Signs and Evidence

Making clinical sense of scientific data

Digestive System

Choose the relevant clinical signs you want to include in the calculation of posttest probabilities. The strongest signs are listed the highest.

Anamnesis

1	Constipation	Yes	No	Unknown
2	Migration of pain	Yes	No	Unknown
3	Colic pain	Yes	No	Unknown
4	Abdominal pain	Yes	No	Unknown
5	Chills	Yes	No	Unknown
6	Radiating pain	Yes	No	Unknown
7	Vomiting	Yes	No	Unknown
8	Fever	Yes	No	Unknown
9	Anorexia	Yes	No	Unknown
10	Nausea	Yes	No	Unknown
11	Diarrhea	Yes	No	Unknown

Clinical signs

12	Bowel sounds increased	Yes	No	Unknown
13	Psoas sign	Yes	No	Unknown
14	Bowel sound decreased	Yes	No	Unknown
15	Rebound tenderness	Yes	No	Unknown
16	Murphy's sign	Yes	No	Unknown
17	Abdominal Mass	Yes	No	Unknown
18	Right upper quadrant pain	Yes	No	Unknown
19	Right lower quadrant pain	Yes	No	Unknown

20	Ultrasound for diverticulitis	Yes	No	Unknown
21	Ultrasound for cholelithiasis	Yes	No	Unknown
22	CT for cholecystitis	Yes	No	Unknown
23	Ultrasound for appendicitis	Yes	No	Unknown
24	MRI for cholecystitis	Yes	No	Unknown
25	Ultrasound for cholecystitis	Yes	No	Unknown
26	Leukocytosis (> 10000 / ml)	Yes	No	Unknown

To further investigations

Select the conditions you want to compare

Pretest probabilities will be calculated based on averages from relevant studies.

Select or deselect all boxes

	Change pretest probability
Appendicitis		Acute abdominal pain
Cholecystitis		Acute abdominal pain
Cholelithiasis		Acute abdominal pain
Diverticulitis		Acute abdominal pain
Small bowel obstruction		Acute abdominal pain

Sources used:

1.	David G. Bundy et al. Does This Child Have Appendicitis? JAMA. 2007 Jul 25; 298(4): 438–451.

2.	Trowbridge RL et al. Does This Patient Have Acute Cholecystitis? JAMA, January 1, 2003—Vol 289, No. 1 80-86

3.	Bohner H et al. Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain. Eur J Surg. 1998 Oct;164(10):777-84

4.	Wilkins T et al. Diagnosis and Management of Acute Diverticulitis. Am Fam Physician. 2013 May 1;87(9):612-620

5.	Abraham S et al. Surgical and Nonsurgical Management of Gallstones. Am Fam Physician. 2014 May 15;89(10):795-802

6.	Wagner JM et al. Does This Patient Have Appendicitis? JAMA. 1996;276(19):1589-1594

7.	Hardin M et al. Acute Appendicitis: Review and Update. Am Fam Physician. 1999 Nov 1;60(7):2027-2034

8.	Nshuti R et al. Clinical presentation of acute appendicitis in adults at the Chris Hani Baragwanath academic hospital. Int J Emerg Med. 2014; 7: 12

9.	Lamture YR et al. The role of rebound tenderness in acute appendicitis and appendicular perforation. Int Surg J. 2017 Feb;4(2):725-727

10.	Idris SA et al. The sensitivity and specificity of the conventional symptoms and signs in making adiagnosis of acute appendicitis. Sudan journal of medical sciences. 4. 55-61

11.	Hwang H et al. Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital. Can J Surg. 2014 Jun; 57(3): 162–168

12.	Al-gaithy Zuhoor K et al. Clinical value of total white blood cells and neutrophil counts in patients with suspected appendicitis: retrospective study. World Journal of Emergency Surgery : WJES. 2012;7:32

13.	Al-Ajerami Y et al. Sensitivity and specificity of ultrasound in the diagnosis of acute appendicitis. East Mediterr Health J. 2012 Jan;18(1):66-9

14.	Al-Khayal KA et al. Computed tomography and ultrasonography in the diagnosis of equivocal acute appendicitis. A meta-analysis. Saudi Med J. 2007 Feb;28(2):173-80

15.	Toorenvliet BR et al. Routine ultrasound and limited computed tomography for the diagnosis of acute appendicitis. World J Surg 34(10):2278, October 2010

16.	Neufeld D et al. Management of acute appendicitis: an imaging strategy in children. Ped Surg Internat 26(2):167, February 2010

17.	Doria AS et al. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241(1):83, October 2006

18.	Kiewiet JJS et al. A Systematic Review and Meta-Analysis of Diagnostic Performance of Imaging in Acute Cholecystitis. Radiology September 2012 Volume 264, Issue 3

19.	Klugsberger B et al. Clinical Value of Sonography and CT-Scan in the Diagnosis of Acute Cholecystitis: A Retrospective Analysis. Ann Emerg Surg 2(3): 1021 (2017)

20.	Kumar K et al. To study the sensitivity and specificity of Ultrasonography for diagnosing cholelithiasis in a tertiary care teaching hospital Int J Med Res Prof.2015;1(3); 64-67

21.	Shea JA et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med. 1994;154(22):2573–2581

22.	Saaiq M et al. Diagnostic Accuracy of Leukocytosis in Prediction of Acute Appendicitis. Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (1): 67-69

23.	Dahmardehei M et al. Diagnostic Value of Leukocytosis, ESR and CRP in Patients with Suspected Acute Appendicitis. Zahedan J Res Med Sci 2013 Jul; 15(7): 59-63

24.	Kamran H et al. Role of total leukocyte count in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad 2008;20(3)

25.	Chou YH et al. Sonography of acute right side colonic diverticulitis. Am J Surg. 2001 Feb;181(2):122-7

26.	Ripolles T et al. The role of ultrasound in the diagnosis, management and evolutive prognosis of acute left-sided colonic diverticulitis: a review of 208 patients. Eur Radiol 2003; 13:2587–2595

27.	Parente F et al. Role of early ultrasound in detecting inflammatory intestinal disorders and identifying their anatomical location within the bowel. Ailment Pharmacol Ther 2003; 18:1009–1016

28.	Hollerweger A et al. Colonic diverticulitis: diagnostic value and appearance of inflamed diverticula—sonographic evaluation. Eur Radiol 2001; 11:1956–1963

29.	Kola S et al. Role of Ultrasonography in the diagnosis of the gallstones. Radiology 2013;4(10)

30.	Sarma D et al. Diagnostic imaging for diverticulitis. J Clin Gastroenterol. 2008;42(10):1139–1141

31.	O'Connor ES et al. Outpatient Diverticulitis: Mild or Myth? J Gastrointest Surg. 2012 Jul; 16(7): 1389–1396

32.	Stefánsson R et al. Diverticulitis of the sigmoid colon. Acta Radiologica (1997) 38:2, 313-319

33.	Hastings RS et al. Abdominal pain in the ED: a 35 year retrospective. Am J Emerg Med. 2011 Sep;29(7):711-6

34.	Cervellin G et al. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Ann Transl Med. 2016 Oct; 4(19): 362

35.	Caporale N et al. Acute abdominal pain in the emergency department of a university hospital in Italy. United European Gastroenterology Journal 2016, Vol. 4(2) 297–304