PUD should be distinguished from other common gastrointestinal problems during pregnancy such as gastroesophageal reflux disease (GERD), nausea and vomiting of pregnancy, HEG, pancreatitis, acute cholecystitis, viral hepatitis, appendicitis, acute fatty liver of pregnancy, and irritable bowel syndrome. GERD is extremely common in pregnancy and may be partially distinguished from PUD by the findings of pain radiating to the neck, pain exacerbated by drinking acidic drinks, and recumbency. Other symptoms more commonly seen with GERD include nocturnal asthma, hoarseness, laryngitis, or periodontal disease. Pancreatitis is marked with pain exacerbated with eating, pain radiating to the back, and presence of leukocytosis or pyrexia. Additionally, serum amylase and lipase levels are generally increased with pancreatitis. Acute cholecystitis is also associated with exacerbation after ingestion of fatty meals, right upper quadrant pain, fever, and leukocytosis. Acute hepatitis is diagnosed serologically, whereas appendicitis typically has an acute onset of abdominal pain, rebound tenderness, pyrexia, leukocytosis, and anorexia.