Differential Diagnosis – “G”

Aug 4, 2019 admin CHẨN ĐOÁN-XN 0

Gait Abnormality
  • Parkinsonism.
  • Degenerative joint disease (hips, back, knees).
  • Multiple sclerosis.
  • Trauma, foot pain.
  • CVA.
  • Cerebellar lesions.
  • Infections (tabes, encephalitis, meningitis).
  • Sensory ataxia.
  • Dystonia, cerebral palsy, neuromuscular disorders.
  • Metabolic abnormalities.
Galactorrhea
  • Prolonged suckling.
  • Drugs (INH, phenothiazines, reserpine derivatives, amphetamines, spironolactone and tricyclic antidepressants).
  • Major stressors (surgery, trauma).
  • Hypothyroidism.
  • Pituitary tumors.
Gallbladder Sonographic Non-visualization
  • Previous cholecystectomy
  • Physiologic contraction
  • Fibrosed gallbladder duct—chronic cholecystitis
  • Air-filled gallbladder or emphysematous cholecystitis
  • Tumefactive sludge
  • Agenesis of gallbladder
  • Ectopic location
Gallbladder Wall Thickening

Generalized Edematous States

  • Congestive heart failure
  • Renal failure
  • End-stage cirrhosis
  • Hypoalbuminemia

Inflammatory Conditions

  • Primary
    1. Acute cholecystitis
    2. Cholangitis
    3. Chronic cholecystitis
  • Secondary
    1. Acute hepatitis
    2. Perforated duodenal ulcer
    3. Pancreatitis
    4. Diverticulitis/colitis

Neoplastic Conditions

  • Gallbladder adenocarcinoma
  • Metastases

Miscellaneous

  • Adenomyomatosis
  • Mural varicosities
Gastric Dilatation33

Mechanical Gastric Outlet Obstruction

  • Duodenal or pyloric canal ulceration.
  • Carcinoma of pyloric antrum.
  • Extrinsic compression.

Paralytic Ileus

  • Surgery.
  • Trauma.
  • Peritonitis.
  • Pancreatitis.
  • Cholecystitis.
  • Diabetes mellitus.
  • Hepatic coma.
  • Drugs.

Gastric Volvulus

  • Intubation.
  • Air swallowing.
Gastric Emptying, Delayed3

Mechanical Causes

  • Peptic ulcer disease, scarred pylorus.
  • Malignancy: gastric cancer, gastric lymphoma, pancreatic cancer.
  • Gastric surgery: vagotomy, gastric resection, Roux-en-Y anastomosis.
  • Crohn’s disease.

Endocrine and Metabolic Causes

  • Diabetes mellitus.
  • Hypothyroidism.
  • Hypoadrenal states.
  • Electrolyte abnormalities.
  • Chronic renal failure.
  • Medications.
  • Anticholinergics.
  • Opiates.
  • Dopamine agonists.
  • Tricyclic antidepressants.

Abnormalities of Gastric Smooth Muscle

  • Scleroderma.
  • Polymyositis, dermatomyositis.
  • Amyloidosis.
  • Pseudoobstruction.
  • Myotonic dystrophy.
  • Neuropathy.
  • Scleroderma.
  • Amyloidosis.
  • Autonomic neuropathy.

Central Nervous System or Psychiatric Disorders

  • Brain stem tumors.
  • Spinal cord injury.
  • Anorexia nervosa.
  • Stress.

Miscellaneous

  • Idiopathic gastroparesis.
  • Gastroesophageal reflux disease.
  • Nonulcer (functional) dyspepsia.
  • Cancer cachexia or anorexia.
Gastric Emptying, Rapid
ICD-10CM # K30 Functional dyspepsia
  • Pancreatic insufficiency.
  • Dumping syndrome.
  • Peptic ulcer.
  • Celiac disease.
  • Promotility agents.
  • Zollinger-Ellison disease.
Genital Discharge, Female21
ICD-10CM # N94.9 Unspecified condition associated with female genital organs and menstrual cycle
  • Physiologic discharge: cervical mucus, vaginal transudation, bacteria, squamous epithelial cells.
  • Individual variation.
  • Pregnancy.
  • Sexual response.
  • Menstrual cycle variation.
  • Infection.
  • Foreign body: tampon, cervical cap, other.
  • Neoplasm.
  • Fistula.
  • IUD.
  • Cervical ectropion.
  • Spermicide.
  • Nongenital causes: urinary incontinence, urinary tract fistula, Crohn’s disease, rectovaginal fistula.
Genital Lesions, Infectious Causes9

Sexually Transmitted Infections

  • Syphilis: Primary (chancre); Secondary (condyloma latum).
  • Herpes simplex virus types 1 and 2.
  • Chancroid (Haemophilus ducreyi).
  • Lymphogranuloma venereum.
  • Granuloma inguinale (donovanosis).
  • Human papillomavirus.
  • Sarcoptes scabiei.
  • Molluscum contagiosum.

Nonsexually Transmitted Infections

  • Folliculitis.
  • Tuberculosis.
  • Tularemia.
  • Histoplasmosis.
  • Candida (balanitis or vaginitis).
  • Amebiasis.
Genital Lesions, Noninfectious Causes9
  • Trauma.
  • Malignancies (e.g., squamous cell carcinoma).
  • Behçet’s syndrome.
  • Lipschütz’s vulvar ulcers.
  • Peyronie’s disease.
  • Fixed-drug eruption.
  • Eczema.
  • Psoriasis.
  • Inflammatory bowel disease.
  • Contact dermatitis.
  • Lichen planus.
  • Hidradenitis suppurativa.
  • Postinflammatory hypopigmentation.
  • Aphthous ulcers (associated with human immunodeficiency virus).
Genital Sores
  • Herpes genitalis.
  • Syphilis.
  • Chancroid.
  • Lymphogranuloma venereum.
  • Granuloma inguinale.
  • Condyloma acuminatum.
  • Neoplastic lesion.
  • Trauma.
ICD-10CM # A60.9 Anogenital herpesviral infection, unspecified
A51.0 Primary genital syphilis
A63.0 Anogenital (venereal) warts
A57 Chancroid
A58 Granuloma inguinale
A55 Chlamydial lymphogranuloma (venereum)
N94.89 Other specified conditions associated with female genital organs and menstrual cycle
N50.8 Other specified disorders of male genital organs
  • Herpes genitalis.
  • Syphilis.
  • Chancroid.
  • Lymphogranuloma venereum.
  • Granuloma inguinale.
  • Condyloma acuminatum.
  • Neoplastic lesion.
  • Trauma.
Glomerulonephritis Associated with Malignancy67
ICD-10CM# N00.9 Acute Nephritic Syndrome with Unspecified Morphologic Changes
Membranous glomerulonephritis:
  • Breast cancer
  • Lung cancer
  • Colon cancer
  • Prostate cancer
  • Graft-versus-host disease
Minimal change disease:
  • Hodgkin’s lymphoma
  • Non-Hodgkin’s lymphoma
  • Graft-versus-host disease
  • Case reports
  • Immunoglobulin A nephritis
  • Antineutrophil cytoplasmic antibody vasculitis
  • Focal segmental glomerulosclerosis
Glomerulonephritis, Rapidly Progressive3

Linear Immune Staining

  • Anti-GBM disease.
  • Goodpasture’s syndrome.
  • Rarely membranous glomerulonephritis.

Granular Immune Staining

  • Subacute bacterial endocarditis (past infectious).
  • Lupus nephritis.
  • Cryoglobulinemia.
  • Membranoproliferative glomerulonephritis (type II more than type I).
  • Immunoglobulin A nephropathy, Henoch-Schönlein purpura.
  • Idiopathic.

No Immune Staining (Pauci-immune)

  • Antineutrophil cytoplasmic antibody-associated vasculitis (Wegener granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome).
  • Idiopathic.
Glomerulopathies, Thrombotic, Microangiopathic3
  • Thrombotic thrombocytopenic purpura.
  • Hemolytic-uremic syndrome.
  • Malignant hypertension.
  • Scleroderma renal crisis.
  • Preeclampsia, eclampsia.
  • HELLP syndrome (hemolysis, elevated liver enzymes, low platelets).
  • Antiphospholipid antibody syndrome.
  • Drugs: oral contraceptives, quinine, cyclosporine, tacrolimus, ticlopidine, clopidogrel.
Glomerulosclerosis, Focal Segmental3
  • Primary idiopathic FSGS.
  • Secondary FSGS.
  • HIV (usually collapsing variant).
  • Reflux nephropathy.
  • Heroin abuse.
  • Sickle cell disease.
  • Oligomeganephronia.
  • Renal dysgenesis or agenesis (low nephron mass).
  • Radiation nephritis.
  • Familial podocytopathies.
  • NPHS1 (nephrin) mutation.
  • NPHS2 (podocin) mutation.
  • TRPC6 (cation channel) mutation.
  • ACTN4 (a-actinin 4 mutation).
Glossodynia72

Denture-Related

  • Dentures (ill-fitting, monomer from denture base).
  • Dental plaque.
  • Oral parafunction.

Infective/Dermatologic

  • Candidiasis.
  • Lichen planus.

Deficiency States

  • Iron, B12, folate, B2 (riboflavin), B6 (pyridoxine), zinc.

Endocrine

  • Diabetes.
  • Myxedema.
  • Hormonal changes occurring during menopause.

Neurologically Mediated

  • Referred from tonsils, teeth.
  • Lingual nerve neuropathy.
  • Glossopharyngeal neuralgia.
  • Esophageal reflux.

Iatrogenic

  • Mouthwash.

Xerostomia

PSYCHOGENIC

IDIOPATHIC

Glucocorticoid Deficiency29
ICD-10CM # E27.1 Primary adrenocortical insufficiency
E27.3 Drug-induced adrenocortical insufficiency

ACTH-independent causes.

TB.

Autoimmune (idiopathic).

Other rare causes:

  • Fungal infection.
  • Adrenal hemorrhage.
  • Metastases.
  • Sarcoidosis.
  • Amyloidosis.
  • Adrenoleukodystrophy.
  • Adrenomyeloneuropathy.
  • HIV infection.
  • Congenital adrenal hyperplasia.
  • Medications (e.g., ketoconazole).

ACTH-dependent causes:

  • Hypothalamic-pituitary-adrenal suppression.
  • Exogenous.
  • Glucocorticoid.
  • ACTH.
  • Endogenous—cure of Cushing’s syndrome.
  • Hypothalamic-pituitary lesions.

Neoplasm:

  • Primary pituitary tumor.
  • Metastatic tumor.
  • Craniopharyngioma.

Infection:

  • Tuberculosis.
  • Actinomycosis.
  • Nocardiosis.

Sarcoid.

Head trauma.

Isolated ACTH deficiency.

Goiter
ICD-10CM # E01.2 Iodine-deficiency related (endemic) goiter, unspecified
E04.9 Nontoxic goiter, unspecified
E04.9 Nontoxic goiter, unspecified
E07.1 Dyshormogenetic goiter
E01.2 Iodine-deficiency related (endemic) goiter, unspecified
E04.9 Nontoxic goiter, unspecified
E04.2 Nontoxic multinodular goiter
E04.0 Nontoxic diffuse goiter
E05.10 Thyrotoxicosis with toxic single thyroid nodule without thyrotoxic crisis or storm
  • Thyroiditis.
  • Toxic multinodular goiter.
  • Graves’ disease.
  • Medications (PTU, methimazole, sulfonamides, sulfonylureas, ethionamide, amiodarone, lithium, etc.).
  • Iodine deficiency.
  • Sarcoidosis, amyloidosis.
  • Defective thyroid hormone synthesis.
  • Resistance to thyroid hormone.
Granulomatous Dermatitides
ICD-10CM # L92.9 Granulomatous disorder of the skin and subcutaneous tissue, unspecified
  • Granuloma annulare.
  • Sarcoidosis.
  • Necrobiosis lipoidica diabeticorum.
  • Cutaneous Crohn’s disease.
  • Rheumatoid nodules.
  • Annular elastolytic giant cell granuloma (actinic granuloma).
  • Foreign body granuloma.
Granulomatous Disorders63

Infections

Fungi

Histoplasma.

Coccidioides.

Blastomyces.

Sporothrix.

Aspergillus.

Cryptococcus.

Protozoa

Toxoplasma.

Leishmania.

Metazoa

Toxocara.
Schistosoma.

Spirochetes

Treponema pallidum.
T. pertenue.
T. carateum.

Mycobacteria

M. tuberculosis.
M. leprae.
M. kansasii.
M. marinum.
M. avian.
Bacille Calmette-Guérin (BCG) vaccine.

Bacteria

Brucella.

Yersinia.

Other Infections

Cat-scratch disease.
Lymphogranuloma.

Neoplasia

Carcinoma.
Reticulosis.
Pinealoma.
Dysgerminoma.
Seminoma.
Reticulum cell sarcoma.
Malignant nasal granuloma.

Chemicals

  • Beryllium.
  • Zirconium.
  • Silica.
  • Starch.

Immunologic Aberrations

  • Sarcoidosis.
  • Crohn’s disease.
  • Primary biliary cirrhosis.
  • Granulomatosis with polyangiitis.
  • Giant cell arteritis.
  • Peyronie’s disease.
  • Hypogammaglobulinemia.
  • SLE.
  • Lymphomatoid granulomatosis.
  • Histiocytosis X.
  • Hepatic granulomatous disease.
  • Immune complex disease.
  • Rosenthal-Melkersson syndrome.
  • Churg-Strauss allergic granulomatosis.

Leukocyte Oxidase Defect

  • Chronic granulomatous disease of childhood.

Extrinsic Allergic Alveolitis

  • Farmer’s lung.
  • Bird fancier’s.
  • Mushroom worker’s.
  • Suberosis (cork dust).
  • Bagassosis.
  • Maple bark stripper’s.
  • Paprika splitter’s.
  • Coffee bean.
  • Spatlese lung.
  • Other Disorders
  • Whipple’s disease.
  • Pyrexia of unknown origin.
  • Radiotherapy.
  • Cancer chemotherapy.
  • Panniculitis.
  • Chalazion.
  • Sebaceous cyst.
  • Dermoid.
  • Sea urchin spine injury.
Granulomatous Liver Disease
  1. ICD-10CM # K75.3 Granulomatous hepatitis
  • Sarcoidosis.
  • Granulomatosis with polyangiitis.
  • Vasculitis.
  • Inflammatory bowel disease.
  • Allergic granulomatosis.
  • Erythema nodosum.
  • Infections (fungal, viral, parasitic).
  • Primary biliary cirrhosis.
  • Lymphoma.
  • Hodgkin’s disease.
  • Drugs (e.g., allopurinol, hydralazine, sulfonamides, penicillins).
  • Toxins (copper sulfate, beryllium).
Green or Blue Urine
  1. ICD-10CM # R82 Other abnormal findings in urine
  • Pseudomonal urinary tract infection
  • Medications: triamterene, amitriptyline, IV cimetidine, IV promethazine.
  • Biliverdin.
  • Dyes (methylene blue, indigo carmine).
Groin Lump72
ICD-10CM # R19.09 Other intraabdominal and pelvic swelling, mass and lump
R22.9 Localized swelling, mass and lump, unspecified

Common Causes

Inguinal hernia.

Femoral hernia.

Lymph node.

Other Causes

Saphena varix.

Femoral artery aneurysm/pseudoaneurysm.

Psoas abscess.

Lipoma of the cord.

Encysted hydrocele of the cord (male).

Testicular maldescent (male).

Hydrocele of canal of Nuck (female).

Groin Masses
ICD-10CM# R22.9 Localized swelling, mass and lump, unspecified
S39.848A Other specified injuries of external genitals, initial encounter
  • Hernia (inguinal, femoral).
  • Hydrocele.
  • Varicocele.
  • Sebaceous cyst.
  • Hidradenitis of inguinal apocrine glands.
  • Neoplasm: lymphoma, metastases.
  • Lipoma.
  • Hematoma.
  • Reactive inguinal adenopathy, femoral adenitis.
  • Folliculitis, psoas abscess.
  • Epididymitis, testicular torsion, ectopic testes.
  • Aneurysm or pseudoaneurysm of femoral artery.
Groin Pain14
  • Surgery
  • Workers’ Compensation.
  • Hernia.
  • Recurrent hernia.
  • Posthernia.
  • Orthopedic
  • Hip disorders.
  • Acetabular labral tears.
  • Avascular necrosis.
  • Chondritis dissecans.
  • Legg-Calvé-Perthes disease.
  • Osteoarthritis.
  • Pelvic stress fractures.
  • Slipped femoral capital epiphysis.
  • Synovitis.
  • Urology
  • Cystitis.
  • Epididymitis.
  • Nephrolithiasis.
  • Prostate cancer.
  • Prostatitis.
  • Torsion of testes.
  • Urethral extravasation.
  • Urinary tract infection.
  • Vas granuloma/fibrosis.
  • Dermatology
  • Lymphadenitis.
  • Psoriasis/burn.
  • Sebaceous cyst/hidradenitis.
  • Thrombophlebitis/cellulitis.
  • Neurosurgery
  • Disk disease.
  • Spinal injuries, inflammation, tumors.
  • Spondylolisthesis.
  • Spondylolysis.
  • Rheumatology
  • Connective tissue disorders.
  • Iliopsoas bursitis.
  • Osteitis pubis.
  • Systemic lupus erythematosus.
  • Neurology
  • Lumbosacral disorders.
  • Neurofibromatosis.
  • Infectious Disease
  • Herpes zoster.
  • HIV/tuberculosis.
  • Lyme disease.
  • Psoas abscess.
  • Sports Medicine
  • “Sports hernia” (adductor strains).
  • Gilmore’s groin.
  • Vascular
  • Abscess hematoma.
  • Post-vein stripping.
  • Pseudoaneurysm.
  • Vascular graft.
  • Gastroenterology
  • Appendicitis/adhesions.
  • Diverticulitis.
  • Inflammatory retroperitoneal phlegmon (pancreatitis).
  • Meckel diverticulum.
  • Granulomatous colitis.
  • Gynecology
  • Cesarean section.
  • Cervical cancer.
  • Endometriosis.
  • Tubal/ovarian disorders.
Groin Pain, Active Patient71
  • Musculoskeletal
  • Avascular necrosis of the femoral head.
  • Avulsion fracture (lesser trochanter, anterior superior iliac spine, anterior inferior iliac spine).
  • Bursitis (iliopectineal, trochanteric).
  • Entrapment of the ilioinguinal or iliofemoral nerve.
  • Gracilis syndrome.
  • Muscle tear (adductors, iliopsoas, rectus abdominis, gracilis, sartorius, rectus femoris).
  • Myositis ossificans of the hip muscles.
  • Osteitis pubis.
  • Osteoarthritis of the femoral head.
  • Slipped capital femoral epiphysis.
  • Stress fracture of the femoral head or neck and pubis.
  • Synovitis.
  • Hernia-Related
  • Avulsion of the internal oblique muscle in the conjoined tendon.
  • Defect at the insertion of the rectus abdominis muscle.
  • Direct inguinal hernia.
  • Femoral ring hernia.
  • Indirect inguinal hernia.
  • Inguinal canal weakness.
  • Urologic
  • Epididymitis.
  • Fracture of the testis.
  • Hydrocele.
  • Kidney stone.
  • Posterior urethritis.
  • Prostatitis.
  • Testicular cancer.
  • Torsion of the testis.
  • Urinary tract infection.
  • Varicocele.
  • Gynecologic
  • Ectopic pregnancy.
  • Ovarian cyst.
  • Pelvic inflammatory disease.
  • Torsion of the ovary.
  • Vaginitis.

LYMPHATIC ENLARGEMENT IN GROIN

Gynecomastia
ICD-10CM # N62 Hypertrophy of breast
  • Physiologic (puberty, newborns, aging).
  • Drugs (estrogen and estrogen precursors, 5-a reductase inhibitors, digitalis, testosterone and exogenous androgens, clomiphene, cimetidine, spironolactone, ketoconazole, amiodarone, ACE inhibitors, isoniazid, phenytoin, methyldopa, metoclopramide, phenothiazine).
  • Increased prolactin level (prolactinoma).
  • Liver disease.
  • Adrenal disease.
  • Thyrotoxicosis.
  • Increased estrogen production (hCG-producing tumor, testicular tumor, bronchogenic carcinoma).
  • Secondary hypogonadism.
  • Primary gonadal failure (trauma, castration, viral orchitis, granulomatous disease).
  • Defects in androgen synthesis.
  • Testosterone deficiency.
  • Klinefelter’s syndrome.

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