Differentials
Anal fissure
SIGNS / SYMPTOMS
Rectal pain, bleeding, excessive straining.
INVESTIGATIONS
Diagnosed clinically by digital rectal examination.
Hypercalcaemia
SIGNS / SYMPTOMS
Tiredness, nausea, vomiting, loss of appetite.
INVESTIGATIONS
Corrected serum calcium level >2.75 micromols/L (>11 mg/dL).
Hypothyroidism
SIGNS / SYMPTOMS
Weight gain, dry skin, depression, fatigue, changes in voice.
INVESTIGATIONS
Thyroid-stimulating hormone level elevated in primary hypothyroidism; low in central hypothyroidism.
Diabetes mellitus
SIGNS / SYMPTOMS
Polyuria, polydipsia, polyphagia.
INVESTIGATIONS
Fasting blood sugar: 6.9 mmol/L (126 mg/dL) or higher.
HbA1c: 48 mmol/mol (6.5%) or higher.
Random plasma glucose: 11 mmol/L (200 mg/dL) or higher in presence of symptoms of polyuria, polydipsia, and unexplained weight loss.
Abnormal oral glucose tolerance test.
Spinal cord lesion
SIGNS / SYMPTOMS
Motor and/or sensory changes in the affected areas of the body.
INVESTIGATIONS
Imaging of the spinal cord with a computed tomography (CT) scan or magnetic resonance imaging (MRI) may help to identify the location and severity of the lesion.
Colonic stricture
SIGNS / SYMPTOMS
Changes in bowel habit, including bowel calibre; gradual onset of symptoms.
INVESTIGATIONS
Endoscopic diagnosis by direct visualisation or by barium enema.
Colon cancer
SIGNS / SYMPTOMS
Weight loss, melaena, haematochezia, changes in bowel habit.
INVESTIGATIONS
Quantitative faecal immunochemical test: positive
Endoscopic diagnosis by direct visualisation or by barium enema/CT.
Ovarian cancer
SIGNS / SYMPTOMS
Abdominal pain, unintentional weight loss, obstructive symptoms.
INVESTIGATIONS
CA-125: may be elevated.
Presence of ovarian mass on abdominal imaging (ultrasound or MRI).
Parkinson's disease
SIGNS / SYMPTOMS
Rigidity, akinesia, tremor.
INVESTIGATIONS
Clinical diagnosis.
Ehlers-Danlos syndrome and joint hypermobility
SIGNS / SYMPTOMS
Joint hypermobility, easily dislocating joints.
INVESTIGATIONS
Clinical diagnosis.
Molecular genetic testing is available for some subtypes of Ehlers-Danlos syndrome.
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