What are the most common chief complaints for a gastroenterology encounter, their differentials, and key characteristics to rule in or out each differential diagnosis in Gastroenterology (GE)?

Common Chief Complaints in Gastroenterology Encounters

The following are common chief complaints in gastroenterology encounters, along with their differential diagnoses, categorized for clarity.

Abdominal Pain

• Single most likely diagnosis:
  • Non-ulcer dyspepsia (functional dyspepsia) - Justification: Most common cause of abdominal pain, often related to eating or stress.
• Other Likely diagnoses:
  • Gastroesophageal reflux disease (GERD) - Justification: Common condition with symptoms of heartburn and regurgitation.
  • Irritable bowel syndrome (IBS) - Justification: Characterized by abdominal pain, bloating, and alteration in bowel habits.
  • Peptic ulcer disease - Justification: Can cause epigastric pain, especially related to food intake.
• Do Not Miss:
  • Acute appendicitis - Justification: Although less common, it's a surgical emergency that requires prompt diagnosis.
  • Mesenteric ischemia - Justification: A life-threatening condition that presents with severe abdominal pain out of proportion to physical findings.
• Rare diagnoses:
  • Intestinal obstruction - Justification: Although rare, it presents with severe abdominal pain, vomiting, and obstipation.
  • Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis) - Justification: Chronic conditions that can present with abdominal pain, diarrhea, and weight loss.

Diarrhea

• Single most likely diagnosis:
  • Viral gastroenteritis - Justification: Most common cause of acute diarrhea, often self-limiting.
• Other Likely diagnoses:
  • Bacterial gastroenteritis - Justification: Common cause of diarrhea, especially after travel or food poisoning.
  • IBS - Justification: Can present with chronic diarrhea, abdominal pain, and bloating.
• Do Not Miss:
  • Clostridioides difficile infection - Justification: A potentially life-threatening condition, especially in hospitalized or immunocompromised patients.
  • Inflammatory bowel disease - Justification: Can present with chronic diarrhea, blood in stool, and weight loss.
• Rare diagnoses:
  • Giardiasis - Justification: A parasitic infection that can cause chronic diarrhea, especially in travelers or immunocompromised patients.
  • Whipple's disease - Justification: A rare bacterial infection that can cause chronic diarrhea, weight loss, and malabsorption.

Vomiting

• Single most likely diagnosis:
  • Viral gastroenteritis - Justification: Most common cause of acute vomiting, often self-limiting.
• Other Likely diagnoses:
  • Food poisoning - Justification: Common cause of vomiting, often related to contaminated food or water.
  • GERD - Justification: Can cause vomiting, especially in patients with severe reflux.
• Do Not Miss:
  • Appendicitis - Justification: Although less common, it can present with vomiting, especially if the appendix is near the stomach or small intestine.
  • Intestinal obstruction - Justification: A life-threatening condition that requires prompt diagnosis and treatment.
• Rare diagnoses:
  • Gastroparesis - Justification: A condition characterized by delayed gastric emptying, often causing vomiting, especially after eating.
  • Cyclical vomiting syndrome - Justification: A rare condition characterized by recurrent episodes of severe vomiting.

Jaundice

• Single most likely diagnosis:
  • Viral hepatitis - Justification: Most common cause of jaundice, often self-limiting.
• Other Likely diagnoses:
  • Alcoholic liver disease - Justification: Common cause of jaundice, especially in patients with a history of heavy alcohol use.
  • Gallstones - Justification: Can cause obstructive jaundice, especially if a stone is lodged in the common bile duct.
• Do Not Miss:
  • Pancreatic cancer - Justification: A life-threatening condition that can cause obstructive jaundice, especially in older patients.
  • Cholangitis - Justification: A potentially life-threatening infection of the bile ducts, often requiring prompt antibiotic treatment.
• Rare diagnoses:
  • Primary biliary cirrhosis - Justification: A chronic liver disease that can cause jaundice, especially in middle-aged women.
  • Primary sclerosing cholangitis - Justification: A rare chronic liver disease that can cause jaundice, especially in patients with inflammatory bowel disease.

Weight Loss

• Single most likely diagnosis:
  • Non-neoplastic conditions (e.g., depression, anxiety) - Justification: Most common cause of weight loss, often related to decreased appetite or increased stress.
• Other Likely diagnoses:
  • Malignancy (e.g., pancreatic cancer, gastric cancer) - Justification: Common cause of weight loss, especially in older patients.
  • Chronic liver disease - Justification: Can cause weight loss, especially in patients with advanced liver disease.
• Do Not Miss:
  • HIV/AIDS - Justification: A life-threatening condition that can cause weight loss, especially in patients with advanced disease.
  • Tuberculosis - Justification: A potentially life-threatening infection that can cause weight loss, especially in immunocompromised patients.
• Rare diagnoses:
  • Whipple's disease - Justification: A rare bacterial infection that can cause weight loss, diarrhea, and malabsorption.
  • Gastric amyloidosis - Justification: A rare condition characterized by deposition of amyloid protein in the stomach, often causing weight loss and gastrointestinal symptoms.