Differential Diagnosis Educational Materials

What is the differential diagnosis for the following symptoms and signs:(NB: These lists are not all exhaustive) Jaundice Increase bilirubin production: Hemolysis due to(e.g. hemolytic anemia, malaria, drugs, septicemia, shock) Impaired bilirubin excetion: Congenital: - Gilberts syndrome Hepatocellular: - Hepatitis - Cirrhosis - Drugs - Autoimmune hepatitis Intrahepatic cholestasis: - Drugs - Primary biliary cirrhosis - Cholangitis Extrahepatic cholestasis: - Gallstones - Cancer: pancreas, cholangiocarcinoma. - Pancreatitis. Cyanosis A) Central cyanosis: Respiratory: 1. 2. 3. 4. 5. 6. 7. Pneumonia Bronchiolitis Bronchial asthma chronic obstructive lung disease Pulmonary embolism Pulmonary Hypertension Upper airway obstruction(including epiglottitis and croup) 8. Pneumothorax Cardiovascular: 1. Congenital heart disease 2. Heart failure 3. Myocardial infarction Central nervous system 1. Intracranial hemorrhage 2. Drug overdose (e.g. Heroin) Blood: 1. Methaemoglobinaemia 2. Polycythemia Others: 1. Septic shock 2. Obstructive sleep apnea 3. Carbon monoxide poisoning 4. Cyanide poisoning 5. Hypoglycemia in the newborn 6. High altitude B) Peripheral cyanosis: 1.Causes of central cyanosis. 2.Reduced cardiac output:as in shock, heart failure and myocardial infarction. 3.Arterial obstruction 4-Venous obstruction (e.g. deep vein thrombosis) 5-Exposure to cold Acanthosisnigricans Lymphadenopathy(llymph nodes enlargement) 1-Obesity. 2-Diabetes. 3-Endocrine disorders(e.g. addison's disease, hypothyroidism, cushing disease, acromegally). 4- Drugs(e.g. contraceptive pills) 5-Cancer. 6- Familial lymph nodes become swollen when they are active either due to an infection, inflammation, or cancer. A)Generalised lymphadenopathy: - Lymphoma - Leukemia -Infections: viral(e.g. infectiousmononucleosis,HIV), bacterial(e.g. TB ,brucellosis, syphilis), protozoal(e.g. toxoplasmosis). - Inflamatory: e.g. rheumatoid arthritis, lupus, sarcoidosis. - Drugs: e.g. phenytoin B) Localised lymphadenopathy: - Local acute or chronic infection - Metastases - Lymphoma, especiallhHodgkins lymphoma Lower limb oedema Pitting lower limb oedema: - Cardiac : Heart failure, constrictive pericarditis - Hepatic: Liver cirrhosis causinghypoalbuminaemia. - Renal:Nephrotic syndrome causing hypoalbuminaemia. - GIT: Malabsorbtion, starvation, Protien losing enteropathies causing hypoalbuminaemia. - Drugs: Ca channel blockers - Pre-eclmpsia - Cyclical oedema Pitting unilateral lower limb edema: 1-Deep venous thrombosis. 2-Compression of large veins with tumor or lymph node. Non-pitting lower limb edema: 1-Lymphoedemacaused by a blockage of lymphatic fiow; ( due to tumors, infection, post surgery or radiation therapy, allergy,Milroys disease). 2-Hypothiroidism. Hepatomegally Infective: - Hepatitis - Infectious mononucleosis - Liver abscess - Malaria - Hydatid cyst - Amoebic infection Neoplastic: - Metastatic tumours - Hemangiomas - Hepatocellular carcinoma - Leukemia - Lymphoma - Myeloma Impaired venous outflow: - Heart failure - Constrictive pericarditis - Hepatic vein thrombosis - Inferior vena cava obstruction Biliary obstruction/cholestatic diseases: - Primary biliary cirrhosis - Biliary atresia Drugs and toxins: - Drugs - Alcoholism - Poisoning Others: - Hemolytic anemia - Fatty infiltration - Autoimmune hepatitis - Hemochromatosis - Wilson disease - Glycogen storage disorders - Alpha-1 antitrypsin deficiency - Polycystic liver disease - Riedel's lobe - Amyloidosis - Sarcoidosis. - Acute fatty liver disease of pregnancy - Porphyria. Done by: DR. Mahdi Qadi