Misdiagnosis of Vomiting
Misdiagnosis and Vomiting
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.
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.
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.
Acute mesenteric ischemia: Acute mesenteric ischemia is a condition which occurs due to the occlusion of the mesenteric vessels by an emboli or thrombus.It is not easily diagnosed by the doctor and can be missed easily as the symptoms are vague and non-specific and hence the diagnosis is poor.It usually occurs in patients who are 50 years of age,younger patients with history of atrial fibrillation,women on oral contraceptive pills and other hypercoaguble states.The clinical presentation is that of abrupt onset of moderate to severe diffuse abdominal pain(abdominal angina)following a meal along with anorexia,nausea,vomiting.Angiography is the investigation of choice in this condition.Recognition of the case before permanent tissue damage is the key to patient survival in these cases.
Not always a case of appendicitis: Pain in the right lower quadrant of the abdomen leads to numerous differential diagnoses in the mind of the doctor.Not all cases of right sided abdominal pain are acute appendicitis.Misdiagnosis of an acute appendicitis leads to unnecessary surgery. A good clinical history must be taken to rule out various other conditions such as gastroenteritis,right renal colic,biliary colic,Meckel's diverticulum etc. Some of the symptoms that need to be looked into include moderate to severe abdominal pain,fever,nausea and vomiting.The intensity and nature of pain must be assessed along with the presence of fever .Fever maybe unlikely in a case of renal colic unless associated with infection.Accurate judgement can be made using investigative modalities such as CT scan and ultrasound.
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.
Toxic shock syndrome in women: Toxic shock syndrome is a toxin mediated
multisysyem disease precipitated by infection with staphylococcus aureus or
either group A streptococcus. It commonly occurs in women who use tampons. It
is characterised by a rapid onset of high fever, hypotension, rash, myalgia and
vomiting. Mortality is high. Quick recognition of the syndrome is important for
enabling appropriate and prompt treatment. Patients who do recover from the
syndrome are at a risk of developing recurrent episodes. It must be
differentiated from cellulitis, gas gangrene, pneumonia, septic shock etc.
Immediate care in extradural haematoma: Extradural haematoma
is a surgical emergency because it can lead to death if the clot is not removed
promptly. It usually occurs following a head injury that has resulted in only a
transient loss of consciousness. A deteriorating conscious state is the most
important neurological sign when it develops after the lucid interval. It is
important to know that the drowsiness that occurs in a patient after a head
injury is not misinterpreted as the patient just wishing to sleep. If treated
early, prognosis usually is excellent, because the underlying brain injury
generally is limited. Urgent craniotomy with evacuation of the clot is the
ideal treatment.
Thunderclap headache in SAH: Advances in the management of SAH have resulted in a
relative reduction in mortality rate which depends upon early diagnosis and
ability to differentiate subarchnoid haemorrhage from cluster headache,
migraine, hypertensive headaches, stroke and transient ischemic attacks.
However, more than one third of survivors have major neurologic deficits. Cognitive
deficits are present, even in many patients considered to have a good outcome. Some
of the factors which affect the outcome include age and overall health of the
patient, location of the bleed, occurrence of rebleed and degree of vasospasm.
Differentiate bulimia from psychoneurotic disorders: Bulimia is
episodic secretive binge eating followed by self induced vomiting, fasting or
the use of laxatives. It comprises of two types- purging and the non- purging types.
The purging type is the most life threatening behaviour because of the danger
of hypokalemia. It commonly occurs in young females and is associated with
other psychoneurotic disorders, fluctuating body weight and irregular periods. It
must be differentiated from personality disorders, obsessive compulsive
disorder, anxiety disorder and substance abuse. Early detection and intervention are essential to redue the risk of chronicity.
Torsion of testis: medical emergency - Torsion of the testis is a medical emergency which occurs in
young boys of age group 5- 15 years of age. It is usually sudden in onset and
is associated with severe pain, vomiting and groin pain. It must be differentiated
from acute epididymo-orchitis which occurs in young adults characterised by
moderate pain, fever and dysuria. Clinical examination will help in coming to a
diagnosis.
Subarachnoid hemorrhage mimics migraine: Subarachnoid hemorrhage occurs due to spontaneous bleeding in the
subarachnoid space. It presents with severe headache usually over the back,
vomiting, and neck stiffness and severe cases with stroke. Due to the onset
of sudden headache with vomiting it is often misdiagnosed as migraine or
tension headache and treated symptomatically with analgesics. Sometimes the symptoms
of headache, vomiting and neck stiffness favor meningitis. CT scan, lumbar
puncture, blood investigations are the required investigations. Early diagnosis
prevents mortality in these 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.
More about Misdiagnosis
» Next page: HEMATEMESIS (Algorithmic Diagnosis of Symptoms and Signs)
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