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Symptoms and Signs – Differential Diagnosis of Leishmaniasis
• African trypanosomiasis
• Bacterial endocarditis
• Brucellosis
• Chronic myelocytic leukemia
• Enteric fever
• Generalized histoplasmosis
• Hepatic cirrhosis
• Hodgkin’s disease and other lymphomas
• Malaria
• Sarcoidosis
• Tuberculosis
• African trypanosomiasis
• Bacterial endocarditis
• Brucellosis
• Chronic myelocytic leukemia
• Enteric fever
• Generalized histoplasmosis
• Hepatic cirrhosis
• Hodgkin’s disease and other lymphomas
• Malaria
• Sarcoidosis
• Tuberculosis
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Symptoms and Signs – Differential Diagnosis of Lentigo
• Actinic keratosis
• Ephelides
• Flat seborrheic keratosis
• Lentigo maligna
• Melanocytic nevus
• Actinic keratosis
• Ephelides
• Flat seborrheic keratosis
• Lentigo maligna
• Melanocytic nevus
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Symptoms and Signs – Differential Diagnosis of Intraocular Neoplasm
• Hemangioma
• Melanocytic nevus
• Melanoma
• Metastatic tumor
• Reactive lymphoid hyperplasia
• Reticulum cell sarcoma
• Retinoblastoma
• Hemangioma
• Melanocytic nevus
• Melanoma
• Metastatic tumor
• Reactive lymphoid hyperplasia
• Reticulum cell sarcoma
• Retinoblastoma
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Symptoms and Signs – Differential Diagnosis of Iron Overload
• Aceruloplasminemia
• African dietary iron overload
• Associated with neurologic abnormalities
• Atransferrinemia
• Autosomal dominant hemochromatosis, ferroprotein associated (type 4)
• Cerebrohepatorenal syndrome
• Chronic liver disease
• DMT1-associated hemochromatosis
• Friedreich’s ataxia
• GRACILE (Fellman) syndrome
• GRACILE (growth retardation, aminoaciduria, cholestasis, iron overload, lactic acidosis, and early death)
• Hemojuvelin associated (type 2A)
• Hepcidin associated (type 2B)
• Hereditary hemochromatosis
• HFE associated (type 1)
• Idiopathic pulmonary hemosiderosis
• Inadvertent iron overload from therapeutic injections
• Insulin resistance–associated hepatic iron overload
• Iron-loading anemias (refractory anemias with hypercellular erythroid marrow)
• Juvenile hemochromatosis (type 2)
• Medicinal iron ingestion
• Neonatal hemochromatosis
• Neuroferritinopathy
• Non–HFE associated
• Pantothenate kinase–associated neurodegeneration (formerly called Hallervorden-Spatz syndrome)
• Parenteral iron overload
• Porphyria cutanea tarda
• Renal hemosiderosis
• Transferrin receptor 2 associated (type 3)
• Transfusional iron overload
• Trichohepatoenteric syndrome
• Aceruloplasminemia
• African dietary iron overload
• Associated with neurologic abnormalities
• Atransferrinemia
• Autosomal dominant hemochromatosis, ferroprotein associated (type 4)
• Cerebrohepatorenal syndrome
• Chronic liver disease
• DMT1-associated hemochromatosis
• Friedreich’s ataxia
• GRACILE (Fellman) syndrome
• GRACILE (growth retardation, aminoaciduria, cholestasis, iron overload, lactic acidosis, and early death)
• Hemojuvelin associated (type 2A)
• Hepcidin associated (type 2B)
• Hereditary hemochromatosis
• HFE associated (type 1)
• Idiopathic pulmonary hemosiderosis
• Inadvertent iron overload from therapeutic injections
• Insulin resistance–associated hepatic iron overload
• Iron-loading anemias (refractory anemias with hypercellular erythroid marrow)
• Juvenile hemochromatosis (type 2)
• Medicinal iron ingestion
• Neonatal hemochromatosis
• Neuroferritinopathy
• Non–HFE associated
• Pantothenate kinase–associated neurodegeneration (formerly called Hallervorden-Spatz syndrome)
• Parenteral iron overload
• Porphyria cutanea tarda
• Renal hemosiderosis
• Transferrin receptor 2 associated (type 3)
• Transfusional iron overload
• Trichohepatoenteric syndrome
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Symptoms and Signs – Differential Diagnosis of Irritable Bowel Syndrome
• Biliary liver disease
• Celiac disease
• Chronic pancreatitis
• Colon malignant neoplasm
• Diverticulitis
• Endometriosis
• Inflammatory bowel disease (IBD)
• Peptic ulcer disease (PUD)
• Biliary liver disease
• Celiac disease
• Chronic pancreatitis
• Colon malignant neoplasm
• Diverticulitis
• Endometriosis
• Inflammatory bowel disease (IBD)
• Peptic ulcer disease (PUD)
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Symptoms and Signs – Differential Diagnosis of Ischemic Colitis, Nonocclusive
Small-Vessel Obstruction
• Collagen-vascular disease
• Vasculitis, diabetes
• Oral contraceptives
Nonocclusive Hypoperfusion
• Hemorrhage
• Congestive heart failure (CHF), myocardial infarction (MI),
arrhythmias
• Sepsis
• Vasoconstricting agents: vasopressin, ergot
• Increased viscosity: polycythemia, sickle cell disease, thrombocytosis Increased Motility
• Mass lesion, stricture
• Constipation
Increased Intraluminal Pressure
• Bowel obstruction
• Colonoscopy
• Barium enema
Small-Vessel Obstruction
• Collagen-vascular disease
• Vasculitis, diabetes
• Oral contraceptives
Nonocclusive Hypoperfusion
• Hemorrhage
• Congestive heart failure (CHF), myocardial infarction (MI),
arrhythmias
• Sepsis
• Vasoconstricting agents: vasopressin, ergot
• Increased viscosity: polycythemia, sickle cell disease, thrombocytosis Increased Motility
• Mass lesion, stricture
• Constipation
Increased Intraluminal Pressure
• Bowel obstruction
• Colonoscopy
• Barium enema
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Symptoms and Signs – Differential Diagnosis of Ischemic Necrosis of Cartilage and Bone
• Burns
• Collagen-vascular disorders
• Dysbaric conditions (e.g., caisson disease)
• Endocrine/metabolic: ethanol abuse, glucocorticoid therapy, Cushing’s disease, diabetes mellitus (DM), hyperuricemia, osteomalacia, hyperlipidemia, storage diseases (e.g., Gaucher’s disease)
• Hemodialysis
• Hemoglobinopathies (e.g., sickle cell disease)
• HIV infection
• Idiopathic, familial
• Intravascular coagulation
• Irradiation
• Organ transplantation
• Pancreatitis
• Trauma (e.g., dislocation, fracture)
• Burns
• Collagen-vascular disorders
• Dysbaric conditions (e.g., caisson disease)
• Endocrine/metabolic: ethanol abuse, glucocorticoid therapy, Cushing’s disease, diabetes mellitus (DM), hyperuricemia, osteomalacia, hyperlipidemia, storage diseases (e.g., Gaucher’s disease)
• Hemodialysis
• Hemoglobinopathies (e.g., sickle cell disease)
• HIV infection
• Idiopathic, familial
• Intravascular coagulation
• Irradiation
• Organ transplantation
• Pancreatitis
• Trauma (e.g., dislocation, fracture)
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Symptoms and Signs – Differential Diagnosis of Jaundice
PREDOMINANCE OF DIRECT (CONJUGATED) BILIRUBIN
• Extrahepatic obstruction
• Common duct abnormalities: calculi, neoplasm, stricture, cyst, sclerosing cholangitis
• Metastatic carcinoma
• Pancreatic carcinoma, pseudocyst
• Ampullary carcinoma
• Hepatocellular disease: hepatitis, cirrhosis
• Drugs: estrogens, phenothiazines, captopril, methyltestosterone,
Labetalol
PREDOMINANCE OF INDIRECT (UNCONJUGATED)
BILIRUBIN
• Hemolysis: hereditary and acquired hemolytic anemias
• Inefficient marrow production
• Impaired hepatic conjugation: chloramphenicol
• Neonatal jaundice
• Hereditary disorders: Gilbert’s syndrome, Crigler-Najjar syndrome
PREDOMINANCE OF DIRECT (CONJUGATED) BILIRUBIN
• Extrahepatic obstruction
• Common duct abnormalities: calculi, neoplasm, stricture, cyst, sclerosing cholangitis
• Metastatic carcinoma
• Pancreatic carcinoma, pseudocyst
• Ampullary carcinoma
• Hepatocellular disease: hepatitis, cirrhosis
• Drugs: estrogens, phenothiazines, captopril, methyltestosterone,
Labetalol
PREDOMINANCE OF INDIRECT (UNCONJUGATED)
BILIRUBIN
• Hemolysis: hereditary and acquired hemolytic anemias
• Inefficient marrow production
• Impaired hepatic conjugation: chloramphenicol
• Neonatal jaundice
• Hereditary disorders: Gilbert’s syndrome, Crigler-Najjar syndrome
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Symptoms and Signs – Differential Diagnosis of Jaundice in the Adult Patient
PREHEPATIC CAUSES
• Unconjugated hyperbilirubinemia: excessive heme metabolism from hemolysis (e.g., sickle cell disease, spherocytosis, G6PD, immune hemolysis), ineffective erythropoiesis (e.g., thalassemia, folate, severe iron deficiency), or large hematoma reabsorption
INTRAHEPATIC CAUSES
• Unconjugated hyperbilirubinemia: disorders of enzyme metabolism such as Gilbert’s disease (common, benign), Crigler- Najjar syndrome (rare, severe), or drugs such as rifampin and probenecid
• Conjugated hyperbilirubinemia: intrahepatic cholestasis
• Viruses: hepatitis A, B, and C; Epstein-Barr
• Alcohol: alcoholic hepatitis, alcoholic cirrhosis
• Autoimmune: primary biliary cirrhosis, primary sclerosing cholangitis
• Drug induced: acetaminophen, penicillins, oral contraceptives, chlorpromazine (Thorazine), steroids (estrogenic or anabolic), some herbals
• Hereditary metabolic: hemochromatosis, Wilson’s disease, Dubin- Johnson and Rotor’s syndromes, α1-antitrypsin deficiency
• Systemic disease: sarcoidosis, amyloidosis, glycogen storage diseases, celiac disease, tuberculosis, Mycobacterium aviumintracellulare
• Other: sepsis, total parenteral nutrition, pregnancy, graft-versushost disease, environmental toxins
POSTHEPATIC CAUSES
• Conjugated hyperbilirubinemia: intrinsic or extrinsic obstruction of the biliary system
• Intrinsic blockage: gallstones, cholangitis, strictures, infection (e.g., cytomegalovirus, Cryptosporidium in AIDS patients, parasites cholangiocarcinoma, gallbladder cancer)
• Extrinsic blockage: pancreatitis, pancreatic carcinoma, pancreatic pseudocyst
• Pseudojaundice: caused by an excessive ingestion of foods containing beta-carotene (carrots, melons, squash); does not result in hyperbilirubinemia or scleral icterus
PREHEPATIC CAUSES
• Unconjugated hyperbilirubinemia: excessive heme metabolism from hemolysis (e.g., sickle cell disease, spherocytosis, G6PD, immune hemolysis), ineffective erythropoiesis (e.g., thalassemia, folate, severe iron deficiency), or large hematoma reabsorption
INTRAHEPATIC CAUSES
• Unconjugated hyperbilirubinemia: disorders of enzyme metabolism such as Gilbert’s disease (common, benign), Crigler- Najjar syndrome (rare, severe), or drugs such as rifampin and probenecid
• Conjugated hyperbilirubinemia: intrahepatic cholestasis
• Viruses: hepatitis A, B, and C; Epstein-Barr
• Alcohol: alcoholic hepatitis, alcoholic cirrhosis
• Autoimmune: primary biliary cirrhosis, primary sclerosing cholangitis
• Drug induced: acetaminophen, penicillins, oral contraceptives, chlorpromazine (Thorazine), steroids (estrogenic or anabolic), some herbals
• Hereditary metabolic: hemochromatosis, Wilson’s disease, Dubin- Johnson and Rotor’s syndromes, α1-antitrypsin deficiency
• Systemic disease: sarcoidosis, amyloidosis, glycogen storage diseases, celiac disease, tuberculosis, Mycobacterium aviumintracellulare
• Other: sepsis, total parenteral nutrition, pregnancy, graft-versushost disease, environmental toxins
POSTHEPATIC CAUSES
• Conjugated hyperbilirubinemia: intrinsic or extrinsic obstruction of the biliary system
• Intrinsic blockage: gallstones, cholangitis, strictures, infection (e.g., cytomegalovirus, Cryptosporidium in AIDS patients, parasites cholangiocarcinoma, gallbladder cancer)
• Extrinsic blockage: pancreatitis, pancreatic carcinoma, pancreatic pseudocyst
• Pseudojaundice: caused by an excessive ingestion of foods containing beta-carotene (carrots, melons, squash); does not result in hyperbilirubinemia or scleral icterus
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Symptoms and Signs – Differential Diagnosis of Joint Pain, Anterior Hip, Medial Thigh, Knee
ACUTE
• Acute rheumatic fever
• Adductor muscle strain
• Avascular necrosis
• Crystal arthritis
• Femoral artery (pseudo) aneurysm
• Fracture (femoral neck or intertrochanteric)
• Hemarthrosis
• Hernia
• Herpes zoster
• Iliopectineal bursitis
• Iliopsoas tendinitis
• Inguinal lymphadenitis
• Osteomalacia
• Painful transient osteoporosis of hip
• Septic arthritis
SUBACUTE AND CHRONIC
• Adductor muscle strain
• Amyloidosis
• Acute rheumatic fever
• Femoral artery aneurysm
• Hernia (inguinal or femoral)
• Iliopectineal bursitis
• Iliopsoas tendinitis
• Inguinal lymphadenopathy
• Osteochondromatosis
• Osteomyelitis
• Osteitis deformans (Paget’s disease)
• Osteomalacia (pseudofracture)
• Postherpetic neuralgia
• Sterile synovitis (e.g., rheumatoid arthritis [RA], psoriatic,
systemic lupus erythematosus [SLE])
ACUTE
• Acute rheumatic fever
• Adductor muscle strain
• Avascular necrosis
• Crystal arthritis
• Femoral artery (pseudo) aneurysm
• Fracture (femoral neck or intertrochanteric)
• Hemarthrosis
• Hernia
• Herpes zoster
• Iliopectineal bursitis
• Iliopsoas tendinitis
• Inguinal lymphadenitis
• Osteomalacia
• Painful transient osteoporosis of hip
• Septic arthritis
SUBACUTE AND CHRONIC
• Adductor muscle strain
• Amyloidosis
• Acute rheumatic fever
• Femoral artery aneurysm
• Hernia (inguinal or femoral)
• Iliopectineal bursitis
• Iliopsoas tendinitis
• Inguinal lymphadenopathy
• Osteochondromatosis
• Osteomyelitis
• Osteitis deformans (Paget’s disease)
• Osteomalacia (pseudofracture)
• Postherpetic neuralgia
• Sterile synovitis (e.g., rheumatoid arthritis [RA], psoriatic,
systemic lupus erythematosus [SLE])
