Difference between revisions of "Sandbox: malabsorption"

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{| style="border: 0px; font-size: 100%; margin: 3px;" align="center"
 
{| style="border: 0px; font-size: 100%; margin: 3px;" align="center"
 
! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
 
! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| colspan="9" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestation'''
+
| colspan="10" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestation'''
 
! colspan="9" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Lab findings'''
 
! colspan="9" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Lab findings'''
 
! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
 
! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
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! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
 
! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
 
|-
 
|-
! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" |Symptoms
+
! colspan="9" style="background:#4479BA; color: #FFFFFF;" align="center" |Symptoms
 
! rowspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
 
! rowspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
 
|-
 
|-
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! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
 
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
 
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
 
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
 +
! rowspan="3" |Vomiting
 
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
 
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
 
!
 
!
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|-
 
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!
 
!
| colspan="9" |'''Clinical manifestation'''
+
| colspan="10" |'''Clinical manifestation'''
 
! colspan="9" rowspan="3" |'''Lab findings'''
 
! colspan="9" rowspan="3" |'''Lab findings'''
 
! rowspan="5" |Extra intestinal findings
 
! rowspan="5" |Extra intestinal findings
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|-
 
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! style="background:#DCDCDC;" align="center" |
 
! style="background:#DCDCDC;" align="center" |
! colspan="8" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Symptoms
+
! colspan="9" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Symptoms
 
! rowspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="left" |GI signs
 
! rowspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="left" |GI signs
 
|-
 
|-
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! rowspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Fever
 
! rowspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Fever
 
! rowspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Abdominal pain
 
! rowspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Abdominal pain
 +
!
 
! rowspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Weight loss
 
! rowspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Weight loss
 
|-
 
|-
 
! style="background:#DCDCDC;" align="center" |
 
! style="background:#DCDCDC;" align="center" |
 +
!
 
! colspan="5" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Stool exam
 
! colspan="5" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Stool exam
 
| colspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''CBC'''
 
| colspan="3" style="padding: 5px 5px; background: #F5F5F5;" align="center" |'''CBC'''
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! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Bloody
 
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Bloody
 
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Fatty
 
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Fatty
 +
!
 
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |WBC
 
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |WBC
 
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |RBC
 
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |RBC
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! style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
 
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Revision as of 22:43, 7 December 2017

Diarrhea

Abbreviations: GI: Gastrointestinal; WBC: White blood cells; Plt: Platelets, Hgb: Hemoglobin, IgE: Immunoglobulin E, IgA: Immunoglobulin A

Cause Clinical manifestation Lab findings Extra intestinal findings Cause/Pathogenesis Gold standard diagnosis
Symptoms GI signs
Duration Diarrhea Fever Abdominal pain Vomiting Weight loss
Stool exam CBC Other lab findings
Acute Chronic Watery Bloody Fatty WBC RBC Ova/Parasite Osmotic gap Other WBC Hgb Plt
Whipple's disease - + + - + ± + + - - - ↓/↑
Celiac disease - + ± - ± - + + - -
  • IgA endomysial antibody
  • Anti-tissue transglutaminase antibody
  • Anti-gliadin antibody
  • IgA endomysial antibody
  • IgA tissue transglutaminase antibody
Tropical sprue + + + - + + + + - -
  • Diagnosis of exclusion
Crohns disease - + + + + + + + -
  • Abnormal immune response to self antigens
Ulcerative colitis - + + + + + + + -
  • Hypoalbuminemia
  • Hypokalemia
  • Hypomagnesemia
  • Iron deficiency
  • Elevated ESR
  • Elevated CRP
  • Abnormal immune response to self antigens
Cystic fibrosis - + - - + ± + + - -
  • Positive DNA analysis for CFTR
  • Evaluated nasal transepithelial potential difference (NPD)
VIPoma + + + - + - + + - - -
  • Primary secretory tumor
  • Elevated VIP levels
  • Followed by imaging
Zollinger-Ellison syndrome - + + - + - + + - -
  • Elevated basal or stimulated serum gastrin> 120 pg/mL
Eosinophilic gastroenteritis  - + + - + - + + - -
Primary bile acid malabsorption - + + - + - + + - -
Abetalipoproteinemia - + + - + - + + - - -
Microscopic colitis - + + + - - + + - - -
Hyperthyroidism - + + - - ± + + - - -
  • Elevated T4
  • Elevated T3
  • Decreased TSH
Lactose intolerance + + + - - - + - - - -
Irritable bowel syndrome - + ± - ± - ± - - - - -
  • Diagnosis of exclusion
Chronic pancreatitis - + + - + - + + - - -
  • Slightly elevated amylase and lipase
  • Abnormal pancreatic function test
  • Repeated acute pancreatitis
  • Alcohol abuse
  • Genetic
  • Autoimmune
Cirrhosis - + + - + + + +
  • Jaundice
  • Hepatosplenomegaly
  • Abdominal distention
  • Shifting dullness
  • Asterixis
  • Skin telangiectasias 
  • Abnormal liver function tests
  • Prolonged PT/PTT
  • Coagulopathy
  • Portal hypertension
  • Hepatic encephalopathy
  • Liver biopsy
Short bowel syndrome + + + - + - - + -
  • Prior intestinal surgery
  • Surgical intestinal resection
Small bowel bacterial overgrowth - + + - + - + + - -
  • Excess bacteria in the small intestine
  • Alterations in intestinal anatomy or GI motility, 
  • Lack of gastric acid secretion
  • Diagnosis of exclusion
 X-linked agammaglobulinemia - + + - + + + +
  • Signs of dehydration
  • Signs of infections
- -
  • Hypogammaglobulinemia
  • Recurrent respiratory tract infections
  • Gastroenteritis
  • Bacterial infections
  • Malabsorption
  • Inherited Gene defect 
  • Low circulating immunoglobulin levels (IgG, IgA, IgM, IgE) on blood tests
Intestinal lymphangiectasia - + - - + - - +
  • Peripheral edema
  • Macular edema 
- - -
  • Hypoproteinemia
  • Hypogammaglobulinemia
  • Protein-losing enteropathy
  • Malabsorption
  • Anergy
  • Homograft rejection
  • Pachydermoperiostosis 
  • Dilatation of intestinal lymphatics
Intestinal biopsy
Amyloidosis +
Mastocytosis
Drug induced enteritis
Giardiasis +
Strongyloidiasis
Tuberculosis
Chronic laxative abuse
Pseudomembranous colitis + - + +/- - + + +/-
  • Abdominal tenderness
  • Presence of pseudomembranes of endoscopy
  • Enzyme immunoassay (EIA) for C difficile toxin A and B
  • Polymerase chain reaction (PCR) assay or C difficile antigen (glutamate dehydrogenase [GDH]) EIA
  • Leukocytosis
  • Elevated serum creatinine
  • Hypoalbuminemia
  • Anasarca
  • Elevated serum lactate
  • Recent antibiotics use
  • Recent surgery
  • Colon cancer
  • Diverticulitis
  • Appendicitis
  • Stool exam
  • CT
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
CMV collitis + + +/- + -
+/- + - -
- -
  • CD 4 level decreased as it is maily associated with HIV
Macrobacterium Aviom Complex + + +/- + -
+/- + - -
- -
  • Immune system analysis may show defects
Colon cancer + + + +
- + - -
- ↑/↓ -
  • May be associated with FAP gene or HNPCC gene
Intestinal metastasis + + + +
- + - -
↑/↓ ↑/↓ ↑/↓
Infectious Diarrhea + + - + +/-
+ + - -
  • Stool culture may be positive for responsible organism
- -
  • Trichuris trichiura infection
  • EHEC
  • Entamoeba
  • Intestinal amebiasi
Infectious Diarrhea + + + + -
+ + - -
  • Stool culture may be positive for responsible organism
- -
  • Campylobacter
  • Escherischia coli enterohemmorrhagic
  • Clostridium Perfringens
  • Salmonellosis
Isosporiasis + + + - + + - - -
Parasitic Diarrhea + + + - + +/- + + + - - - Amebiasis

Intestinal Schistosomiasis

Balantidiasis

Trichuriasis


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