Differentials
Viral gastroenteritis
SIGNS / SYMPTOMS
Limited course of illness. May be associated with diarrhea. Fever may be present.
INVESTIGATIONS
Diagnosis is clinical.
Food poisoning
SIGNS / SYMPTOMS
History of travel or exposure to possible contaminated food. Often associated with abdominal pain or cramps, diarrhea, and fever.
INVESTIGATIONS
Stool culture for enteric pathogens such as Salmonella, Shigella, and Campylobacter organisms.
Cholecystitis
SIGNS / SYMPTOMS
Right upper quadrant (RUQ) pain, worse after fatty meals. RUQ tenderness to palpation. Positive Murphy sign (the examiner's hand rests along the costal margin, and deep inspiration causes pain).
INVESTIGATIONS
Positive abdominal ultrasound for gallstones.
May have elevated LFTs.
Hepatitis
SIGNS / SYMPTOMS
May be associated with jaundice. Right upper quadrant pain frequent. Palpable liver edge, which is tender to palpation.
INVESTIGATIONS
Elevated LFTs.
Signs of hepatic inflammation on abdominal ultrasound.
Viral serology positive if infectious cause.
Antinuclear antibodies present in autoimmune hepatitis.
Acute pancreatitis
SIGNS / SYMPTOMS
Right upper quadrant pain and/or epigastric pain frequent.
INVESTIGATIONS
Elevated amylase and lipase. Signs of pancreatic inflammation on abdominal ultrasound.
Acute appendicitis
SIGNS / SYMPTOMS
Right lower quadrant pain consistent. Low-grade fever typical.
INVESTIGATIONS
CBC shows leukocytosis.
Ultrasound suggestive of inflamed appendix.
Acute pyelonephritis
SIGNS / SYMPTOMS
History of frequency, urgency, dysuria. History of fever. Costovertebral angle tenderness.
INVESTIGATIONS
Urinalysis shows pyuria.
Positive urine culture.
Kidney stones
SIGNS / SYMPTOMS
Colicky abdominal pain. History of blood in urine. Costovertebral angle tenderness.
INVESTIGATIONS
Hematuria on urinalysis.
Ultrasound shows calcification within urinary tract.
Hyperthyroidism
SIGNS / SYMPTOMS
History of heat intolerance, palpitation, dry skin. Enlarged and possibly tender thyroid on palpation. Thyroid nodules on palpation.
INVESTIGATIONS
Decreased thyroid-stimulating hormone and elevated thyroxine (T4).
Pseudotumor cerebri
SIGNS / SYMPTOMS
Presence of headache, pulsatile tinnitus, diplopia, and visual loss.
INVESTIGATIONS
CT scan of brain fails to demonstrate mass and is consistent with increased intracranial pressure.
Vestibular lesions
SIGNS / SYMPTOMS
Presence of balance disturbances and vertigo. Tinnitus may be present.
INVESTIGATIONS
Diagnosis is clinical.
Migraine headaches
SIGNS / SYMPTOMS
Severe headaches with presence of phonophobia and photophobia. History and/or family history of migraine headache.
INVESTIGATIONS
Diagnosis is clinical.
Central nervous system tumors
SIGNS / SYMPTOMS
Presence of neurologic findings (e.g., headache, visual disturbance, focal neurologic signs).
INVESTIGATIONS
Intracranial mass on CT.
Acute fatty liver of pregnancy
SIGNS / SYMPTOMS
Onset during the third trimester. Fever and jaundice occur in up to 70% of women.[14]
INVESTIGATIONS
Elevated LFTs and bilirubin with elevated WBC count.
Use of this content is subject to our disclaimer