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Possible Diagnoses
Alcoholic liver disease
Alcoholic liver disease
Anorexia
Fatigue
Fever
Jaundice
Nausea
Right upper quadrant abdominal discomfort
Vomiting
Weight loss
Digital clubbing
Palmar erythema
Ascites
Splenomegaly
Asterixis
Confusion
Dupuytren contractures
Gynecomastia
Hematemesis
Leg swelling
Weight gain
Gastrointestinal bleeding
Cirrhosis
Liver cirrhosis
Anesthesia
Increased need for sleep
Lack of stamina
Lethargy
Listlessness
Neurological manifestations
Poor energy
Symptoms of temporal lobe seizures
Abdominal swelling
Decreased libido
Jaundice
Muscle wasting
Splenomegaly
Weight loss
Palmar erythema
Spider angiomas
Fatigue
Weakness
Abdominal distention
Afternoon fatigue
Primary biliary cirrhosis
Malignancy
Portal hypertension
Urinary tract infection
Anesthesia
Burning sensation in extremities
Crawling sensation in extremities
Creeping sensation in extremities
Increased need for sleep
Lack of stamina
Lethargy
Listlessness
Numbness sensation in extremities
Paresthesia in entire hand
Paresthesia in wrist
Poor energy
Significant fatigue
Somatosensory symptoms
Symptoms of temporal lobe seizures
Tingling sensation in extremities
Concentration impairment
Biliary cirrhosis
Anesthesia
Increased need for sleep
Lack of stamina
Lethargy
Listlessness
Poor energy
Symptoms of temporal lobe seizures
Muscle weakness
Proximal muscle weakness
Absence of parenchymal kidney disease
Absence of shock
Amnesia
Anxiety
Ataxic gait
Babinski sign
Bizarre behavior
Clonus
Disorientation for time
Dyspraxia
Euphoria
Alcoholic liver cirrhosis
Ascites
Anorexia
Fatigue
Fever
High-grade fever
Increased need for sleep
Lack of stamina
Lethargy
Listlessness
Low-grade fever
Malaise
Nausea
Poor energy
Right upper quadrant abdominal discomfort
Vomiting
Weight loss
Cardiomyopathy
Pancreatic dysfunction
Skeletal muscle wasting
Abdominal wall collaterals
Alcoholic fatty liver
Alcoholic fatty liver
Hepatomegaly
Asterixis
Anorexia
Fatigue
Fever
Lack of stamina
Lethargy
Poor energy
Right upper quadrant abdominal discomfort
Vomiting
Weakness
Weight loss
Cardiomyopathy
Pancreatic dysfunction
Skeletal muscle wasting
Abdominal wall collaterals
Cutaneous telangiectasias
Digital clubbing
Disheveled appearance
Muscle weakness
Crohn disease
Crohn disease
Abdominal tenderness
Perianal skin tag
Sinus tracts
Abdominal pain
Diarrhea
Abdominal mass
Recurrence after surgery
Response to antibiotics
Prolonged diarrhea
Chronic diarrhea
Tender mass is palpable
Fever
Fatigue
Weight loss
Episodes of colonic obstruction
Episodes of small bowel obstruction
Frequently right lower quadrant pain
Crampy abdominal pain
Right lower quadrant mass
Pain relieved by defecation
Intestinal obstruction
Intestinal obstruction
Abdominal distension
Vomiting
Appear critically ill
Crampy pain
Colicky pain
Abdominal pain
Early abnormally active bowel sounds
Nausea
Peritoneal irritation
Constipation
Abdominal tenderness
Inability to pass flatus
Abdominal mass
Early high-pitched bowel sounds
Percussion reveal tympany
Empty rectal vault
Peritoneal signs
Rectal mass
Weight loss
Constant pain
Toxic megacolon
Toxic megacolon
Frequently severe bloody diarrhea
Malaise
Abdominal distention
Abdominal pain
Altered sensorium
Hypotension
Mental status changes
Volume depletion
Fever
Tachycardia
Abdominal tenderness
Acute diarrhea
Postural hypotension
Appear very ill
Chronic diarrhea
Generalized peritonitis
Localized peritonitis
Lower abdominal distension
Lower abdominal tenderness
Toxic appearing patient
Hepatitis
Alcoholic hepatitis
Right upper quadrant abdominal discomfort
Fails to correct prolonged prothrombin time with vitamin k
Liver is enlarged
Fever
Anorexia
Liver is tender
Asterixis
Gastrointestinal bleeding
Fatigue
Lack of stamina
Lethargy
Poor energy
Weakness
Cardiomyopathy
Pancreatic dysfunction
Skeletal muscle wasting
Abdominal distension
Abdominal wall collaterals
Bruit heard over liver
Cutaneous telangiectasias
Cholangitis
Primary sclerosing cholangitis
Associated with inflammatory bowel diseases
Anesthesia
Increased need for sleep
Lack of stamina
Lethargy
Listlessness
Poor energy
Symptoms of temporal lobe seizures
Muscle weakness
Proximal muscle weakness
Increasing cholestasis
Right upper quadrant pain
Jaundice
Fatigue
Fever
Complication ulcerative colitis
Absence of parenchymal kidney disease
Absence of shock
Amnesia
Anxiety
Pancreatitis
Acute pancreatitis
Nausea
Vomiting
Mild discomfort
Left upper quadrant pain
Alleviated in fetal position
Worsens with movement
Acute upper abdominal pain
Boring pain
Periumbilical pain
Relief on bending forward
Relieved by sitting up
Epigastric pain
Pain radiate to back
Signs of hypovolemia
Anorexia
Hypotension
Abdominal distention
Blue-red-purple of flanks
Clinical signs of hypocalcemia
Gradual pain
Nausea and Vomiting
History, PE, Laboratory evaluation
Assess for mechanical obstruction, peritonitis, dehydration, or bleeding
YES (mechanical obstruction, peritonitis, dehydration, or bleeding)
Replace fluids, Consider hospitalization
NO (mechanical obstruction, peritonitis, dehydration, or bleeding)
Regurgitation of undigested food? rumination, esophageal stricture, Zenker’s diverticulitis
Assess for pharmacologic or toxic causes
YES (pharmacologic or toxic causes)
Discontinue offending agent Treat toxicity
NO (pharmacologic or toxic causes)
Constant or recurrent, intermittent
Consider: Migraines, Seizure disorder, Cyclic vomiting, CNS lesions
Duration < 1 wk
Consider: Food poisoning, Gastroenteritis
Fluid and electrolyte replacement, observation, antiemetics
Duration > 7 days
Predominantly AM vomiting
Consider: Pregnancy, Uremia, Alcohol use, Increased intracranial pressure
Focal defects, Brainstem Posterior fossa, Abdominal migraine
Etiology still uncertain
Consider: Electrogastrography, MRI of brain
Vomiting > 1 hr after meal
Gastric emptying study
Prolonged emptying
Consider: Gastroparesis, Trial prokinetic agents, Gastric outlet obstructions
EGD
Normal emptying
Consider: Conversion reaction, Depression
Psychological evaluation
Vertigo
Consider: Labyrinthine disorder
Etiology still uncertain
Consider: Electrogastrography, MRI of brain
Vomiting immediately after meals
Consider: Gastroesophageal reflux disease, Bulimia
Etiology still uncertain
Consider: Electrogastrography, MRI of brain
Chronic orthostatic hypotension, hyponatremia
Consider: Adrenal insufficiency
Etiology still uncertain
Consider: Electrogastrography, MRI of brain
Weight loss
Consider: Malignancy, Gastroparesis, Gastric outlet obstruction
EGD
Etiology still uncertain
Consider: Electrogastrography, MRI of brain