Read Differential Diagnosis of Common Complaints PDF Ebook by Andrew B. Symons MD deotertuachartpep.mlhed 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.

Differential Diagnosis Of Common Complaints Pdf

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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.

Thanks in advance for your time. Skip to content. Search for books, journals or webpages All Webpages Books Journals. Robert Seller Andrew Symons. Published Date: Page Count: In older adults, intestinal obstruction is usually caused by strangulated hernias or cancer.

However, in any patient with severe abdominal pain and a history of abdominal surgery, adhesions constitute the most likely cause of intestinal obstruction. Pancreatitis occurs most frequently in alcoholic patients and patients with gallstones. Sigmoid volvulus is more common in males, patients with cognitive disabilities, and patients with parkinsonism; cecal volvulus is more common in females. Gallstone ileus causes small bowel obstruction more often in older adults and in women. Mesenteric adenitis is more common in children.

Peptic esophagitis is more common in obese patients.

The incidence of diverticulitis increases with age; this disorder is more common after age Classically, biliary colic develops in the evening and is usually a steady midepigastric or RUQ pain. Colicky or crampy pain that begins in the midabdomen and progresses to a constant pain in the RLQ suggests appendicitis. Other conditions that may begin in a crampy or colicky manner and progress to a more constant pain include cholelithiasis and cholecystitis which tend to localize in the RUQ , intestinal obstruction, and ureterolithiasis which involves excruciating pain that frequently radiates to the groin, testes, or medial thigh.

A constant, often annoying burning or gnawing pain located in the midepigastrium and occasionally associated with posterior radiation is seen with peptic ulcer. Peptic ulcer pain may be worse at night, although this pattern is unusual.

The pain is not ordinarily made worse by recumbency. The pain of peptic ulcer in older patients may be vague and poorly localized. Because of a lack of classic symptoms, an occasional absence of prior symptoms, and a confusing picture of abdominal pain, perforation associated with peritonitis is more common in older patients.

It is particularly important to note that pain induced by percussion in the epigastrium may be the only physical finding to suggest ulcer disease in a person complaining of typical peptic ulcer pain.

Likewise, severe exacerbation of pain that occurs when the physician percusses over the RUQ strongly suggests the presence of an inflamed gallbladder. The Rome II criteria 12 weeks of symptoms in the preceding year; a change in the frequency or form of the stool, bloating, and pain that is usually dull, crampy, and recurrent suggest IBS.

It is often associated with constipation that alternates with diarrhea, small stools, and mucus in the stools. In addition, moderate pain may be elicited when the physician palpates the colon.

However, in older patients, severe diverticulitis may exist with similar symptoms. Most abdominal pain, even when severe, usually develops over several hours.

When the onset of severe abdominal pain is abrupt, it 33 suggests perforation, strangulation, torsion, dissecting aneurysms, or ureterolithiasis. The most severe abdominal pain occurs with dissecting aneurysms and ureterolithiasis.

Andrew B. Symons, MD, MS

The pain of a dissecting aneurysm is often described as a tearing or ripping sensation and frequently radiates into the legs and through the torso to the back. Such pain usually manifests in patients who are in profound shock. Individuals with the excruciating pain of ureterolithiasis may be writhing in agony but do not experience cardiovascular collapse. The pain of ureterolithiasis is usually unilateral in the flank, groin, or testicle and is often associated with nausea and occasional vomiting.

The location of the pain is one of the best tests for determination of a diagnosis Fig. RUQ pain is most frequently seen in cholecystitis, cholelithiasis, and leaking duodenal ulcer Fig. Another clue to gallbladder disease is the radiation of RUQ pain to the inferior angle of the right scapula. RUQ pain is also seen in patients with hepatitis or congestive heart failure. In the latter group the pain is thought to be caused by swelling of the liver, which results in distention of Glisson capsule.

Myocardial infarction may manifest as RUQ pain. Less severe RUQ pain may be seen in patients with hepatic flexure syndrome gas entrapment in the hepatic flexure of the colon. If questioned carefully, these patients will admit to experiencing relief with the passage of flatus. From Schwartz S.

New York: McGraw-Hill; From Cope Z. Early Diagnosis of the Acute Abdomen.

London: Oxford University Press; A gnawing, burning, midabdominal to upper abdominal pain suggests a condition with a peptic etiology—ulcer, gastritis, or esophagitis. Burning epigastric pain that radiates to the jaw is frequently seen in patients with peptic esophagitis. Severe upper abdominal pain that radiates into the back and is associated with 36 nausea and vomiting suggests pancreatitis.

This pain is typically worse when the patient lies down and improves when he or she leans forward. Left upper quadrant LUQ pain is most frequently seen in patients with gastroenteritis or irritable bowel and less often in those with splenic flexure syndrome, splenic infarction, or pancreatitis.

The pain from splenic flexure syndrome may be located in the LUQ or in the chest; therefore it is also part of the differential diagnosis of chest pain. These pains tend to arise when the individual bends over or wears a tight garment, and they are frequently relieved by the passage of flatus. Other causes of both RUQ and LUQ pain include supradiaphragmatic conditions with inflammation of the diaphragm, such as pneumonia, pulmonary embolism, pleurisy, and pericarditis.

RLQ pain is most often seen with muscle strain, appendicitis, salpingitis, and diverticulitis Fig. However, pain associated with diverticulitis is more common in the LLQ. Other causes of RLQ or LLQ pain are ureterolithiasis, salpingitis, endometriosis, ruptured ovarian cyst, ovarian torsion, ectopic pregnancy, and obturator hernia.

The pain of salpingitis is usually unilateral, although it may manifest bilaterally. LLQ pain suggests irritable bowel and diverticulitis. Common causes of central abdominal pain include early appendicitis, small bowel obstruction, gastritis, and colic Fig. Associated symptoms Red flags include new onset of pain, change in pain or altered bowel habits in older adults, weight loss, blood in stools or melena, anemia, enlarged supraclavicular lymph nodes, family history of serious bowel disease, or nocturnal pain.


The abdominal pain seen with a truly acute abdomen is usually of such severity that patients overlook any associated symptoms they might have. Thus it can be 39 said that any additional complaint e. The timing of vomiting in relation to the onset of abdominal pain and associated symptoms may help the physician to establish a precise diagnosis.

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The earlier the vomiting occurs in relation to the onset of abdominal pain, the less the abdominal distention.

Patients with lower intestinal obstruction experience less vomiting and greater distention. Vomiting that precedes the onset of pain reduces the probability of an acute abdomen. Vomiting that begins after the onset of pain is more consistent with the diagnosis of an acute abdomen and is frequently seen in patients with appendicitis. However, the absence of vomiting does not preclude the diagnosis of an acute abdomen.

If vomiting occurs soon after the onset of pain and the vomitus is light in color, it probably consists of digestive juices and bile; this suggests gastritis, cholecystitis, or obstruction. Jaundice, dark urine, and light to acholic stools may be seen in patients with abdominal pain caused by cholecystitis.


These symptoms suggest an obstructive etiology of the jaundice, and complete biliary obstruction should be suspected. A history of occasional silver-colored stools alternating with normal or light- colored stools is virtually pathognomonic of carcinoma of the ampulla of Vater.

The production of silver-colored stools is a result of mixing of upper GI blood from the ampullary carcinoma with acholic stools. Examination of vomitus from patients with acute abdominal obstruction may provide a clue to the location of the obstruction. Undigested food in the vomitus suggests that the obstruction is proximal to the stomach; this may result from achalasia or peptic esophagitis. Undigested food may occasionally be seen in vomitus from patients with pyloric obstruction.

This diagnosis is most likely if the vomiting persists and does not contain bile. Brown vomitus with a fecal odor suggests mechanical or paralytic bowel obstruction. The more proximal the obstruction, the more frequent the vomiting. Constipation with small, dry stools—sometimes alternating with diarrhea or mucus in the stool—is frequently seen in patients experiencing increasing stress and suggests IBS.

When diarrhea and 40 constant abdominal pain occur in patients older than 40 years, a cause requiring surgical intervention is likely. Precipitating and aggravating factors The pain of appendicitis is aggravated by motion or coughing, as is the pain of peritonitis, regardless of its cause.

The pain of gastritis is worsened by the ingestion of most foods, particularly alcoholic beverages. Peptic ulcer pain usually begins an hour or so after eating and is generally relieved by eating. If epigastric pain occurs primarily or is worsened in the recumbent position, peptic esophagitis should be suspected.

Differential Diagnosis of Common Complaints E-Book (6th ed.)

Lower abdominal pain may be precipitated or aggravated by laxatives, particularly in instances of intestinal obstruction or constipation. The pain of salpingitis and endometriosis is often worse during or before menstruation. Although patients may find that this pain is not exacerbated by limited movement in bed, more strenuous activity, such as descending a flight of stairs, frequently increases the severity of the discomfort.

They may also be part of a long-term psychiatric illness. If the patient experiences relief after eating or taking antacids, peptic ulcer or peptic esophagitis is the probable cause of pain. The pain of gastritis, although worsened by the ingestion of food and alcoholic beverages, may be relieved by antacids. The pain of peptic esophagitis is often lessened when the patient is in an upright position.

Pain relieved by defecation or the passage of flatus suggests an irritable bowel or gas entrapment in the large bowel, whereas pain relieved by belching suggests gaseous distention of the stomach or esophagus. The pain of gastroenteritis is occasionally relieved by vomiting or diarrhea. Pelvic pain relieved by urination and associated with urinary frequency and dyspareunia suggests interstitial cystitis, which occurs most frequently in young women.

This part of the examination can often provide major clues to the diagnosis because it allows the physician to note distention, abnormal pulsations, and abdominal movement with respiration.

The second part of the examination should always consist of auscultation; it is preferable for the physician to listen to bowel sounds before beginning a manual investigation.

Evaluation of chest pain

In all patients with abdominal pain, the physician should begin palpation away from the painful area and gradually move toward palpation over the most painful spot. When palpating the abdomen and vaginal area, the physician should be particularly attentive to lymph node enlargements or hernias and to the quality of femoral pulses. Abdominal wall pain can be diagnosed by the positive result of Carnett test—palpation of the tender abdominal wall spot while the patient tenses the abdominal wall by raising the head and trunk or lower extremities off the examining table.

If the pain persists or gets worse, the result is positive and pain is originating in the abdominal wall, not intraabdominally. Specific physical findings in appendicitis, cholecystitis, diverticulitis, and bowel perforation or infarction vary with the disease. However, if peritonitis is present, certain physical findings are common, regardless of the disease.

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