Other Systems Differential Diagnoses
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| Pancreatitis | Chronic alcoholism, gallstones or other agent toxicity can cause attack. Symptoms = epigastric pain radiating to back, nausea, vomiting, fever, perspiration, tachycardia, malaise, weakness, jaundice.
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| Pancreatic Cancer | Anorexia, weight loss, epigastric/upper abdominal pain with radiation to the back, jaundice, light colored stools, constipation, nausea, vomiting, loss of appetite, weakness.
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| Hyperparathyroidism | Excess PTH incr Ca and decr serum phosphate levels,demineralization, loss of bone strength and density. Sx: proximal weakness,fatigue,drowsiness, arthralgia/myalgia,depression, glove/stocking sensory loss,osteopenia/fx, pancreatitis,gout,pancreatitis,gout
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| Hypoparathyroidism | Decr PTH and Ca, Hi phosphorous, low serum level.Sx: neck stiffness/muscle cramps,seizures,irritability,depression,arrhythmias,skeletal muscle twitching,paresthesias,Chvostek's sign(twitching of facial muscles with tapping of facial nerve in front of ear)
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| Hypothyroidism | Inc TSH, metabolism depr. Sx: cold intolerance, lethargy, excessive fatigue, headaches, weight gain, dry skin, peripheral edema, peripheral neuropathy, proximal weakness, increasing thinness of hair and nails.
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| Hyperthyroidism | Decr TSH, metabolism elevated, Incr thyroid hormone (Grave's Disease). Sx: tachycardia,increased sweating,heat intolerance,increased appetite,dyspnea,weight loss, inability to gain weight, goiter, exophthalmia (eyes bulge out)
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| Addison's Disease | Under produce cortisol and aldosterone. Screening by ACTH stim. testing. Early symptoms are nonspecific weakness and fatigue
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| Addison's Disease symptoms | Hyperpigmentation of skin, GI disturbances, progressive fatigue, nausea, vomiting, weight loss, hypoglycemia. May cause hyperkalemia leading to flaccid paraplegia, poly neuropathy.
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| Cushing's syndrome | Over secretion of cortisol or long term use of corticosteroids.
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| Cushing's syndrome symptoms | Moon face, cervical fat pad, truncal obesity, muscle wasting and weakness, osteoporosis, HTN, easy bruising, excessive facial hair, slow wound healing, ruddy complexion.
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| Osteoporosis | Back pain, compression fractures of spine, bone fractures, kyphosis, Dowager's hump, decreased activity tolerance, early satiety.
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| Osteomalacia | Softening of bones due to decreased Vitamin D. Symptoms: bone pain, skeletal deformities, fractures, severe muscle weakness, myalgia. In children, its called Rickets.
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| Paget's Disease | Excessive bone resorption, producing bone that is larger, less compact, increased vascular, more susceptible to fracture. Sx: pain, stiffness, fatigue, headache, dizziness, vertebral compression and collapse, fractures, deformity.
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| Cholelithiasis | Presence or formation of gallstones, mostly asymptomatic
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| Biliary Colic | Gallstone lodged in neck of gallbladder, R upper abdominal pain that comes and goes in waves.
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| Cholecyctitis | Blockage of gallstones in cystic duct causing infection or inflamm in gallbladder. Pain that steadily increases. Sx: nausea,fever,GI symp,chills,tenderness over gallbladder and 10th R rib anteriorly
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| Cholangitis | Gallstones lodged in common bile duct, leads to jaundice, as well as liver infection.
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| Peptic Ulcer | Epigastric pain that feels like heartburn,gnawing,cramping pain in epigastric area near xiphoid,back pain. Stomach ulcer pain increases in presence of food.Duodebal ulcer pain prominent on empty stomach, early AM. Comp:hemorrhage, performation, dark stool
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| Diverticular Disease | Mucosa of colon balloons out, mostly asymp. Episodic or constant L lower quadrant pain, bloody stools, pelvic pain constipation alternating with diarrhea.
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| Appendicitis | Nausea,vomiting,fever,pain waves first,then steady,then aggrv. by movement,periumbilical/epigastric pain,R flank/lower quad pain,coated tongue,bad breath, + McBurney's point(pain or tenderness between umb and R ASIS), R testicular pain,abd muscl rigidity
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| Crohn's Disease | Chronic inflamm disorder, discontinuous (skip pattern). Intermittent pain periumbilical region, R lower quadrant pain with possible iliopsoas involvement, relief of low back pain after passsing stool or gas, almost 25% have arthritis
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| Ulcerative Colitis | Chronic inflamm, continuous order. Rectal bleeding, diarrhea (20 times or more/day), nausea, vomiting, anorexia, weight loss, decreased serum potassium.
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| Irritable Bowel Syndrome (IBS) | Contractions due to stress,emotions,certain food. Sx vary: painful abd cramps, constip,diarrhea,nausea,vomiting,anorexia,flatulence,foul breath,dull deep discom with sharp cramps in AM or after eating.Sx tend to disapp in sleep. L lower quad pain steady
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| Stress Incontinence | Loss of urine with increased abdominal pressure: coughing, sneezing, laughing. Related to pelvic floor weakness, urethral sphincter weakness, bladder is normal. Ex: Pregnancy
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| Urge Incontinence | Involuntary loss of urine associated with an abrupt and strong desire to void. Usually due to detrusor overactivity (D.O) or urethral instability. Can also be caused my medications, infection, and bladder tumor. Ex: CVA, PD.
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| Overflow Incontinence | Involun. loss of urine asso.with overdistention of bladder without compl emptying of bladder.Caused by underactive/deficient detrusor musc, diabetic neuropathy,fecal impaction,lower SCI injury,prostate path,detrusor external sphincter dysynergia (with MS)
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| Functional Incontinence | Mind-body connection disrupted. Ex: Dementia
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| GERD definition and symptoms | Inflammation of esophagus due to backflow of stomach acids and other content. Sx: Heartburn, reflux, painful swallowing, bitter taste in mouth, chest pain. Must be differentiated from MI.
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| GERD Complications and Treatment | Aspiration pneumonia, esophagitis, asthma, Barrett's esophagus (cancer). Treatment: Antacids, H2 Receptor Blockers (Pepcid, Zantac, Tagamet), Proton Pump Inhibitors (Nexium, Prilosec, Pravacid)
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| GERD Physical Therapy Considerations | High calorie/fatty food to be avoided before exerc. Interventions requiring supine positions should be done before meals and avoided after eating.Clients with nocturnal reflex should be encouraged to sleep on L side (prevents aspiration and regurgitation)
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| Diabetes Mellitus | Type 1: fasting glucose > 126 mg/dL or blood glucose level > 200 mg/dL. Hand stiffness = limited jt mobility,flexor synovitis, Dupuytren's contracture, Complex regional pain syndrome. Rx: keep blood glucose levels 80-120 mg/dL
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| Diabetes Mellitus Exercise Guidelines | Avoid exer if blood glucose > 250 mg/dL with or without urinary ketones.Exer with insulin can cause hypoglycemia.Do not exer between 2-4 hours after insulin injection. Decr insulin dose 30-35% b4 - after exercise.Best time to exer is 1 hour after a meal.
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| Diabetes Mellitus Complications | Neuropathy, Periarthritis, Depression, Retinopathy, Infection, Impaired wound healing, CVD, CAD, Renal artery stenosis, PVD, Carpal Tunnel, Charcot's joint
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