Sandbox: malabsorption

Jump to: navigation, search

Differential Diagnosis of Diarrhea

To review the differential diagnosis of diarrhea, click here.

To review the differential diagnosis of acute diarrhea, click here.

To review the differential diagnosis of chronic diarrhea, click here.

To review the differential diagnosis of traveler's diarrhea, click here.

To review the differential diagnosis of acute watery diarrhea, click here.

To review the differential diagnosis of acute bloody diarrhea, click here.

To review the differential diagnosis of acute fatty diarrhea, click here.

To review the differential diagnosis of chronic watery diarrhea, click here.

To review the differential diagnosis of chronic bloody diarrhea, click here.

To review the differential diagnosis of chronic fatty diarrhea, click here.

To review the differential diagnosis of acute diarrhea and fever, click here.

To review the differential diagnosis of chronic diarrhea and fever, click here.

To review the differential diagnosis of acute diarrhea and abdominal pain, click here.

To review the differential diagnosis of chronic diarrhea and abdominal pain, click here.

To review the differential diagnosis of acute diarrhea and weight loss, click here.

To review the differential diagnosis of chronic diarrhea and weight loss, click here.

Diarrhea

The following table outlines the major differential diagnoses of diarrhea.[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]

Abbreviations: GI: Gastrointestinal, CBC: Complete blood count, WBC: White blood cell, RBC: Red blood cell, Plt: Platelet, Hgb: Hemoglobin, ESR: Erythrocyte sedimentation rate, CRP: C–reactive protein, IgE: Immunoglobulin E, IgA: Immunoglobulin A, ETEC: Escherichia coli enteritis, EPEC: Enteropathogenic Escherichia coli, EIEC: Enteroinvasive Escherichia coli, EHEC: Enterohemorrhagic Escherichia coli, EAEC: Enteroaggregative Escherichia coli, Nl: Normal, ASCA: Anti saccharomyces cerevisiae antibodies, ANCA: Anti–neutrophil cytoplasmic antibody, DNA: Deoxyribonucleic acid, CFTR: Cystic fibrosis transmembrane conductance regulator, SLC10A2: Solute carrier family 10 member 2, SeHCAT: Selenium homocholic acid taurine or tauroselcholic acid, IEL: Intraepithelial lymphocytes, MRCP: Magnetic resonance cholangiopancreatography, ANA: Antinuclear antibodies, AMA: Anti-mitochondrial antibody, LDH: Lactate dehydrogenase, CPK: Creatine phosphokinasePCR: Polymerase chain reaction, ELISA: Enzyme–linked immunosorbent assay, LT: Heat–labile enterotoxin, ST: Heat–stable enterotoxin, RT-PCR: Reverse–transcriptase polymerase chain reaction, CD4: Cluster of differentiation 4, HIV: Human immunodeficiency virus, RUQ: Right-upper quadrant, VIP: Vasoactive intestinal peptide, GI: Gastrointestinal, FAP: Familial adenomatous polyposis, HNPCC: Hereditary nonpolyposis colorectal cancer, MTP: Microsomal triglyceride transfer protein, Scl‑70: Anti–topoisomerase I, TSH: Thyroid-stimulating hormone, T4: Thyroxine, T3: Triiodothyronine, DTR: Deep tendon reflex, RNA: Ribonucleic acid

Categories Cause Clinical manifestation Lab findings Extra intestinal findings Cause/Pathogenesis Gold standard diagnosis
Symptoms GI signs
Duration Diarrhea Fever Abdominal pain Weight loss
Stool exam CBC Other lab findings
Acute Chronic Watery Bloody Fatty WBC RBC Ova/Parasite Osmotic gap Other WBC Hgb Plt
Gastrointestinal Crohn's disease + + + + ± + + + + Nl
  • Abnormal immune response to self antigens
Ulcerative colitis + + + + ± + + + + Nl
  • Abnormal immune response to self antigens
Celiac disease + ± ± + + Nl Nl Nl
Cystic fibrosis + + ± + + Nl Nl Nl
Chronic pancreatitis + + + + + Nl Nl Nl Nl
Bile acid malabsorption + + + + Nl Nl Nl Nl
Microscopic colitis + + + + Nl Nl Nl
Infective colitis + + + + + + + + + Nl
Ischemic colitis + + + + + + + + + Nl
Lactose intolerance + + + + Nl Nl Nl
  • Lactose tolerance test
  • Genetic testing
  • Reduction of lactase enzyme activity or inability to produce persistent lactase
  • Congenital lactase deficiency
  • Secondary lactose malabsorption
Irritable bowel syndrome + ± ± ± Nl Nl Nl Nl Nl
  • Unknown
  • Diagnosis of exclusion
Infection Bacterial Whipple's disease + + + ± + + Nl ↓/↑
Tropical sprue + + + + + + + + Nl Nl Nl
  • Diagnosis of exclusion
Small bowel bacterial overgrowth + + + + + + Nl Nl Nl
  • Diagnosis of exclusion
Pseudomembranous enterocolitis + + ± + + ± + + Nl
 Campylobacteriosis + + + + + + + Nl Nl Nl Nl
Salmonellosis + + + + + + + + Nl Nl
Shigellosis + + + + + + + Nl ↑/↓
Escherichia coli enteritis ETEC

(Traveler's diarrhea)

+ + + + Nl Nl Nl
EPEC + + + + + + + + + Nl Nl Nl
EIEC + + + + + + + Nl Nl Nl
EHEC + + + + + + Nl
EAEC + + + + + + + Nl
Yersinia enterocolitica + + + + + + + Nl Nl Nl
Vibrio cholera + + + + Nl Nl Nl
Aeromonas + + + + + + + + Nl Nl Nl
Plesiomonas + + + + + + + Nl Nl Nl
Mycobacterium avium complex + + + + + + + + Nl Nl
Food poisoning + + ± + + ± + ± Nl Nl Nl
  • History of travel or ingestion of infected food
Virus Norovirus + + + + Nl Nl Nl
  • Clinical diagnosis
Rotavirus + + + + Nl Nl Nl Nl
  • Stool immune–based assays
Echovirus + + + + Nl Nl Nl Nl
  • Clinical diagnosis
Adenovirus + + + + Nl
  • Viral antigen assay
Nl Nl Nl
  • Clinical diagnosis
CMV colitis + + + ± + + + Nl
  • Viral antigen assay
Nl Nl
HIV + + + + + + Nl Nl
  • HIV virologic (viral load) test
  • Immunoassay 
Parasite Entamoeba histolytica + + + + + + + + + Nl Nl Nl
  • Antigen testing
  • Serology 
Giardia + + + + + + Nl Nl Nl Nl
  • Antigen detection assays
Cryptosporidium + + + + + Nl
  • Positive stool microscopy
Nl Nl Nl
  • Polymerase chain reaction
Microsporidia + + + + + + Nl
  • Positive stool microscopy
Nl Nl Nl
  • Decreased CD4 count
  • Antigen detection assays
Isospora + + + + + + + + + + Nl Nl Nl
  • Detecting oocysts in the feces
Tumors Carcinoid tumor + + + + + + Nl Nl Nl
VIPoma + + + + + + Nl Nl Nl
  • Primary secretory tumor
  • Blood VIP levels
  • Followed by imaging
Zollinger–Ellison syndrome + + + + + + Nl Nl
Somatostatinoma + + + + Nl Nl Nl
Lymphoma + + + + + + + Nl Nl Nl
  • Primary tumor of GI tract
Colorectal cancer + + + + + + + Nl Nl Nl
Medication/Toxicity Medications + + + ± ± + + ↑/↓ Nl Nl
  • Elevated plasma level of drug
  • Clinical evaluation after discontinuation of the drugs
Factitious diarrhea + + + + + ↑/↓ Nl Nl Nl
  • Clinical evaluation after discontinuation of the drugs
Heavy metal ingestion + + + + Nl Nl Nl Nl
  • Elevated plasma heavy metal level
  • Plasma level of heavy metal
Organophosphate poisoning + + + + Nl Nl Nl Nl
  • Clinical diagnosis
Opium withdrawal + + + + Nl Nl Nl Nl
Iatrogenic Short bowel syndrome + + + + + Nl Nl
Radiation enteritis + + + + + + + + + Nl Nl Nl
Dumping syndrome + + + + Nl Nl Nl Nl
Others Abetalipoproteinemia + + + + + Nl Nl Nl Nl
Hyperthyroidism + + ± + + Nl Nl Nl Nl
Diabetic neuropathy + + + + + Nl Nl Nl
Systemic sclerosis + + ± + + + + Nl Nl Nl
  • Clinical diagnosis
  • Followed by serologic tests
  1. Casburn-Jones, Anna C; Farthing, Michael Jg (2004). "Traveler's diarrhea". Journal of Gastroenterology and Hepatology. 19 (6): 610–618. ISSN 0815-9319. doi:10.1111/j.1440-1746.2003.03287.x. 
  2. Kamat, Deepak; Mathur, Ambika (2006). "Prevention and Management of Travelers’ Diarrhea". Disease-a-Month. 52 (7): 289–302. ISSN 0011-5029. doi:10.1016/j.disamonth.2006.08.003. 
  3. Pfeiffer, Margaret L.; DuPont, Herbert L.; Ochoa, Theresa J. (2012). "The patient presenting with acute dysentery – A systematic review". Journal of Infection. 64 (4): 374–386. ISSN 0163-4453. doi:10.1016/j.jinf.2012.01.006. 
  4. Barr W, Smith A (2014). "Acute diarrhea". Am Fam Physician. 89 (3): 180–9. PMID 24506120. 
  5. Amil Dias J (2017). "Celiac Disease: What Do We Know in 2017?". GE Port J Gastroenterol. 24 (6): 275–278. PMID 29255768. doi:10.1159/000479881. 
  6. Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi A (2017). "Shigellosis". Lancet. PMID 29254859. doi:10.1016/S0140-6736(17)33296-8. 
  7. Yamamoto-Furusho, J.K.; Bosques-Padilla, F.; de-Paula, J.; Galiano, M.T.; Ibañez, P.; Juliao, F.; Kotze, P.G.; Rocha, J.L.; Steinwurz, F.; Veitia, G.; Zaltman, C. (2017). "Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation". Revista de Gastroenterología de México. 82 (1): 46–84. ISSN 0375-0906. doi:10.1016/j.rgmx.2016.07.003. 
  8. Borbély, Yves M; Osterwalder, Alice; Kröll, Dino; Nett, Philipp C; Inglin, Roman A (2017). "Diarrhea after bariatric procedures: Diagnosis and therapy". World Journal of Gastroenterology. 23 (26): 4689. ISSN 1007-9327. doi:10.3748/wjg.v23.i26.4689. 
  9. Crawford, Sue E.; Ramani, Sasirekha; Tate, Jacqueline E.; Parashar, Umesh D.; Svensson, Lennart; Hagbom, Marie; Franco, Manuel A.; Greenberg, Harry B.; O'Ryan, Miguel; Kang, Gagandeep; Desselberger, Ulrich; Estes, Mary K. (2017). "Rotavirus infection". Nature Reviews Disease Primers. 3: 17083. ISSN 2056-676X. doi:10.1038/nrdp.2017.83. 
  10. Kist M (2000). "[Chronic diarrhea: value of microbiology in diagnosis]". Praxis (Bern 1994) (in German). 89 (39): 1559–65. PMID 11068510. 
  11. Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH (1985). "Evaluation and diagnosis of acute infectious diarrhea". Am. J. Med. 78 (6B): 91–8. PMID 4014291. 
  12. López-Vélez R, Turrientes MC, Garrón C, Montilla P, Navajas R, Fenoy S, del Aguila C (1999). "Microsporidiosis in travelers with diarrhea from the tropics". J Travel Med. 6 (4): 223–7. PMID 10575169. 
  13. Wahnschaffe, Ulrich; Ignatius, Ralf; Loddenkemper, Christoph; Liesenfeld, Oliver; Muehlen, Marion; Jelinek, Thomas; Burchard, Gerd Dieter; Weinke, Thomas; Harms, Gundel; Stein, Harald; Zeitz, Martin; Ullrich, Reiner; Schneider, Thomas (2009). "Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas". Scandinavian Journal of Gastroenterology. 42 (3): 391–396. ISSN 0036-5521. doi:10.1080/00365520600881193. 
  14. Mena Bares LM, Carmona Asenjo E, García Sánchez MV, Moreno Ortega E, Maza Muret FR, Guiote Moreno MV, Santos Bueno AM, Iglesias Flores E, Benítez Cantero JM, Vallejo Casas JA (2017). "75SeHCAT scan in bile acid malabsorption in chronic diarrhoea". Rev Esp Med Nucl Imagen Mol. 36 (1): 37–47. PMID 27765536. doi:10.1016/j.remn.2016.08.005. 
  15. Gibson RJ, Stringer AM (2009). "Chemotherapy-induced diarrhoea". Curr Opin Support Palliat Care. 3 (1): 31–5. PMID 19365159. doi:10.1097/SPC.0b013e32832531bb. 
  16. Abraham BP, Sellin JH (2012). "Drug-induced, factitious, & idiopathic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 633–48. PMID 23384808. doi:10.1016/j.bpg.2012.11.007. 
  17. Reintam Blaser A, Deane AM, Fruhwald S (2015). "Diarrhoea in the critically ill". Curr Opin Crit Care. 21 (2): 142–53. PMID 25692805. doi:10.1097/MCC.0000000000000188. 
  18. McMahan ZH, DuPont HL (2007). "Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy". Aliment. Pharmacol. Ther. 25 (7): 759–69. PMID 17373914. doi:10.1111/j.1365-2036.2007.03261.x. 
  19. Schiller LR (2012). "Definitions, pathophysiology, and evaluation of chronic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 551–62. PMID 23384801. doi:10.1016/j.bpg.2012.11.011. 
  20. Giannella RA (1986). "Chronic diarrhea in travelers: diagnostic and therapeutic considerations". Rev. Infect. Dis. 8 Suppl 2: S223–6. PMID 3523719. 
  21. Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology.". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544. 
  22. Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy.". Am J Gastroenterol. 97 (7): 1732–5. PMID 12135027. doi:10.1111/j.1572-0241.2002.05779.x. 
  23. Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia.". Gastroenterology. 100 (2): 359–69. PMID 1702075. 
  24. RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue.". Gastroenterology. 38: 28–49. PMID 14439871. 
  25. Konvolinka CW (1994). "Acute diverticulitis under age forty.". Am J Surg. 167 (6): 562–5. PMID 8209928. 
  26. Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006). "The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications.". Gut. 55 (6): 749–53. PMC 1856208Freely accessible. PMID 16698746. doi:10.1136/gut.2005.082909. 
  27. Haque R, Huston CD, Hughes M, Houpt E, Petri WA (2003). "Amebiasis.". N Engl J Med. 348 (16): 1565–73. PMID 12700377. doi:10.1056/NEJMra022710. 
  28. Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance.". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025. 
  29. Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556Freely accessible. PMID 9414969. 
  30. BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease.". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722. 

Linked-in.jpg