Misdiagnosis of Abdominal pain
Misdiagnosis and Abdominal pain
Undiagnosed acute appendicitis deadly in children: It is a sad reality that a child with acute appendicitis
has a high likelihood of misdiagnosis.
This misdiagnosis is a well-known cause of death, and indeed of malpractice lawsuits, in the medical industry.
That it is often overlooks is somewhat understandable.
Compared to other causes of abdominal pain, it is less common than simple explanations like gastroenteritis
or food poisoning.
The hallmark symptom of appendicitis, abominal pain located right at the navel, is also the way that
young children report almost any type of abdominal discomfort.
See the introduction to appendicitis and misdiagnosis of appendicitis.
Chronic digestive conditions often misdiagnosed: When diagnosing chronic symptoms
of the digestive tract, there are a variety of conditions that may be misdiagnosed.
The best known, irritable bowel syndrome, is over-diagnosed, whereas other
causes that are less known may be overlooked or misdiagnosed: celiac disease,
Crohn's disease, ulcerative colitis (both are called inflammatory bowel disease (IBD)),
diabetic gastroparesis, diabetic diarrhea.
Other possibilities include giardia, colon cancer, or other chronic infections.
Intestinal bacteria disorder may be hidden cause: One of the lesser known causes of diarrhea
is an imbalance of bacterial in the gut, sometimes called intestinal imbalance.
The digestive system contains a variety of "good" bacteria that aid digestion,
and they can decline for various reasons,
leading to digestive symptoms such as diarrhea.
The main treatment is to eat foods containing probiotics, typically yoghurt cultures.
See intestinal imbalance and probiotics.
Antibiotics often causes diarrhea: The use of antibiotics are very likely
to cause some level of diarrhea in patients.
The reason is that antibiotics kill off not only "bad" bacteria,
but can also kill the "good" bacteria in the gut.
This leads to "digestive imbalance" where there are too few remaining "good"
bacteria in the digestive system.
The treatment is typically to use "probiotics", such as by eating yoghurt cultures
containing more of the good bacteria.
See digestive imbalance and probiotics.
Food poisoning may actually be an infectious disease: Many people who come down
with "stomach symptoms" like diarrhea assume that it's "something I ate" (i.e. food poisoning).
In fact, it's more likely to be an infectious diarrheal illness (i.e. infectious diarrhea), that has been caught
from another person.
Such conditions may be transmitted via the fecal-oral route.
Mesenteric adenitis misdiagnosed as appendicitis in children: Because appendicitis is one of the
more feared conditions for a child with abdominal pain, it can be over-diagnosed
(it can, of course, also fail to be diagnosed with fatal effect).
One of the most common misdiagnosed is for children with mesenteric adenitis
to be misdiagnosed as appendicitis.
Fortunately, thus misdiagnosis is usually less serious than the reverse failure to diagnose appendicitis.
Leg cramps at night a classic sign: The symptom of having leg muscle cramps,
particularly at night, is a classic sign of undiagnosed diabetes.
However, there are also various other causes.
See causes of leg cramps or misdiagnosis of diabetes.
Celiac disease often fails to be diagnosed cause of chronic digestive symptoms: One of the most common chronic digestive
conditions is celiac disease, a malabsorption disorder with a variety of symptoms (see symptoms of
celiac disease). A variety of other chronic digestive disorders tend to be diagnosed
rather than this condition.
See introduction to celiac disease or misdiagnosis of celiac disease.
Hypertension misdiagnosis common in children: Hypertension is often
misdiagnosed in adults (see misdiagnosis of hypertension), but its misdiagnosis is even more likely in children.
Some of the symptoms of hypertension that can be overlooked include chest pain, headaches, abdominal pain, etc.
See symptoms of hypertension or misdiagnosis of hypertension.
Vitamin B12 deficiency under-diagnosed: The condition of Vitamin B12 deficiency
is a possible misdiagnosis of various conditions, such as multiple sclerosis (see symptoms of multiple sclerosis).
See symptoms of Vitamin B12 deficiency or misdiagnosis of multiple sclerosis.
Chronic digestive diseases hard to diagnose: There is an inherent
difficulty in diagnosing the various types of chronic digestive diseases.
Some of the better known possibilities are peptic ulcer, colon cancer, irritable bowel syndrome, or GERD.
Other sometimes overlooked possibilities include Crohn's disease, ulcerative colitis, chronic appendicitis,
Celiac disease, Carcinoid syndrome, gastroparesis, and others. See all types of chronic digestive diseases.
Pancreatic cancer often diagnosed too late: Pancreatic cancer has the reputation of being one of the "worst" cancers, because its prognosis is often poor due to delayed diagnosis. Early stage pancreatic cancer has no symptoms or mild symptoms. The onset of symptoms such as abdominal pain or jaundice is often a sign of late pancreatic cancer. Thus, failure to diagnose the condition due to its inherent nature makes pancreatic cancer misdiagnosis a fatal problem.
Pelvic inflammtory disease due to STD's: Pelvic inflammory disease is a general term to describe an inflammation of the uterus and fallopian tubes. It occurs as a serious complication due to sexually transmitted diseases like chlamydia and gonorrhea and occurs commonly in women of child bearing age. It can lead to serious consequences like infertilty and ectopic pregnancy.A woman can present with very vague symptoms such as mild abdominal pain,fever,unusual vaginal discharge and painful urination.The condition may be mistaken for urinary tract infection. Careful clinical assessment along with investigations like an ultrasound are helpful in coming to a prompt diagnosis.Test to identify the organisms leading to PID must also be done so that the correct antibiotics can be delivered.
Meckel's diverticulum: Meckel's diverticulum is one of the major causes of lower gastrointestinal bleeding in children.Meckel's diverticulum is a remnant of the omphalomesenteric duct and the condition occurs in children,young adults as well as in the elderly and is commonly mistaken as a case of acute appendicitis.It can present with acute pain abdomen,rectal bleeding,nausea and vomiting.The condition must be identified by the clinician as it is associated with some serious complications such as bleeding due to the presence of ectopic gastric mucosa,diverticulitis,umbilical discharge,perforation,torsion and peritonitis.The clinician may find it difficult to diagnose a case of Meckel's diverticulum especially in an elderly individual due to lack of specificity.
Ectopic pregnancy can be life threatening: Ectopic pregnancy is one of the leading
causes of death in the 1st trimester. Physicians must not depend only on
the physical symptoms alone and an ultrasound must be done in a female patient
of child bearing age presenting with acute abdominal pain, vaginal bleeding.
Due to the acute onset of pain it may be misdiagnosed as renal colic, acute
appendicitis or ovarian torsion. Early diagnosis can save the patients life.
Budd Chiari syndrome prognosis poor if untreated: Budd Chiari syndrome is an uncommon condition
which occurs in individuals in the 3rd or 4th decade due
to obstruction to the venous outflow in the hepatic vein. Patients present with
ascites, abdominal pain more so in the right upper quadrant along with jaundice.
Most of the patients have an underlying thrombotic pathology which leads to the
obstruction. It must be distinguished from other conditions which present with
similar symptoms of jaundice and upper abdominal pain. A thorough abdominal work
up is needed so as to rule out other causes such as liver abscess, liver
cirrhosis, liver metastasis and right heart failure. Prognosis is poor in cases
where the cause of the obstruction is not determined and if life long anticoagulation is not provided. Younger patients have a
better prognosis.
Rash with abdominal pain can be HSP: Henoch Schonlein purpura is a common
vasculitis condition in children. It classically presents with purpura, abdominal
pain and arthritis. The presentation usually follows a respiratory tract
infection. It must be differentiated from varicella, renal failure,
gastroenteritis, systemic lupus erythematosus and rheumatoid arthritis. HSP can involve nearly every organ system. Most of the patients have at least one recurrence. Young
patients (<3 y) usually have an improved prognosis. The prognosis is best
for patients with minimal or no renal involvement at the onset of the illness.>
Abdominal pain in the elderly: Abdominal pain in the elderly could be due to a wide range
of diseases. The most common ones that have to be kept in mind in order not to
miss the diagnosis include ischemic events, emboli, cancers and diverticula. Ischemic
events such as rupture of an abdominal aortic aneurysm, mesenteric ischemia
must be diagnosed as soon as possible as these conditions are medical
emergencies if missed out can prove to be fatal. Other conditions include perforated
peptic ulcer, biliary disorders, diverticulitis, strangulated hernia and
carcinoma of the colon.
Addison's disease has a good prognosis: Addison’s disease when treated
with adequate replacement therapy has a good prognosis and life expectancy
approximates normal. Lifelong medical supervision is required for signs of
continued adequate therapy and avoidance of overdose and avoidance of
complications such as hyperpyrexia, Addisonian crisis, psychotic reactions and
hyperkalemic paralysis. It must be differentiated from conditions such as
pituitary stalk resection, withdrawal from long term use of steroids, Sheehan’s
syndrome and trauma.
Typhoid fever: Typhoid fever is caused by salmonella typhi and can be a
severe infection. A detailed history of the nature of the fever, duration,
spikes, aggravating and relieving factors must be asked for. Blood culture
remains the main investigative modality. The nature of the fever is similar to
that of several other conditions such as brucellosis, malaria, respiratory
tract infection, malaria, endocarditis, typhus and liver amoebiasis, hence
chances of misdiagnosing typhoid fever are present. However prognosis for
recovery is good for most patients.
Kawasaki's disease can be misdiagnosed as common childhood ailments: Kawasaki’s disease is a febrile disorder affecting children
below 5 years. It affects mainly the blood vessels but can also affect
the mucous membrane, lymph nodes and skin. Kawasaki's disease is
a self limiting condition but early diagnosis and treatment prevents the
development of fatal complications. Since there are no specific tests
to diagnose Kawasaki's disease, diagnosis is made by exclusion
of other common childhood conditions which have similar symptoms.
It can be misdiagnosed as Scarlet Fever, Measles, Stevens Johnson Syndrome,
Juvenile Rheumatoid Arthritis, Toxic Shock Syndrome. A diagnosis of Kawasaki's
Disease can be made if the fever lasts for five or more days and the child has
accompanying signs and symptoms.
Unusual case of Pseudomyxoma peritonei: Pseudomyxoma peritonei is a locally malignant unusual disease commonly seen in females which
is caused by a low -grade mucinous cystadenocarcinoma of the appendix
or ovary that secretes large amounts of mucus containing epithelial
cells. In most cases the site of origin is the appendix with secondary
implantation in one or both the ovaries. In this condition there is
diffuse collection of gelatinous fluid in the peritoneal cavity
associated with mucinous implants on the surface of the peritoneum and
omentum.There is no lymph node or extraperitoneal metastasis.
Psudomyxoma is often asymptomatic until very late in its course with
the patient often experiencing overall deterioration of health long
before the diagnosis is made. The symptoms are non specific and include
abdominal pain and abdominal distention. Occasionally a palpable mass
may be present. It is usually confused with loculated ascites and
ovarian carcinoma. It can be investigated using US and CT scan. The
treatment consists of thorough surgical debulking along with adjuvant
intraperitoneal chemotherapy. Appendicectomy is routinely performed
along with Bilateral salpingo-oopherectomy in females.
Cystic hydatid disease a parasitic infestation: Cystic hydatid disease is a parasitic infestation caused by the larval/
cyst stage of the Tapeworm ( Echinococcus granulosus) . Dog is the
definitive host of this parasite, sheep are the usual intermediate
host but humans are accidental intermediate hosts. The organs commonly
infested by this parasite are the liver and the lung. Usually the cysts
are single and involve the right lobe of the liver. It should be
differentiated from other hepatic cysts, liver abcess, biliary
obstruction, lung abcess, etc. Ultrasound and CT scan can diagnose the
cystic lesion, serodiagnostic assay (ELISA) is helpful in 85% of
patients. The treatment consists of PAIR (percutaneous aspiration,
infusion of scolicidal agents and reaspiration) for anatomically and
surgically appropriate lesions. Surgery remains the treatment of choice
for cysts where PAIR is not possible.
More about Misdiagnosis
» Next page: FLANK PAIN (Algorithmic Diagnosis of Symptoms and Signs)
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