VIPoma differential diagnosis: Difference between revisions

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*[[Facial flushing]]
*[[Facial flushing]]
*[[Abdominal distention]]
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right upper abdominal quadrant
*[[Abdominal tenderness]] in the [[right upper abdominal quadrant]]
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* Elevated [[VIP]] levels
* Elevated [[VIP]] levels

Revision as of 16:59, 4 October 2019

https://www.wikidoc.org/index.php/VIPoma
https://www.wikidoc.org/index.php/VIPoma

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2]Parminder Dhingra, M.D. [3] Homa Najafi, M.D.[4]

Overview

VIPoma must be differentiated from ganglioneuroblastoma, ganglioneuroma, factitious diarrhea, bile salt enteropathy, rectal vilous adenomas, and laxative abuse.

Differential Diagnosis

VIPoma must be differentiated from:[1]

Cause Osmotic gap History Physical exam Gold standard Treatment
< 50 mOsm per kg > 50 mOsm per kg*
Watery Secretory Crohns + -
Hyperthyroidism + -
VIPoma + -
  • Elevated VIP levels
  • Followed by imaging
Osmotic Lactose intolerance - +
Celiac disease - +
Functional Irritable bowel syndrome - -

Abdominal pain or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following:

  • Onset associated with change in frequency of stool
  • Onset associated with change in appearance of stool

History of straining is also common

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VIPoma must be differentiated from diseases that cause abdominal pain and chronic diarrhea. The table below summarizes the findings that differentiate watery causes of chronic diarrhea:[6][2][3][4][5]

Cause Osmotic gap History Physical exam Gold standard for diagnosis
< 50 mOsm per kg > 50 mOsm per kg*
Zollinger-Ellison syndrome + - Gastrin levels
Crohn's disease + -
Hyperthyroidism + -
VIPoma + -
  • Elevated VIP levels
  • Followed by imaging
Lactose intolerance - +
Celiac disease - +
Irritable bowel syndrome - -

Abdominal pain or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following:

  • Onset associated with change in frequency of stool
  • Onset associated with change in appearance of stool

History of straining is also common.


References

  1. Reindl T, Degenhardt P, Luck W, Riebel T, Sarioglu N, Henze G; et al. (2004). "[The VIP-secreting tumor as a differential diagnosis of protracted diarrhea in pediatrics]". Klin Padiatr. 216 (5): 264–9. doi:10.1055/s-2004-44901. PMID 15455292.
  2. 2.0 2.1 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.
  3. 3.0 3.1 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. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.
  4. 4.0 4.1 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.
  5. 5.0 5.1 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.
  6. SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA (1964). "EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME". Gastroenterology. 47: 184–7. PMID 14201408.


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