee. Patients have difficulty locating a precise point of maximum pain. It is usually well localized at the lumbosacral region.
The pain of a musculoskeletal strain and a postural backache is often described as dull and persistent and associated with stiffness. The low back pain of degenerative lumbosacral arthritis has a gradual onset. The pain of a disc syndrome has been compared with a toothache—sharp.
Many patients with this condition complain that their lumbosacral motion is limited by pain and stiffness that is often worse in the morning but improves an hour or so after they arise. The pain of acute lumbosacral strain is characterized by a sudden onset often related to turning.
After trauma. Many patients with herniated disc syndrome have a history of previous. Radiation of pain does not always indicate nerve root compression. Trochanteric bursitis. Table 3. In these cases. Some patients with depression may experience chronic low back Remitting pain usually indicates a posterolateral disc protrusion.
In sacroiliitis inflammatory arthritis of the sacroiliac joints the pain may alternate from side to side. The low back pain from prostatitis is usually a vague ache that is not affected by movement or coughing and is not associated with muscle spasm or limited mobility.
The pain of sacroiliitis does not have a radicular distribution. The qualitative characteristics of low back pain can be of considerable practical diagnostic importance. On rare occasions. With renal colic the straight-leg raising test result is usually negative. If root irritation is present. Inflammatory disease e. This pain does not radiate into the leg. The patient shows a gradual shift in the location of pain to the flank.
The patient may also have tenderness on palpation in the sciatic notch. When the pain is described consistently and specifically. Back pain in sacroiliac syndromes tends to be localized over the posterosuperior iliac spine.
Associated symptoms With lumbar osteoarthritis. Cancer or infection is suggested by unexplained weight loss. Low back pain associated with vaginal discharge suggests a gynecologic cause. When somatic pain is a manifestation of depression. Cauda equina syndrome or some other severe neurologic compromise is suggested by acute urinary retention.
If an elderly patient describes a burning or aching back pain. If herpes zoster is associated with back pain. In men. IV drug use. Spinal fracture is suggested by a history of trauma. Pressure on the unmyelinated fibers may cause cauda equina syndrome. Patients with herniated disc syndrome usually have neurologic symptoms such as sciatica. It is often described as diffuse. The physician should be aware of the red flags of serious disease.
Backaches that worsen during or just after menstruation suggest a gynecologic cause. Ameliorating factors Acute lumbosacral strain in adolescent athletes may be precipitated or aggravated during periods of rapid growth. Aging also facilitates the development of this syndrome. The pain of a disc syndrome may be exacerbated by coughing.
Postural backaches worsen as the day progresses. The pain caused by degenerative lumbosacral arthritis may also be increased by lateral bending and extension of the lumbar spine.
The polyradicular pain of spinal stenosis worsens with lumbar extension. In patients with herniated disc syndrome. Patients with acute lumbosacral strain experience pain with motion but not with coughing and straining. Back pain that is aggravated by recumbence or infection or that wakens the patient at night suggest malignancy.
Acute lumbosacral strain is usually precipitated by lifting. Precipitating and aggravating factors Spondylolysis in adolescents is often precipitated by athletic activity. It often manifests as low back pain that is aggravated by activity and leads to an erroneous diagnosis of lumbosacral strain.
Many patients are older and overweight and have not been physically active. When acute lumbosacral strain occurs in athletes.
Physical findings The investigation of low back pain should include a general medical. Special attention should be paid to previous backaches and factors that precipitate. Some patients with disc syndrome inform the physician that they feel better when walking or lying on their sides with their knees flexed fetal position. Many patients with an acute lumbosacral strain state that lying prone and motionless relieves the pain. Any evidence of systemic inflammatory disease. This variable is therefore not helpful in the differential diagnosis of low back pain.
This fact can be a significant point in differential diagnosis in that it rules out the malingerer. The pain of spinal stenosis improves with lumbar flexion. Physical examination should include rectal and pelvic evaluations. Examination of the spine should include determination of range of motion anteriorly.
Patients with inflammatory. Inflammatory back pain often improves with exercise. Many patients with low back pain from osteoarthritis state that their pain diminishes when they lie on the floor or on a firm mattress. This section outlines a satisfactory examination of a patient with low back pain. Most acute back pain relieved by rest is of a mechanical origin.
This latter finding strongly suggests that the pain is caused by disc disease. The back discomfort from irritable bowel syndrome may be relieved by defecation. Particular attention should be devoted to observations made during examination of the breast.
In teenagers with low back pain. With the patient sitting. The examiner should also determine the strength of dorsiflexion of the toes and ankles. Examination of the back should also include observation of the patient in the anatomic position.
In this test. If the pain is reproduced. Med Trial Tech Q. From Lane F. The range of motion of hip joints must be established. From Birnbaum JS.
With the patient supine.. With the patient prone. WB Saunders Co. The Musculoskeletal Manual. Although a straight-leg Palpation over the sciatic notch may reveal pain or tenderness with some radiation to the knee or upper calf.
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Find a copy in the library Finding libraries that hold this item Ressources Internet Additional Physical Format: Print version: Seller, Robert H. Document, Internet resource Document Type: Reviews User-contributed reviews Add a review and share your thoughts with other readers. Be the first.Undigested food in the vomitus suggests that the obstruction is proximal to the stomach. Patients with peritonitis are often in shock.
Although it is true that more than two weeks are required to observe the full therapeutic effects of treatment with an SSRI such as fluoxetine, symp- toms should not worsen once treatment has begun. Managing scientific uncertainty in medical decision making: The case of the advisory committee on immunization practices. A constant, often annoying burning or gnawing pain located in the midepigastrium and occasionally associated with posterior radiation is seen with peptic ulcer.
Dominguez L. If an acute surgical abdomen is suspected but the diagnosis is unknown or dubious. Add to cart.
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