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Differential Diagnosis in Surgery
Mahmoud Sakr
CHAPTER 1:
Differential Diagnosis of Swellings
1. SWELLINGS OF THE SCALP
I. CONGENITAL SWELLINGS
Meningocele/Encephalocele
Inclusion Dermoid Cyst (Sequestration Dermoid)
Differences between Dermoid Cyst and Sebaceous Cyst
Circoid Aneurysm
II. ACQUIRED SWELLINGS
A. Traumatic
Difference between Subperiosteal Hematoma and Depressed Fracture
B. Inflammatory
C. Sebaceous Cyst
D. Neoplastic
E. Pott's Puffy Tumor
2. SWELLINGS OF THE FACE
I. DIFFUSE SWELLINGS
A. Acute Diffuse Swellings
B. Chronic Diffuse Swellings
II. LOCALIZED SWELLINGS
A. Cystic Swellings
B. Solid Swellings
3. SWELLINGS OF THE LIPS
SURGICAL ANATOMY
LOCALIZED SWELLINGS
1. Mucus Retention Cyst
2. Minor Salivary Gland Tumors (Look Later)
3. Hemangioma
4. Lymphangioma
5. Papilloma
4. SWELLINGS OF THE TONGUE
CAUSES OF ACUTE SWELLINGS OF THE TONGUE
CAUSES OF CHRONIC OR PERSISTENT SWELLING OF THE TONGUE
Tumors of the Tongue
5. SWELLINGS OF THE ORAL CAVITY
SWELLINGS IN THE FLOOR OF THE MOUTH
A. Cysts of the Floor of the Mouth
B. Solid Swellings of the Floor of the Mouth
SWELLINGS IN THE PALATE
A. From the Mucosa
B. Extension From
6. SWELLINGS OF THE JAW
I. EPULIDES
Definition
Fibrous Epulides
Myelomatous Epulides (Giant Cell Epulides)
Granulomatous Epulides
Carcinomatous Epulides
Sarcomatous Epulides
Epulides Associated with Pregnancy
II. ODONTOMAS
Definition
Main Types
III. TUMORS ARISING FROM THE BONE
A. INFLAMMATORY
Dental Granuloma
Alveolar (Dental) Abscess
Osteomyelitis
Cervicofacial Actinomycosis
B. NEOPLASTIC
Benign Tumors (Osteoma, Chondroma)
Paget's Disease
Hyperparathyroidism (HPT) (Generalized Osteitis Fibrosa)
Carcinoma of the Maxilla
Sarcoma of the Maxilla
Burkitt's Lymphoma
Osteoclastoma (Giant Cell Tumor)
2. Other Giant Cell Lesions
7. SWELLINGS OF SALIVARY GLANDS
I. PAROTID GLAND
Swelling in the Parotid Region
CLINICAL CLASSIFICATION
ACUTE SWELLINGS IN THE PAROTID REGION
Swellings of Salivary Origin
CHRONIC SWELLINGS IN THE PAROTID REGION
Swellings of Salivary (Parotid) Gland Origin
Differences between Pleomorphic Adenoma and Adenolymphoma (Warthin's Tumor)
Differential Diagnosis between Benign Tumors and Malignant Tumors
Swellings of Nonsalivary (Parotid) Gland Origin
II. SUBMANDIBULAR GLAND
Swellings in Submandibular Region
Submandibular Lymphadenitis
Swellings from the Oral Cavity
III. MINOR SALIVARY GLANDS
The Sublingual Salivary Gland
Swellings of Minor Salivary Glands
8. CERVICAL LYMPHADENOPATHY
CAUSES OF CERVICAL LYMPHADENOPATHY
A. Inflammatory
Differential Diagnosis between TB and Chronic Non-Specific Lymphadenitis
Differential Diagnosis between TB (Lymphadenoid Type) and Hodgkin's Disease
Differential Diagnosis between TB (Senile Type) and Metastatic (Secondary) Deposits
B. NEOPLASTIC (MALIGNANT) LYMPHADENOPATHY
C. Miscellaneous Causes of Cervical Lymphadenopathy
9. SWELLINGS OF THE THYROID GLAND
10. SWELLINGS OF MIDLINE OF THE NECK
CLASSIFICATION ACCORDING TO ANATOMICAL REGION
CLASSIFICATION ACCORDING TO CONSISTENCY
Midline Cystic Swellings of the Neck
11. SWELLINGS IN LATERAL SIDE OF THE NECK
I. SOLID SWELLINGS
Swellings of the Lower Pole of Parotid Gland
Carotid Body Tumor
Schwannoma
Sternomastoid Tumor
Cervical Rib Syndrome
Lipoma
Lymphadenopathy
II. CYSTIC SWELLINGS
Ranula (Refer Back)
Laryngocele
Pharyngeal Pouch (Diverticulum)
Pyogenic Abscess
Cold Abscess (TB Abscess)
Cystic Hygroma (Lymph Cysts, Lymphangioma)
Carotid and Subclavian Aneurysms
Pneumatocele
Sebaceous Cyst
12. SWELLINGS OF THE CHEST WALL
I. SWELLINGS FROM THE CHEST WALL
A. Cystic Swellings
B. Solid Swellings
II. SWELLINGS FROM WITHIN THE CHEST
13. SWELLINGS OF THE AXILLA
I. SWELLINGS FROM THE WALLS OF THE AXILLA
Tumors of the Skin
Swellings of the Axillary Wall
Characteristics of Aneurysm of the Axillary Artery (Figure 1.46)
II. SWELLINGS FROM CONTENTS OF THE AXILLA
Axillary Lymph Nodes
Axillary Tail of the Breast (Axillary Tail of Spence)
Accessory Breast
Lipoma in the Axilla
Cystic Hygroma
Hydradenitis Suppurativa
14. SWELLINGS OF THE BREAST
CLASSIFICATION
I. SWELLINGS OF THE WHOLE BREAST
Bilateral
Unilateral
II. SWELLINGS IN THE BREAST
A. Acute Swellings
B. Chronic Swellings
Cystic Swellings of the Breast
III. SWELLINGS PUSHING THE BREAST FORWARD
MALE BREAST DISEASES
B. Mastitis
C. Fibroadenosis
D. Fibroadenoma
E. Carcinoma
BENIGN BREAST CONDITIONS THAT MIMIC BREAST CANCER
Benign Breast Disease in Relation to later Malignancy
Benign Lesions that Mimic Breast Cancer with the Signs of Malignancy they cause
BREAST LESIONS IN CHILDREN AND ADOLESCENTS
Differences between Mammary Paget's Disease and Eczema
What are the Causes of the Following?
NIPPLE DISCHARGE
A. Normal Discharges ………. milk
B. Normal Discharges at Abnormal Times
C. Abnormal Discharges
15. ABDOMINAL MASSES
MASS IN THE RIGHT ILIAC FOSSA (RIF)
I. Parietal Swellings
II. Intra-abdominal Swellings
III. Retroperitoneal Swellings
I. PARIETAL SWELLINGS (ABSCESS POINTING IN THE RIF)
Appendicular Abscess Pointing into the RIF
Iliopsoas Cold Abscess
Iliac Abscess of Pyogenic Origin
II. INTRA-ABDOMINAL SWELLINGS
Appendicular Mass
Cancer Cecum
Hypertrophic Ileocecal TB
Ameboma
Actinomycosis
Intussusception
Crohn's Disease (Regional Ileitis)
Mesenteric Lymph Nodes
Other Causes
III. RETROPERITONEAL SWELLINGS
Iliac Lymph Nodes
Aneurysm of the External Iliac Artery
Retroperitoneal Sarcoma
Iliac Bone Swellings
THE MOST COMMON CAUSES OF A SWELLING IN THE RIF (Figure 1.64)
Investigations
MASS IN THE RIGHT HYPOCHONDRIUM
Classification
I. PARIETAL SWELLINGS
II. INTRA-ABDOMINAL SWELLINGS
A. Liver Swellings
Differential Diagnosis: Differences between Hepatoma and Secondary Tumors
B. Gallbladder Swellings
C. Kidney (Renal Swelling) and Suprarenal Gland
D. Colonic Causes
E. Gastric Causes
III. RETROPERITONEAL SWELLINGS
Investigations
MASS IN THE EPIGASTRIC REGION (FIGURE 1.68)
I. Parietal Swellings
Investigations
II. Intra-abdominal Swellings
III. Retroperiotneal Swellings
MASS IN THE UMBILICAL REGION (FIGURE 1.71)
Parietal Swellings
Investigations
Intra-abdominal Swellings
Retroperitoneal Swellings
MASS IN THE SUPRAPUBIC REGION
Parietal Swellings
Intra-abdominal Swellings
Differences between Full Bladder and Bladder Carcinoma
Differences between Pregnant Uterus, Fibroid and Ovarian Cyst
Retroperitoneal Swellings
MASS IN THE LEFT ILIAC FOSSA (LIF)
Parietal Swellings
Intra-abdominal Swellings
The main three causes of mass in the LIF
A Carcinoma in the Left Colon
RETROPERITONEAL SWELLINGS
Investigations
MASS IN THE LEFT HYPOCHONDRIUM (FIGURE 1.74)
I. Parietal Swellings
II. Intra-abdominal Swellings
Investigations
III. Retroperitoneal Swellings
MASS IN THE LUMBAR REGION
I. Parietal Swellings
II. Intra-abdominal Swellings
III. Retroperitoneal Swellings
Causes of Huge Cysts of the Abdomen
Causes of Huge Abdominal Distention (5F)
Solid Tumors
16. SWELLING IN THE GROIN
INGUINAL SWELLINGS
Groin Hernia
To Differentiate Between Inguinal and Femoral Hernia
To Differentiate Between Direct and Indirect Inguinal Hernia (Figure 1.75)
Enlarged Lymph Nodes
Abscess: Acute or Chronic
Hydrocele of the Cord or of the Hernial Sac
Retained Testis: Undescended or Ectopic
Tumors of the Cord or Round Ligament
Aneurysm of the External Iliac Artery (and Other Vascular Swellings)
FEMORAL SWELLINGS
Femoral Hernia (Reducible)
Femoral Hernia (Irreducible)
Hydrocele of the Femoral Hernial Sac
Saphena Varix
Psoas Abscess (Cold Abscess)
Femoral Artery Aneurysm
Arteriovenous Fistula
Enlarged Lymph Nodes (Cloquet)
Ectopic Testis
Femoral Neuroma (Very Rare)
Primary Tumors
INGUINAL-FEMORAL SWELLINGS
Investigations
17. INGUINOSCROTAL SWELLINGS
CAUSES
Hernia
Hydrocele
Varicocele
Differences Between Primary and Secondary Varicocele
Other Spermatic Cord Lesions
Testicular Causes
18. SCROTAL SWELLINGS
SWELLINGS AFFECTING THE SKIN
SWELLINGS OF THE CONNECTIVE TISSUE COVERINGS
Scrotal Edema
Elephantiasis Scroti
Tumors
SWELLINGS OF THE TUNICA VAGINALIS
Primary Vaginal Hydrocele
Secondary Hydrocele
Hematocele
Pyocele
Chylocele
SWELLINGS OF THE TESTICLE/EPIDIDYMIS
Cystic Swellings
Acute Solid Swellings
Chronic Solid Swellings
SWELLINGS OF THE SPERMATIC CORD (LOWER END)
Varicocele
URETHRAL CONDITIONS
Periurethral Abscess
Primary Epithelioma of the Urethra
Extravasation of Urine
Diagnostic Algorithm
19. SWELLINGS OF THE POPLITEAL FOSSA
CHRONIC CYSTIC SWELLINGS
Bursa
Morrant Baker's Cyst
Difference between Semimembranosus Bursa and Baker's Cyst
Varicosity
CHRONIC CYSTIC SWELLINGS
Aneurysm of the Popliteal Artery
Pulsating Tumors (Sarcoma)
Transmitted Pulsations
CHRONIC SOLID SWELLINGS
Swellings Not Connected with Bone
Swellings Connected with Bone
20. CYSTIC SWELLINGS OF SKIN AND SC TISSUES
SEBACEOUS CYST
INCLUSION DERMOID CYST (SEQUESTRATION DERMOID)
Differences between a Dermoid Cyst and a Sebaceous Cyst
IMPLANTATION DERMOID CYST (ACQUIRED)
GANGLION
SUBCUTANEOUS BURSA
21. SOLID SWELLINGS OF THE SKIN
CLASSIFICATION (ACKERMANN)
BENIGN TUMORS OF THE SKIN
Benign Tumors of the Skin Epidermis
Moles (Pigmented Nevi)
Benign Tumors of Skin Adnexa
Benign Tumors of the Skin Dermis
Miscellaneous Benign Skin Lesions
MALIGNANT TUMORS OF THE SKIN
Basal Cell Carcinoma (BCC)
Squamous Cell Carcinoma (SCC)
Malignant Melanoma
Mycosis Fungoides
Metastatic Carcinoma
22. SOLID SWELLINGS OF “SC” TISSUES
BENIGN TUMORS
Lipoma
Neurofibroma
Multiple Neurofibromatosis (Von Recklinghausen's Disease)
Cavernous Hemangioma
Lymphangioma
SOFT TISSUE SARCOMA (STS)
Liposarcoma
Fibrosarcoma
Malignant Fibrohistiocytic Tumors
23. BONE SWELLINGS
SWELLINGS AT THE END OF LONG BONES
Traumatic
Inflammatory
Benign Tumors
Locally Malignant Tumors
Malignant Tumors
Differences between Osteogenic Sarcoma and Osteoclastoma
Differences between Osteogenic Sarcoma and Sclerosing Osteomyelitis
Bone Cysts
Generalized Bone Disease
SWELLINGS AT THE MID-SHAFT OF LONG BONES
Diffuse Osteomyelitis or Diaphysitis
Syphilis
Ewing's Tumor
Secondaries
MULTIPLE BONE SWELLINGS
Secondaries
Multiple Myeloma (Plasma Cell Myeloma)
Multiple Exostosis
Multiple Enchondromata (Ollier Disease)
Generalized Bone Disease
Syphilis
Osteitis Fibrosa Cystica (von Recklinghausen's Disease of Bone)
CHAPTER 2:
Differential Diagnosis of Organomegaly
1. HEPATOMEGALY
ETIOLOGIC CLASSIFICATION OF HEPATOMEGALY
CLINICAL CLASSIFICATION OF HEPATOMEGALY
Characteristic of a Hepatic Swelling
Clinical Approach
CHARACTERISTIC CLINICAL FEATURES ACCORDING TO CAUSE
Liver Cirrhosis
Liver Malignancy
Amebic Liver Abscess
Hydatid Cyst
Infective Hepatitis
Congestive Heart Failure
2. SPLENOMEGALY
CAUSES OF SPLENIC ENLARGEMENT
Examination of Splenomegaly (or Splenic Swelling)—Characteristics
CHARACTERISTIC FEATURES OF COMMON CAUSES OF SPLENOMEGALY
Bilharzial Splenomegaly
Malarial Splenomegaly
Typhoid Splenomegaly
Leukemic Splenomegaly
Lymphoma
Amyloidosis
CHAPTER 3:
Differential Diagnosis of Lymphadenopathy
1. LOCALIZED LYMPH NODE ENLARGEMENT
A. INFECTIONS
Non-specific Inflammation
Specific Inflammation
B. MALIGNANCY
Early Hodgkin Disease
Metastatic Lymphadenopathy
2. GENERALIZED LYMPH NODE ENLARGEMENT
A. INFECTIONS
Infectious Mononucleosis (IMN)
Secondary TB (Due to Blood-Borne Infection)
Secondary Stage of Syphilis
B. MALIGNANCY
Advanced Stages of Hodgkin Disease
Non-Hodgkin Lymphoma (NHL)
Leukemia
OTHER CAUSES
Sarcoidosis (Boeck's Sarcoid, Benign Lympho-granulomatosis)
Connective Tissue Diseases Involving Lymph Nodes
CHAPTER 4:
Differential Diagnosis of Ulcers
1. CLASSIFICATION OF ULCERS
DEFINITION
PATHOLOGICAL CLASSIFICATION
NON-SPECIFIC ULCERS
Traumatic Ulcers
Ischemic Ulcers
Venous Ulcers
Neurogenic (Trophic) Ulcer
Tropical Ulcer
Gouty Ulcers
SPECIFIC ULCERS
Tuberculous Ulcer (TB)
Syphilitic Ulcer ($)
Soft Chancres or Soft Sores (Ducrey's)
Meleney's Ulcer
Actinomycosis
Fungus Infections
MALIGNANT ULCERS
Squamous Cell Carcinoma (Carcinomatous Ulcer)
Basal Cell Carcinoma (Rodent Ulcer)
Malignant Melanoma
Ulcerating Sarcoma or Carcinoma
2. ULCERS OF THE FACE
CLASSIFICATION
I. ULCERATING INFECTIVE LESIONS
Non-Specific Ulcers
Specific Ulcers
II. ULCERATING TUMORS
A. Basal Cell Carcinoma
B. Squamous Cell Carcinoma (Epithelioma)
C. Malignant Melanoma
D. Fungating Malignancy
3. ULCERS OF THE LIPS
CRACKED OR FISSURED LIPS
MALIGNANT ULCER
SYPHILITIC ULCER
DYSPEPTIC (APHTHOUS) ULCERS
TRAUMATIC (DENTAL) ULCERS
N.B.
4. ULCERS OF THE TONGUE
CAUSES OF TONGUE ULCERS
A. TRAUMATIC ULCERS
Dental Ulcers
Frenulum (Pertussis) Ulcer
B. INFLAMMATORY ULCERS
Herpetic Ulcers
Tuberculous Ulcers
Syphilitic Ulcers
Chronic Superficial Glossitis
Ulcers in Connection with Stomatitis (Ulcerative Stomatitis)
C. DYSPEPTIC (APHTHOUS) ULCERS
Characteristic Features
D. MALIGNANT ULCERS
Types
Epitheliomatous Ulcer
5. SCROTAL AND PENILE ULCERS
SCROTAL ULCERS
Tumors of the Scrotum
Fistulae
Syphilis of the Scrotum
Testicular Diseases
Suppurating Cysts of the Scrotum
Infected Hematocele
Irritants and Corrosives (Mustard Gas)
Behcet's Syndrome, Herpes Simplex, Candidiasis
PENILE ULCERS (SORES)
Balanitis
Herpes Genitalis
Soft Sores (Chancroids) of the Penis
Syphilitic Chancre
Granuloma Inguinale (Granuloma Venereum)
Lymphogranuloma Venereum (Lymphogranuloma Inguinale)
Gummatous Ulceration of the Penis
Tuberculous or Lupoid Ulceration of the Penis
Epithelioma
Papillomata (Venereal Warts or Condylomata Acuminata)
Injury (Bite !)
6. ULCERS OF THE LEG
CAUSES OF CHRONIC LEG ULCER
DIAGNOSTIC APPROACH
VENOUS ULCER
A. Varicose Ulcers
B. Post-phlebitic Ulcers (Post-thrombotic Ulcers = Blow Out Syndrome)
C. Carcinoma Secondary to Venous Ulcer (Marjolin Ulcer)
ARTERIAL ULCER
Characteristic Features
Differences Between Venous and Arterial Ulcers
TRAUMATIC ULCER (FOOTBALLER’S ULCER)
TUBERCULOUS ULCER
GUMMATOUS ULCER (SYPHILIS—THIRD STAGE)
MELENEY’S ULCER (MELENEY’S GANGRENE; PYODERMA GANGRENOSUM)
PARASITIC ULCER (ORIENTAL SORE—LEISHMANIASIS)
LEG ULCERS IN THE TROPICS
Yaws
Diphtheric Desert Sore
Tropical Ulcer (Chronic Phagedenic Ulcer)
NEUROPATHIC ULCERS (TROPHIC - PERFORATING ULCERS)
MALIGNANT ULCERS
Squamous Cell Carcinoma (SSC)
Basal Cell Carcinoma (BCC)
Malignant Melanoma
Fungating Tumors
LEG ULCER COMPLICATING BLOOD DISEASES
LEG ULCER IN RHEUMATOID ARTHRITIS
LEG ULCER ASSOCIATED WITH OSTEITIS DEFORMANS
ARTEFACT ULCER (FACTITIOUS ULCER; AUTOMUTILATION ULCER)
CHAPTER 5:
Differential Diagnosis of Pain
1. PAIN IN THE TONGUE
I. PAIN UNDERNEATH THE TONGUE OR DEEPER
Injury to the Fraenum Linguae
Inflamed Ranula
Calculus in the Duct of the Submandibular Salivary Gland
Foreign Body in the Tongue
Myositis of the Tongue
II. PAIN UPON THE SURFACE OF THE TONGUE
Bitten Tongue
After General Anesthetic
Injury by a Tooth or Dental Plate
Glossitis
Congenital Fissured Tongue (Scrotal Tongue)
Geographical Tongue
Smoking
Epithelioma of the Tongue
2. PAIN IN THE BREAST
PREGNANCY
MENSTRUATION
THE ONSET OF PUBERTY
LACTATION
CRACKED/INFLAMED NIPPLE
BREAST ABSCESS (Acute Suppurative Mastitis)
OTHER CAUSES OF MASTITIS
TUBERCULOSIS (TB) OF THE BREAST
OTHER INFLAMMATORY LESIONS OF THE BREAST
GALACTOCELE (MILK CYST)
FIBROCYSTIC DISEASE
ACUTE CANCER OF PREGNANCY AND LACTATION (MASTITIS CARCINOMATOSA)
AFTER EFFECTS OF A BLOW OR INJURY
LESIONS OUTSIDE THE BREAST
ANXIETY STATE
3. PAIN IN THE ABDOMEN
A. INFLAMMATION
Acute Appendicitis
Acute Cholecystitis
Diverticulitis
Acute Pancreatitis
Acute Pyelitis/Pyelonephritis
Pelvic Inflammatory Diseases (e.g. Pyosalpinx and Acute Salpingitis)
Acute Regional Ileitis (Crohn's Disease)
Acute Pneumococcal Peritonitis (Primary)
B. PERFORATION
Perforated Peptic Ulcer (PPU)
Perforated Typhoid Ulcer
C. TORSION/VOLVULUS
Volvulus of the Sigmoid
Volvulus of the Cecum
Volvulus of the Intestine
Twisted Ovarian Cyst
Torsion of Fallopian Tube, Fimbrial and Broad Ligament Cysts
D. ABDOMINAL COLIC
Renal (Ureteric) Colic
Intestinal Colic
Biliary Colic
Dysmenorrhea
E. INTESTINAL OBSTRUCTION
Main Features
Intussusception (Intrinsic Cause) (Figure 5.6)
Hernia (Extrinsic Cause)
Gallstone Ileus (Intraluminal Cause)
F. ISCHEMIA
Mesenteric Vascular Occlusion (MVO)
Omental Infarction
G. INTERNAL HEMORRHAGE
Ruptured Ectopic Pregnancy
Rupture of “Ovarian Follicle” (Mittelschmerz Pain)
Traumatic Rupture (of Spleen, Liver, or Mesenteric Tear)
Ruptured Aortic Aneurysm
H. EXTRA-ABDOMINAL DISEASE
Pleurisy and Pneumonia
Coronary Thrombosis
I. MEDICAL CAUSES
Acute Gastroenteritis
Acute Mesenteric Lymphadenitis
Generalized Medical Diseases
4. EPIGASTRIC PAIN
I. SUDDEN SEVERE EPIGASTRIC PAIN
Etiology
II. CHRONIC OR RECURRENT EPIGASTRIC PAIN
Extra-abdominal Causes
Abdominal Causes
5. PAIN IN THE UMBILICAL REGION
I. PAIN ARISING IN THE UMBILICUS
Umbilical Hernia and Paraumbilical Hernia (PUH) (Figure 5.8)
Eczema and Suppuration of the Umbilical Scar
Extension of Abdominal Lesions to the Umbilicus
II. PAIN REFERRED TO THE UMBILICUS
A. Pain Arising in the Area Supplied by Visceral Nerves
B. Pain Arising in the Spinal Nerves and Spinal Cord
6. CHRONIC BACK PAIN
ACUTE BACK PAIN
CHRONIC BACK PAIN
Traumatic, Mechanical or Degenerative
Metabolic
Unknown Causes
Infective Conditions of Bone, Joint and Theca of Spine
Neoplastic: Benign or Malignant (Primary or Secondary)
Cardiac and Vascular
Gynecological Conditions
Gastrointestinal Conditions
Renal and Genitourinary Causes
Blood Disorders
Drugs
Psychogenic
7. PAIN IN THE PERINEUM
ANAL AND PERIANAL CONDITIONS
Anal Fissure
Perianal Hematoma
Perianal Abscess
Complicated Piles
Perianal Fistula
Anal Carcinoma
Proctalgia Fugax
Pruritis Ani
8. PAIN IN THE TESTICLE
I. DISEASES OF BODY OF TESTIS OR EPIDIDYMIS
A. Inflammatory Lesions
B. Malignant Tumors of the Testis
C. Torsion of the Testis
D. Cysts of the Testis
II. DISEASES OF COVERINGS OF THE TESTIS
Hydrocele
Hematocele
Pyocele
III. DISEASES OF THE SPERMATIC CORD
IV. RETAINED OR MISPLACED (ECTOPIC) TESTIS
V. TESTICULAR PAIN FROM EXTRA-TESTICULAR LESIONS
9. PAIN IN THE PENIS
I. CAUSES OF PAIN IN THE PENIS DURING MICTURITION
Diseases of Urethra
Diseases of the Prostate
Diseases of the Bladder
II. PENILE PAIN FOLLOWING MICTURITION
PAIN IN THE PENIS APART FROM MICTURITION
A. Local Lesions of the Penis and Urethra
B. Pain Referred from Disease Elsewhere
10. PAIN IN THE LOWER LIMBS
I. SCIATICA
Affections of Nerve-Roots, Lumbosacral Plexus and Sciatic Nerve
Extraneural Causes
II. PAIN IN THE FRONT AND SIDES OF THE THIGH
A. Pain Down the Front of the Thigh to the Knee
B. Obturator Pain
C. Meralgia Paresthetica
III. PAIN IN THE FOOT
A. Local Disease or Abnormality
B. Referred Pain
IV. TABES DORSALIS
V. VASCULAR CAUSES
Acute Ischemia
Chronic Ischemia
Deep Vein Thrombosis
11. PAIN IN THE UPPER LIMBS
I. LOCAL CAUSES
Trauma
Inflammation
Bone Tumors
Vascular Causes
Orthopedic Causes
II. REFERRED PAIN
Lesions in the Cervical Spine and Cord
Lesions of the Brachial Plexus
Pain Referred from Viscera
Pain Referred from Extraneural Lesions
CHAPTER 6:
Differential Diagnosis of Dyspepsia
DYSPEPSIA
I. SIMULATION OF SYMPTOMS OF DYSPEPSIA BY OTHER CONDITIONS
The Vomiting of Pregnancy
Cerebral Vomiting
Uremia
Pulmonary TB
Gastric Crises of Tabes (Syphilis)
Chronic Intestinal Obstruction (Cancer Colon)
Cholecystitis
Recurrent Appendicitis
Angina Pectoris
Chronic Bronchitis
Migraine
Acute Glaucoma
Extra-abdominal Causes of Pain
Nervous or Hysterical Vomiting
Eructio Nervosa
Porphyria
II. ORGANIC VERSUS FUNCTIONAL DYSPEPSIA
III. CAUSES OF ORGANIC DYSPEPSIA
Carcinoma
Gastric Ulcer
Gastritis
Gastric Dilatation
Hiatal Hernia
IV. CAUSES OF FUNCTIONAL DYSPEPSIA
Dietetic Causes
Physical Causes and Bad Habits
Mental Causes
Emotional Causes
CHAPTER 7:
Differential Diagnosis of Dysphagia
DYSPHAGIA
FUNCTIONAL GRADES OF DYSPHAGIA
CAUSES OF DYSPHAGIA
Causes at the Oral Level (Mouth and Tongue)
Causes at the Pharyngeal Level (Larynx and Pharynx)
Causes at the Esophageal Level
DIFFERENTIAL DIAGNOSIS
I. MECHANICAL OBSTRUCTION TO THE ESOPHAGUS
Carcinoma of the Esophagus
Corrosive Stricture
Congenital Stricture of Esophagus
Hiatal Hernia (Causing Peptic Esophagitis)
Aortic Aneurysm (Compressing the Esophagus)
Pharyngeal Pouch (Diverticulum)
Carcinoma of the Thyroid Gland
Dysphagia Lusuria
Impacted Foreign Bodies
II. DYSPHAGIA DUE TO NERVOUS CAUSES
Achalasia of the Cardia
Plummer-Vinson Syndrome
Post-diphtheritic Dysphagia
Globus Hystericus
Bulbar Paralysis
Syphilitic Degeneration
Lead Poisoning and Alcoholism
Rabies
Tetanus
Acute Encephalitis Lethargica
Botulism (Poisoning by the Bacillus botulinus)
Myasthenia Gravis
III. MECHANICAL DEFECTS OF MOUTH AND PHARYNX
IV. PAIN - BUT NO MECHANICAL OBSTRUCTION
Inflammatory Affections of the Mouth or Tongue
Laryngeal Diseases
CHAPTER 8:
Differential Diagnosis of Constipation
CONSTIPATION
DEFINITION
Objectively
Subjectively
COMMON COMPLICATIONS OF CONSTIPATION
PATHOPHYSIOLOGY
Abnormalities of Colonic Motility
Colonic Absorption
ETIOLOGY
Drug-induced Constipation
Metabolic and Endocrine Disorders
Systemic Disorders
Neurogenic Constipation
Constipation due to Bowel Disorders
EVALUATION OF PATIENTS WITH SEVERE CHRONIC CONSTIPATION
PERTINENT QUESTIONS THAT MAY AID IN DIAGNOSIS OF CONSTIPATION
INDIVIDUAL CAUSES OF CONSTIPATION
Not Enough Fiber in the Diet
Not Enough Liquids
Lack of Exercise
Irritable Bowel Syndrome (IBS)
Medications
Change in Life or Routine
Abuse of Laxatives
Ignoring the Urge to have a Bowel Movement
Hirschsprung's Disease
Mechanical Causes
Fecal Impaction
CHAPTER 9:
Differential Diagnosis of Jaundice
JAUNDICE
I. UNCONJUGATED HYPERBILIRUBINEMIA— PREHEPATIC (HEMOLYTIC)
Etiology
Diagnosis
II. UNCONJUGATED HYPERBILIRUBINEMIA—HEPATIC
Etiology
III. CONJUGATED HYPERBILIRUBINEMIA—HEPATIC
Jaundice due to Acute Hepatocellular Damage
Jaundice due to Chronic Hepatocellular Damage
Jaundice due to Intrahepatic Cholestasis
Differences between Intrahepatic and Extrahepatic Obstruction
IV. CONJUGATED HYPERBILIRUBINEMIA—POSTHEPATIC SURGICAL JAUNDICE
Etiology
Clinical Picture
CALCULAR OBSTRUCTIVE JAUNDICE
Clinical Picture
Courvoisier's Law
MALIGNANT OBSTRUCTIVE JAUNDICE
Etiology
Clinical Picture
Investigations
Differences between Calcular and Malignant Obstructive Jaundice
Differences between Different Types of Jaundice
Diagnosis of Jaundice
POSTOPERATIVE JAUNDICE
Definition
Etiology
Clinical Picture
Investigations
Algorithm for Diagnosis
CHAPTER 10:
Differential Diagnosis of Bleeding
1. HEMATEMESIS
CAUSES OF HEMATEMESIS
SWALLOWED BLOOD
Epistaxis
Hemoptysis
Bleeding from the Mouth and Throat
Malingering
DISEASES OF THE ESOPHAGUS
Esophageal Varices
Reflux Esophagitis (Hiatal Hernia)—Esophageal Ulcer
Esophageal Carcinoma (Epithelioma)
An Aneurysm of the Thoracic Aorta
Rupture or Laceration of the Esophageal Wall (Mallory-Weiss Syndrome)
Mediastinal Tumor Perforating the Esophagus and Aorta
Foreign Body Perforating the Esophagus and Aorta
DISEASES OF THE STOMACH
Gastric Ulcer
Acute Gastritis
Chronic Gastritis
Drug-induced Gastritis
Hemorrhagic Erosions
Gastric Carcinoma
Leiomyosarcoma
Hemangioma
Injuries
Abdominal Aneurysm Opening into the Stomach
DISEASES OF THE DUODENUM
Duodenal Ulcer
Duodenal Diverticulum
Duodenal Carcinoma
Gallstones Ulcerating through the Gallbladder into the Duodenum
PORTAL OBSTRUCTION
Liver Cirrhosis
Portal Vein Thrombosis or Compression
BLOOD DISEASES
Purpura Hemorrhagica
Scurvy
Hemophilia and Allied Disorders
Leukemia
Hodgkin's Disease
Malarial Cachexia
ACUTE FEBRILE DISEASES
Malignant Variola
Malignant Scarlet Fever
Malignant (Black) Measles
Yellow Fever
Cholera
Acute Massive Liver Necrosis
Leptospirosis
MISCELLANEOUS DISEASES
Chronic Nephritis
Following Abdominal Operations
Prolonged Jaundice
Sea-Sickness - Airplane Sickness
Injury to the Epigastrium
2. MELENA
DEFINITION
CAUSES (SOURCE)
Lesions Lower Down (Distal to Duodenum)
Blood Dyscrasias
OTHER CAUSES OF BLACK STOOLS
3. BLEEDING PER RECTUM
DEFINITION
The passage of blood per anus may be
Causes (Sources)
FRANK RED BLOOD PASSED PER ANUS
Malignant Disease of the Rectum and Colon
Polyps of the Rectum and Colon
Non-malignant Ulceration
PASSAGE OF BLOOD PER ANUS IN A CHILD
Acute Intussusception
Prolapse of the Anal Mucosa
4. HEMATURIA
DEFINITIONS
PATHOGENESIS OF HEMATURIA
OTHER CAUSES OF RED COLORATION OF URINE
CAUSES OF HEMATURIA
Hematuria from Affection of Some Part of the Urinary Tract (Figure 10.2)
HEMATURIA FROM NEIGHBORING VISCERA INVOLVING THE URINARY TRACT
Carcinoma of the Uterus, Vagina or Colon
Acute Appendicitis
Acute Salpingitis
Pelvic Abscess
Dysenteric or TB Ulceration of the Intestine
Diverticulitis of the Colon
HEMATURIA IN GENERAL DISEASE
GENERAL CAUSES OF HEMATURIA
Diagnosis of Hematuria
DIFFERENTIAL DIAGNOSIS OF HEMATURIA - CLINICAL KEY POINTS
History-Taking
Clinical Examination
Investigations
5. MENORRHAGIA
DEFINITIONS
DIAGNOSIS
CAUSES OF MENORRHAGIA
6. HEMOPTYSIS
DEFINITIONS
SOURCES OF HEMOPTYSIS
CHAPTER 11:
Differential Diagnosis of Urinary Retention
URINARY RETENTION
DEFINITIONS
ACUTE URINARY RETENTION
Causes
Differential Diagnosis
CHRONIC URINARY RETENTION
Clinical Features
Investigations
CHAPTER 12:
Differential Diagnosis of Swollen Limb
SWOLLEN LIMB
DIFFERENTIAL DIAGNOSIS
Differences between Venous, Lymphatic and A-V Fistula as Causes of Swollen Leg
HISTORY TAKING
Personal Data
Complaints
Present History
Past History
Family History
CLINICAL EXAMINATION
General Examination
Local Examination of the Swollen Limb
SPECIAL INVESTIGATIONS
Laboratory Tests
Biopsy
Non-invasive Radiological Tests
Invasive Investigations
CHAPTER 13:
Differential Diagnosis of Gangrene
GANGRENE
DEFINITION
CARDINAL SIGNS OF GANGRENE
TYPES OF GANGRENE
CLASSIFICATION OF GANGRENE ACCORDING TO ETIOLOGY
CAUSES OF GANGRENE
CARDIOVASCULAR GANGRENE
Thrombotic Gangrene
Differences between Atherosclerosis and Buerger's Disease
Embolic Gangrene
Raynaud's Disease and Phenomenon
Clinical Picture
Clinical Examination
Investigations
NEUROPATHIC GANGRENE
Leprosy
Syringomyelia
TRAUMATIC GANGRENE
Direct Trauma
Indirect Trauma
Physico-Chemical Gangrene
INFECTIVE GANGRENE
Specific Infection
Non-specific Infection
CHAPTER 14:
Differential Diagnosis of Testicular Atrophy and Impotence
1. TESTICULAR ATROPHY
DEFINITION
CAUSES OF ATROPHY OF A NORMALLY SITUATED TESTIS
Interference with the Blood Supply
Atrophy after Orchitis or Epididymitis, Due to
Disturbance of the Endocrine System
2. IMPOTENCE
DEFINITIONS
Impotence
Sterility
Premature Ejaculation (Ejaculatio Praecox)
TEMPORARY IMPOTENCE
CAUSES OF IMPOTENCE
Impotence Secondary to Physical Abnormality
Primary Impotence (Abnormal Psychological Influences)
CHAPTER 15:
Differential Diagnosis of Gynecomastia
GYNECOMASTIA
DEFINITIONS
Gynecomastia
Pseudogynecomastia
CAUSES OF GYNECOMASTIA
PHYSIOLOGICAL GYNECOMASTIA
Neonatal Gynecomastia
Pubertal Gynecomastia
Involutional (Senescent) Gynecomastia
PATHOLOGICAL GYNECOMASTIA
Endocrine Causes
Klinefelter's Syndrome
Diseases of the Central Nervous System
Diseases of the Respiratory System
Drugs
Bibliography
INDEX
TOC
Index
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