DDx for Acute Hepatitis?

DAAMH VW

Drugs, Alcohol, Autoimmune, Hemachromatosis Viral, Wilson

DDx for Cirrhosis? VW HAPPENS

Viral, Wilson disease Hemochromatosis Autoimmune/A1-Anti trypsin def. PSC PBC Ethanol NASH
Something else

Px

Acute-onset abd pain AFTER REPEATED BOUTS of vomiting WITH NO SIRS + hematemesis = Mallory
Weiss tear

Differentiate from Boerhave syndrome where you have SIRS and pneumomediastinum.

Differentiate from gastritis where you do not need repeated bouts of vomiting to have hematemesis.

Severe, acute onset chest (retrosternal)/abd pain AFTER REPEATED BOUTS of vomiting/straining WITH
SIRS + 1) pneumomediatinum, crepitus, 2) widened mediastinum on CXR, 3) pleural effusion with
amylase = Esophageal Perf (Boerhave)

Acute pancreatitis could px similarly but you would not see pneumomediastium or widened
mediastinum. Aortic dissection can present with severe chest pain, widened mediastinum, pleural
effusion (hemothorax), and some SIRS criteria (tachycardia, hypotension) but pt would not be febrile,
have amylase in pleural fluid, have vomiting, or crepitus. Mallory Weiss tear can present with chest
pain BUT no crepitus or SIRS.
Esophageal Diseases:

Chronic (years), progressive dysphagia for Solids and liquids, + cough, regurgitation, GERD, mild weight
loss, improvement of symptoms in upright position = Achalasia

Esophageal carcinoma can px similarly but would be MORE rapid in presentation (months), MORE
serious weight loss, and you may see dysphagia that progresses initially from SOLIDS and then liquids

Progressive dysphagia for SOLIDs and then liquids and chest pain + weight loss, hematemesis +/- hx of
long-standing GERD, Obesity, smoking or alcohol use = Esophageal Carcinoma

Intermittent, episodic, dysphagia for solids and liquids AND chest pain that may precipitated by drinking
hot and cold liquids = Diffuse Esophageal Spasm

Differentiate from Achalasia which causes a CHRONIC dysphagia not intermittent or episodic

Dysphagia + chest pain, food impaction, and GERD that does not respond to standard medications =
Eosinophilic Esophagitis

Dysphagia +/- issue with initiating swallow AND halitosis, regurg of food, neck mass, in an old man (> 60)
= Zenkers Diverticulum

Differentiate from Achalasia which can also present with regurg and cough but would not have halitosis.
Disorders of the stomach

Abd pain + hematemesis in context of ingesting NAAS (NSAIDS, Alcohol, Smoking, Steroids) = Erosive
gastritis

Key difference b/w gastritis and Mallory-Weiss tear is that with MW you need repeated bouts of
vomiting before hematemesis appears. With gastritis, hematemesis appears after a few vomiting
episodes or none.

Epigastric pain or Chest pain described as burning that occurs after a meal, worsens with reclining but
improves with sitting or standing and antacids. May have sour taste/globus = GERD

Differentiate from gastritis which is often triggered by Recent use of medications.

Differentiate from peptic ulcer disease

Chronic abd pain described as dull, burning, or gnawing +/- hematemesis that may improve or worsen
with meals, can be caused by H. pylori, NASS, Zollinger Ellison = Peptic Ulcer Disease Duodenal
ulcers improve with meals; Gastric ulcers worsen with meals

Dx. EGD w/bx and to r/o cancer with gastric ulcers

Chronic abd pain, recurrent or refractory peptic ulcers, and diarrhea = Zollinger Ellison Syndrome

Differentiate from H. pylori which would be responsive to therapy; would not have refractory ulcers

Differentiate from VIPoma which can also cause diarrhea but would not peptic ulcers

Dx 1) Fasting gastrin level 2) Secretin stimulating test, 3) CT to stage tumor

Tx: PPI to control symptoms and Resection

Diarrheas
Acute diarrhea (< 2 weeks) ddx Infectious diarrhea (bacterial or viral)

Chronic diarrhea (> 4 weeks) ddx Secretory, Malabsorptive, Inflammatory, Motility

Chronic diarrhea ( > 4 weeks), malabsorption with bloating, abd cramps, flatulence in middle aged or
older non-white person, ingestion of diary = Lactose Intolerance

Chronic diarrhea ( > 4 weeks), malabsorption with bloating, abd cramps, flatulence with cardiac
symptoms, arthralgias, and neurologic symptoms in an old white man, PAS positive staining in small
bowel = Whipple Disease

Abnormal LFTs, signs of portal HTN, and nonspecific symptoms such as fatigue, weakness, and nausea =
Liver Dysfunction

Pt: Hep C, Alcoholism,