VIPoma differential diagnosis: Difference between revisions
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*Factitious [[diarrhea]] | *Factitious [[diarrhea]] | ||
*[[Laxative abuse]] | *[[Laxative abuse]] | ||
'''The table below summarizes the findings that differentiate watery causes of chronic diarrhea'''<ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=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. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue= | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544 }} </ref><ref name="pmid12135027">{{cite journal| author=Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D| title=Bowel habits and bile acid malabsorption in the months after cholecystectomy. | journal=Am J Gastroenterol | year= 2002 | volume= 97 | issue= 7 | pages= 1732-5 | pmid=12135027 | doi=10.1111/j.1572-0241.2002.05779.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12135027 }} </ref><ref name="pmid1702075">{{cite journal| author=Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R et al.| title=Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia. | journal=Gastroenterology | year= 1991 | volume= 100 | issue= 2 | pages= 359-69 | pmid=1702075 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1702075 }} </ref><ref name="pmid14439871">{{cite journal| author=RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC| title=Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue. | journal=Gastroenterology | year= 1960 | volume= 38 | issue= | pages= 28-49 | pmid=14439871 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14439871 }} </ref> | |||
<small> | |||
{| class="wikitable" | |||
! colspan="3" rowspan="2" |Cause | |||
! colspan="2" |Osmotic gap | |||
! rowspan="2" |History | |||
! rowspan="2" |Physical exam | |||
! rowspan="2" |Gold standard | |||
! rowspan="2" |Treatment | |||
|- | |||
!< 50 mOsm per kg | |||
!> 50 mOsm per kg* | |||
|- | |||
| rowspan="5" |Watery | |||
| rowspan="3" |Secretory | |||
|[[Crohns disease|Crohns]] | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
| | |||
* [[Abdominal pain]] followed by [[diarrhea]] | |||
| | |||
* [[Abdominal]] [[tenderness ]]when palpated in severe [[disease]] | |||
* Blood seen on [[rectal exam]] | |||
*[[Fever]] | |||
*[[Tachycardia]] | |||
*[[Hypotension]] | |||
| | |||
* [[Colonoscopy]] with [[biopsy]] | |||
| | |||
* Topical mucosamine and [[corticosteroids]] are preferred | |||
* [[Mesalamine]] and [[sulfasalazine]] are used for remission | |||
|- | |||
|[[Hyperthyroidism]] | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
| | |||
* Excessive [[sweating]] | |||
* Heat intolerance | |||
* [[Hypermotility|Increased bowel movements]] | |||
| | |||
* Lump in the neck | |||
* [[Proptosis]] | |||
* [[Tremors]] | |||
* Increased DTR | |||
| | |||
* [[TSH]] with [[T3]] and [[T4]] | |||
| | |||
* [[Carbimazole]] and [[methimazole]] | |||
* [[Beta blockers]] like [[propylthiouracil]] | |||
* [[Iodine-131]] | |||
|- | |||
|[[VIPoma]] | |||
|<nowiki>+</nowiki> | |||
| - | |||
| | |||
* Watery [[diarrhea]] | |||
* [[Dehydration]] ([[thirst]], [[dry skin]], [[dry mouth]], [[tiredness]], [[headaches]], and [[dizziness]]) | |||
* [[Lethargy]], [[muscle weakness]] | |||
* [[Nausea]], [[vomiting]] | |||
* Crampy [[abdominal pain]] | |||
* [[Weight loss]] | |||
* [[Flushing]] | |||
| | |||
* [[Tachycardia]] | |||
* [[Rash]] | |||
* [[Facial flushing]] | |||
* [[Abdominal distention]] | |||
* [[Abdominal tenderness]] in the right upper abdominal quadrant | |||
| | |||
* Elevated [[VIP]] levels | |||
* Followed by imaging | |||
| | |||
* [[Sandostatin]] or [[chemotherapy]] for [[malignant tumors]] | |||
* Surgical removal of the [[tumor]] | |||
|- | |||
| rowspan="2" |[[Osmotic]] | |||
|[[Lactose intolerance]] | |||
| - | |||
|<nowiki>+</nowiki> | |||
| | |||
:* [[Abdominal pain]] | |||
:* [[Bloating]] | |||
:* [[Diarrhea]] | |||
:* [[Flatulence]] | |||
| | |||
* [[Abdominal tenderness]] | |||
| | |||
* Intestinal [[biopsy]] | |||
| | |||
* Avoidance of dietary [[lactose]] | |||
* Substitution to maintain nutrient intake | |||
* Regulation of [[calcium]] intake | |||
* Use of [[enzyme]] [[lactase]] | |||
|- | |||
|[[Celiac disease (patient information)|Celiac disease]] | |||
| - | |||
| + | |||
| | |||
* May be asymptomatic | |||
* Vague [[abdominal pain]] | |||
* [[Diarrhea]] | |||
* [[Weight loss]] | |||
* [[Malabsorption]] / [[steatorrhea]] | |||
* Bloatedness | |||
| | |||
* [[Abdominal pain]] and [[cramping]] | |||
* [[Abdominal distention]] | |||
* [[Tetany]] | |||
* [[Mouth ulcers]] | |||
* [[Dermatitis herpetiformis]] | |||
* Signs of the fat-soluble [[Vitamin A|vitamins A]], D, E, and K deficiency | |||
| | |||
* [[IgA]] tissue [[transglutaminase]] Ab | |||
| | |||
* [[Gluten-free diet]] | |||
|- | |||
| | |||
|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: | |||
* Improves with [[defecation]] | |||
* Onset associated with change in frequency of [[stool]] | |||
* Onset associated with change in appearance of stool | |||
* 25% of [[Bowel movement|bowel movements]] are loose stools | |||
History of straining is also common | |||
| | |||
* [[Abdominal tenderness]] | |||
* Hard stool in the rectal vault | |||
| | |||
* [[Diagnosis|Clinical diagnosis]] | |||
** ROME III criteria | |||
** [[Pharmacological|Pharmacologic]] studies based criteria | |||
| | |||
* High [[dietary fiber]] | |||
* [[Osmotic]] [[laxatives]] such as [[polyethylene glycol]], [[sorbitol]], and [[lactulose]] | |||
* [[Antispasmodic]] drugs (e.g. [[Anticholinergic|anticholinergics]] such as [[hyoscyamine]] or [[dicyclomine]]) | |||
|}{{WikiDoc Help Menu}} {{WikiDoc Sources}} | |||
<small> | |||
==References== | ==References== | ||
Revision as of 17:48, 26 July 2017
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VIPoma Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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VIPoma differential diagnosis On the Web |
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American Roentgen Ray Society Images of VIPoma differential diagnosis |
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Risk calculators and risk factors for VIPoma differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
Overview
VIPoma must be differentiated from ganglioneuroblastoma, ganglioneuroma, factitious diarrhea, bilt salt enteropathy, rectal vilous adenomas, and laxative abuse.[1][2]
Differential Diagnosis
VIPoma must be differentiated from:[1][2]
- Ganglioneuroblastoma
- Ganglioneuroma
- Enterotoxin production by Vibrio cholera and E.coli
- Rectal vilous adenomas
- Bile salt entropathy
- Factitious diarrhea
- Laxative abuse
The table below summarizes the findings that differentiate watery causes of chronic diarrhea[3][4][5][6]
| Cause | Osmotic gap | History | Physical exam | Gold standard | Treatment | |||
|---|---|---|---|---|---|---|---|---|
| < 50 mOsm per kg | > 50 mOsm per kg* | |||||||
| Watery | Secretory | Crohns | + | - |
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| Hyperthyroidism | + | - |
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| VIPoma | + | - |
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| ||
| Osmotic | Lactose intolerance | - | + |
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| Celiac disease | - | + |
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| 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:
History of straining is also common |
|
|
| |
References
- ↑ 1.0 1.1 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.
- ↑ 2.0 2.1 Elshafie O, Grant C, Al-Hamdani A, Jain R, Woodhouse N (2011). "VIPoma Crisis: Immediate and life saving reduction of massive stool volumes on starting treatment with octreotide". Sultan Qaboos Univ Med J. 11 (1): 104–7. PMC 3074686. PMID 21509215.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.