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A 16-year-old girl presents to emergency care with perianal pain

16 years old | Female

Vignette:

A 16-year-old girl presents to emergency care with perianal pain and discharge. She reports a 2-year history of intermittent bloody diarrhea with nocturnal symptoms. On examination, she is apyrexial with normal vital signs. Her abdomen is soft and slightly tender on palpation in the left lower quadrant. Rectal examination is difficult to perform due to pain, but an area of erythematous swelling is visible close to the anal margin, discharging watery pus from its apex. Several anal tags are also present.

Summary:

perianal pain | perianal discharge | 2-year history | intermittent diarrhea | bloody diarrhea | nocturnal symptoms | left lower quadrant tenderness | perianal erythematous swelling | discharging watery pus | Several anal tags

Dx:

Crohn disease Inflammatory Bowel Diseases

Ref:

https://online.epocrates.com/diseases/4222/Crohn-disease/Common-Vignette

Rank

Disease

Weight

1 Intestinal Entamoeba histolytica amebiasis 195.0
2 Ulcerative Colitis 141.0
3 Hemolytic uremic syndrome 129.0
4 Mesenteric ischemia 127.0
5 mucosal Eosinophilic gastroenteritis 120.0
6 Anal Fissure 114.0
7 Bacterial gastroenteritis 112.0
8 Muscle Layer Eosinophilic gastroenteritis 106.0
9 subserosal eosinophilic gastroenteritis 106.0
10 Diverticulitis 103.0
11 Salmonella infection 96.0
12 Non-cholera Vibrio infections 96.0
13 Foodborne E coli infection 93.0
14 Graves Disease 92.0
15 Crohn Disease 90.0
16 Listerial gastroenteritis 90.0
17 Gastrointestinal Hemorrhage 89.0
18 Lower gastrointestinal hemorrhage 89.0
19 Upper gastrointestinal hemorrhage 89.0
20 Intestinal Pseudo Obstruction 88.0
21 Viral Gastroenteritis 87.0
22 Peritoneal dialysis associated peritonitis 86.0
23 Eosinophilic gastroenteritis 81.0
24 Giardiasis 80.0
25 Extraintestinal Entamoeba histolytica amebiasis 79.0
26 Abetalipoproteinemia 78.0
27 Hemorrhoids 77.0
28 Lactose intolerance 76.0
29 Shigellosis 76.0
30 Toxic Megacolon 73.0
31 Acute perforated appendicitis 73.0
32 Ruptured Tuboovarian abscess 73.0
33 Kawasaki disease 72.0
34 Campylobacter infection 72.0
35 Anal Cancer 71.0
36 Gastroenteritis 71.0
37 Type 1 Diabetes mellitus 69.0
38 Irritable Bowel Syndrome 68.0
39 Type 2 Diabetes mellitus 67.0
40 Cholera 66.0
41 Thrombotic thrombocytopenic purpura 65.0
42 Primary sclerosing cholangitis 63.0
43 Secondary Peritonitis 63.0
44 Duodenal Ulcer 62.0
45 Gastric Ulcer 62.0
46 Familial Mediterranean fever 62.0
47 Celiac Disease 60.0
48 Anaphylaxis 60.0
49 Diabetic Amyotrophy 60.0
50 Pheochromocytoma 60.0
51 Anthrax 60.0
52 Klebsiella pneumoniae liver abscess 56.0
53 Hyperthyroidism 56.0
54 Malaria 56.0
55 Brucellosis 56.0
56 Acute Appendicitis 55.0
57 Graves ophthalmopathy 55.0
58 Splenic abscess 55.0
59 Malt lymphoma 54.0
60 Intestinal malrotation 52.0
61 Autosomal Dominant Polycystic Kidney Disease 51.0
62 Systemic sclerosis 51.0
63 pancreatic cancer 50.0
64 Addison Disease 50.0
65 Polyarteritis nodosa 50.0
66 Choledochal Cyst 50.0
67 Zollinger-Ellison Syndrome 49.0
68 Hereditary Angioedema 49.0
69 Amebiasis 49.0
70 Food poisoning 49.0
71 Short bowel syndrome 49.0
72 Hypogammaglobulinemia 49.0
73 Splenic Infarction 49.0
74 Diabetes Mellitus 48.0
75 Rumination Syndrome 46.0
76 Spontaneous bacterial peritonitis 46.0
77 Sarcoidosis 46.0
78 Sigmoid volvulus 45.0
79 Acute bacterial meningitis in children 44.0
80 STI HIV Pharyngitis 43.0
81 Systemic lupus erythematosus 43.0
82 Exocrine pancreatic insufficiency 43.0
83 Acute viral meningitis 43.0
84 Chronic pelvic pain in women 43.0
85 Acute otitis media 41.0
86 Intra-abdominal abscess 41.0
87 Chronic Myeloid Leukemia 41.0
88 Stevens-Johnson syndrome 41.0
89 Aseptic meningitis 41.0
90 Alcoholic hepatitis 40.0
91 Alcoholic Fatty Liver 40.0
92 Pelvic inflammatory disease 40.0
93 Acute pelvic inflammatory disease 40.0
94 Liver Cirrhosis 39.0
95 Biliary cirrhosis 39.0
96 Primary biliary cirrhosis 39.0
97 Henoch-Schonlein purpura 39.0
98 Multiple endocrine neoplasia 2B 39.0
99 Autoimmune Pancreatitis 38.0
100 Amebic Liver Abscess 37.0
101 Medullary thyroid cancer 36.0
102 Multiple endocrine neoplasia 2A 36.0
103 Meckel diverticulum 36.0
104 Psoas Abscess 35.0
105 Travelers diarrhea 34.0
106 Foreign body ingestion 34.0
107 Epiploic appendagitis 34.0
108 Tuboovarian abscess 33.0
109 Ruptured ovarian cyst 32.0
110 Autoimmune hepatitis 31.0
111 Churg-Strauss Syndrome 31.0
112 Primary Myelofibrosis 31.0
113 Choledocholithiasis 31.0
114 Hereditary hemochromatosis 30.0
115 Pancreatic Pseudocyst 30.0
116 Diabetic Ketoacidosis 30.0
117 Intestinal Obstruction 30.0
118 Gastroparesis 30.0
119 Ovarian and fallopian tube torsion 30.0
120 Pyogenic Liver Abscess 29.0
121 Colorectal cancer 29.0
122 Acute peritonitis 29.0
123 Chronic Clonorchiasis 28.0
124 Endometriosis 28.0
125 Psoriasis 28.0
126 Familial adenomatous polyposis syndrome 28.0
127 Chronic Pancreatitis 27.0
128 Clostridium difficile infection 25.0
129 Pneumonia 24.0
130 Acute bacterial meningitis in neonates 24.0
131 Alcoholic Liver Disease 24.0
132 Ovarian Cancer 24.0
133 COVID19 23.0
134 Alopecia areata 23.0
135 Liver disease 22.0
136 Hepatocellular carcinoma 22.0
137 Endometrial cancer 22.0
138 Tinnitus 22.0
139 Atypical pneumonia 22.0
140 Achilles tendinopathy 22.0
141 Achilles tendon rupture 22.0
142 Premenstrual syndrome 21.0
143 Testicular cancer 21.0
144 Tuberculous Peritonitis 21.0
145 Wilson disease 20.0
146 Alcoholic Liver Cirrhosis 20.0
147 Acute peptic ulcer 20.0
148 Disseminated intravascular coagulation 20.0
149 Analgesic nephropathy 20.0
150 Acromegaly 20.0
151 Ectopic Pregnancy 20.0
152 Ruptured ectopic pregnancy 20.0
153 Guillain-Barre syndrome 19.0
154 Migraine headache in adults 19.0
155 Influenza 18.0
156 Rocky Mountain spotted fever 18.0
157 Gastric cancer 18.0
158 Chronic Hepatitis 18.0
159 Amyloidosis 17.0
160 Acute intermittent porphyria 16.0
161 Budd Chiari Syndrome 16.0
162 Ascites 16.0
163 Intussusception 16.0
164 Systemic vasculitis 16.0
165 Cholangiocarcinoma 15.0
166 Von willebrand disease 15.0
167 Acute Myeloid Leukemia in adults 15.0
168 Parkinson disease 15.0
169 Gastric Volvulus 15.0
170 Acalculous Cholecystitis 15.0
171 Abdominal compartment syndrome 15.0
172 chronic acalculous cholecystitis 15.0
173 Adrenal crisis 15.0
174 Morton neuroma 15.0
175 Acute heart failure 15.0
176 Ovarian Torsion 14.0
177 Epidemic keratoconjunctivitis 14.0
178 Hypothyroidism 14.0
179 Acute pericarditis 14.0
180 Infectious mononucleosis 13.0
181 Chronic Lymphocytic Leukemia 13.0
182 Endometritis 13.0
183 Ovarian Hyperstimulation Syndrome 12.0
184 Peptic Ulcer 12.0
185 Annular pancreas 12.0
186 Cystic Fibrosis 12.0
187 Gastritis 11.0
188 Glomerulonephritis 11.0
189 Diabetic Neuropathy 10.0
190 Painless thyroiditis 10.0
191 Renal vein thrombosis 10.0
192 Chronic Renal vein thrombosis 10.0
193 Acute Renal vein thrombosis 10.0
194 Cushing syndrome 10.0
195 Pulmonary Embolism 10.0
196 Pressure ulcer 10.0
197 Acute Clonorchiasis 9.0
198 Heparin-induced thrombocytopenia 9.0
199 Mallory-Weiss syndrome 9.0
200 Angiodysplasia of the colon 9.0
201 Goiter 9.0
202 Diffuse nontoxic goiter 9.0
203 Toxic multinodular goiter 9.0
204 Obstructive cervical goiters 9.0
205 Cervical goiter 9.0
206 Chronic bacterial prostatitis 9.0
207 Osteomyelitis 9.0
208 Peutz-Jeghers Syndrome 8.0
209 Allergic rhinitis 8.0
210 Common cutaneous drug reactions 8.0
211 Typhoid infection 8.0
212 Ankylosing spondylitis 7.0
213 Herpes zoster 7.0
214 Discogenic low back pain 7.0
215 Ileus 7.0
216 Dyspepsia 7.0
217 Musculoskeletal sprains and strains 7.0
218 Hiatus hernia 6.0
219 Inguinal hernia 6.0
220 Cellulitis 6.0
221 Animal bites 6.0
222 Achalasia 5.0
223 Common cold(adults) 5.0
224 Common cold(children) 5.0
225 Hepatorenal Syndrome 4.0
226 Mitral Stenosis 4.0
227 Ramsay Hunt syndrome 4.0
228 Psoriatic arthritis 4.0
229 Meniere disease 4.0
230 Bed bugs 4.0
231 Hyperprolactinemia 4.0
232 Leiomyomas 4.0
233 Lung Cancer 3.0
234 Thyroid lymphoma 3.0
235 Acute Rhinosinusitis 3.0
236 Acute viral rhinosinusitis 3.0
237 Acute bacterial rhinosinusitis 3.0
238 Anaplastic thyroid cancer 3.0
239 Panic disorder in adults 3.0
240 Adrenocortical carcinoma 3.0
241 Primary ciliary dyskinesia 3.0
242 Kartagener syndrome 3.0
243 Umbilical hernia 3.0
244 Non-alcoholic Fatty Liver Disease 2.0
245 Renal and perinephric abscess 2.0
246 Migraine 2.0
247 Multiple Myeloma 2.0
248 Inflammatory Bowel Diseases 1.0
249 Hemorrhagic stroke 1.0
250 Ischemic stroke 1.0
251 Acute Bronchitis 1.0
252 Granulomatosis with polyangiitis 1.0
253 Chlamydia pneumoniae infection 1.0
254 endocarditis 1.0
255 Gallbladder Dyskinesia 0.0
256 biliary SOD 0.0
257 Motion Sickness 0.0
258 Recurrent aphthous stomatitis 0.0
259 Anemia of chronic disease 0.0
260 Myasthenia Gravis 0.0
261 Neonatal Myasthenia Gravis 0.0
262 Congenital Myasthenic Syndromes 0.0
263 Insect bites and stings 0.0
264 Alzheimer disease 0.0
265 Acute Pancreatitis 0.0
266 Gallstone pancreatitis 0.0
267 Acute pyelonephritis in adults 0.0