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DDxPro
Possible Diagnoses
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
Gallstone pancreatitis
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
Vomiting
Pain radiate to back
Nausea
Clinical signs of hypocalcemia
Gradual pain
Worse when supine
Sudden onset
Fever
Guarding
Increased pain several weeks after onset
Gastroenteritis
Mucosal eosinophilic gastroenteritis
Diarrhea
Early satiety
Nausea
Vomiting
Abdominal bleeding
Acute onset of gastrointestinal bleeding
Black stool
Bleeding episodes
Blood in the vomitus
Colitis
Gi bleeding
Hemorrhagic complications
Melena
Occult blood
Stool guaiac-positive
Tarry stool
Bloody diarrhea
Discomfort or pain in upper belly
Discomfort or pain near the ribs
Upset stomach
Viral gastroenteritis
Non bloody diarrhea
Watery diarrhea
Acute onset of vomiting
Acute onset of diarrhea
Diarrhea
Vomiting
Anorexia
Malaise
Fever
Nausea
Signs of volume depletion
Colicky pain
Pain is less marked
Cramping pain
Dry mucous membranes
Hypotension
Tenesmus
Abdominal cramps
Abdominal tenderness
Blood in stool
Bacterial gastroenteritis
Signs of volume depletion
Abdominal pain
Diarrhea
Watery diarrhea
Bloody diarrhea
Continuous pain
Radiates to right iliac fossa
Colicky pain
Pain is less marked
Cramping pain
Severe pain
Abdominal tenderness
Dry mucous membranes
Hypotension
Tenesmus
8-10 bowel movements on day
Abdominal discomfort
Anorexia
Increased bowel sounds
Lethargy
Listerial gastroenteritis
Signs of volume depletion
Abdominal pain
Decreased skin turgor
Reduced skin turgor
Diarrhea
Dry mucous membranes
Watery diarrhea
Bloody diarrhea
Last less than two days
Travel
Continuous pain
Radiates to right iliac fossa
Colicky pain
Constitutional symptoms
Drinking unclean well or surface water
Drinking unpasteurized milk
Ingesting ground beef
Pain is less marked
Cramping pain
Fever
Muscle layer eosinophilic gastroenteritis
Small bowel obstruction
Abdominal bleeding
Acute onset of gastrointestinal bleeding
Black stool
Bleeding episodes
Blood in the vomitus
Colitis
Gi bleeding
Hemorrhagic complications
Melena
Occult blood
Stool guaiac-positive
Tarry stool
Bloody diarrhea
Abdominal pain
Diarrhea
Discomfort or pain in upper belly
Discomfort or pain near the ribs
Upset stomach
three months
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
Salmonella infection
Salmonella infection
Pea soup
Watery diarrhea
Weight loss
Diarrhea
Abdominal symptoms
Enteric fever
Fever
Foodborne disease
Gastroenteritis
Poultry dairy items
Raw milk
Reptile exposure
Sickle cell disease
Undercooked eggs
Fatigue
Malaise
Chills
Headaches
Decreased skin turgor
Dry mucus membranes
Non-cholera vibrio infections
Non-cholera vibrio infections
Diarrhea
Abdominal cramps
Chemotherapy
Corticosteroid use
Hiv
Immunosuppression
Organ transplantation
Bullous skin lesions
Leg pain
Cellulitis
Ear pain
Eye pain
Eye redness
Primary septicemia
Bloody diarrhea
Cirrhosis
Hemochromatosis
Hepatitis b
Hepatitis c
Underlying hepatic disease
Foodborne e coli infection
Foodborne e coli infection
Contaminated water
Lacking adequate sanitation
Poor hygiene practices
Contaminated food
Abdominal discomfort
Abdominal pain
Bloody diarrhea
Diarrhea
Dry mucous membranes
Hypotension
Profuse watery diarrhea
Tachycardia
Volume depletion
Fever
Anorexia
Lethargy
Nausea
Vomiting
Undercooked ground beef consumption
Undercooked hamburger consumption
Pyelonephritis
Acute pyelonephritis in adults
Back pain
Costovertebral angle tenderness
Flank pain
Chills
Fever
Enlarging uterus
Hormonal changes
Dehydration
Nausea
Vomit
Autonomic dysreflexia
Change in functional status
Change in mental status
Chemotherapy
Corticosteroid
Delirium
Fall
Frequent sexual intercourse
Having new sex partner
Health care exposures
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
Tinnitus
History Consider: Systemic illness Medication
PE, BP, Cerumen impaction, Perforated tympanic membrane, Otitis media, Localization
Nonlocalized tinnitus
Neurologic and psychiatric examination
Consider: Encephalitis of temporal lobe, Psychosis
Localized tinnitus
Auscultate external canal, carotids, skull
No sound noted on examination (Subjective tinnitus)
Consider: 90% otologic problem Metabolic disorders Depression/anxiety
Hearing Evaluation
Hearing loss
Peripheral tinnitus/cochlear: Symmetric hearing loss, Normal impedance, Normal speech discrimination
Consider: Presbycusis, Noise-induced hearing loss
Therapy: Hearing Aids, Masking, Biofeedback, Medications
Central tinnitus/retrocochlear: Asymmetric hearing loss, and/or Abnormal impedance, and/or Abnormal speech discrimination
MRI with Gadolinium
Cochlear
Retrocochlear
Mixed or conductive hearing loss
Consider: External/middle ear or nasopharyngeal pathologic condition
See Hearing Loss algorithm
Bruit or sound noted on examination
Objective tinnitus
Pulsatile
Consider: AV shunt, Arterial bruit, Venous hum, Valvular murmur
Otoscopy
Normal
Magnetic Resonance Angiography and Imaging
Retrotympanic mass
High-Resolution CT of Temporal Bones
Crackling
Worsens with external noise
Stapedial muscle spasm
Consider: Division of muscle
Clicking
EMG of palatal muscles
Tetanic contractions
Palatal myoclonus
Consider: Benzodiazepines
Blowing
Tympanic membrane fluctuates with respiration
Tympanometry
Patulous eustachian tube
ENT consult
Hypotension
Assess stability
Unstable
Basic/Advanced Cardiac Life Support protocol
Stable
Etiology
Cardiogenic
Acute ischemia
Urgent catheterization, IABP, Dobutamine, Other inotropes
Other
Inotropes, Treat underlying cause
Noncardiogenic
Vasodilatory
Fluids, Vasopressors
Obstructive
Thrombolysis, Thrombectomy
Hypovolemic
Fluids
Unclear