Sandbox mir: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 1: Line 1:
{| class="wikitable"
! rowspan="2" |Cause
! colspan="2" |Diarrhea
! rowspan="2" |Age of onset
! colspan="3" |History
! rowspan="2" |Physical exam
! rowspan="2" |Lab findings
! rowspan="2" |Additional finding
! rowspan="2" |Cause
! rowspan="2" |Gold standard dignosis
|-
!Watery
!Fatty
!Weight loss
!FTT
!Abdominal pain
|-
|[[Celiac disease (patient information)|Celiac disease]]
| +/-
| +/-
|Childhood
Adult
| +
| +
| +
|
*[[Abdominal distention]]
*[[Tetany]]
*[[Mouth ulcers]]
*[[Dermatitis herpetiformis]]
*Signs of the fat-soluble [[Vitamin A|vitamins A]], [[Vitamin D|D]], E, and K deficiency
|
* IgA endomysial antibody (IgA EMA)
* IgA tissue transglutaminase antibody (IgA tTG)
* IgG tissue transglutaminase antibody (IgG tTG)
* IgA deamidated gliadin peptide (IgA DGP)
* IgG deamidated gliadin peptide (IgG DGP)
|
*[[Gluten-free diet]]
|
* HLA-DQ2 and/or DQ8 gene mutation
* Innate responses to wheat proteins
|
*Immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody
|-
|[[Lactose intolerance]]
| +
| -
|Adult
| -
| -
| +
|
*[[Abdominal tenderness]]
|
* Stool osmotic gap of >125 mOsm/kg
* Stool pH <6
|
*Avoidance of dietary [[lactose]]
*Substitution to maintain nutrient intake
*Regulation of [[calcium]] intake
*Use of [[enzyme]] [[lactase]]
|
* Acquired primary lactase deficiency
** Adult-type hypolactasia
** Lactase nonpersistence)
|
*Lactose breath hydrogen test
|-
|[[Cystic fibrosis]]
| -
| +
|Infancy and childhood
| +
| +
| +
|
*Digital clubbing
*Respiratory rale, wheeze, and crunckles
*Abdominal pain
*Cyanosis
|
*Positive DNA analysis for CFTR multimutation method
*Evaluated nasal transepithelial potential difference (NPD)
|
*Disease manifestations in multiple organ systems:
**Diabetes
**Recurrent upper and lower respiratory tract infections
**Infertility
|Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein
|
*Elevated sweat chloride ≥60 mmol/L
|-
|[[Laxative abuse|Laxative overuse]]
| +
| -
|After childhood
|<nowiki>+/-</nowiki>
| -
| +/-
|
* enhanced gastrointestinal motility and gastrointestinal sound
* Mild abdominal tenderness
* Abdominal bloating
|
* Hypokalemia
* Metabolic alkalosis
* Hypermagnesemia(in case of magnesium laxative usage)
|<nowiki>-</nowiki>
|Laxative drug abuse
|
* laxative screening on a stool for:
** Diphenolic laxatives (eg, bisacodyl)
** Polyethylene glycol-containing laxatives
|-
|[[Crohns disease]]
| +
| -
|Young adults
(20th)
| +
|
| +
|
*[[Abdominal]] [[tenderness ]]when palpated in severe [[disease]]
*Blood seen on [[rectal exam]]
*[[Fever]]
*[[Tachycardia]]
*[[Hypotension]]
|
|
*Topical mucosamine and [[corticosteroids]] are preferred
*[[Mesalamine]] and [[sulfasalazine]] are used for remission
|
|
*[[Colonoscopy]] with [[biopsy]]
|-
|[[Hyperthyroidism]]
| +
| -
|
|
|
|
|
*Lump in the neck
*[[Proptosis]]
*[[Tremors]]
*Increased DTR
|
*
|
*
|
|
*[[TSH]] with [[T3]] and [[T4]]
|-
|[[VIPoma]]
| +
| -
|
|<nowiki>+</nowiki>
|
|
|
*[[Tachycardia]]
*[[Rash]]
*[[Facial flushing]]
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right upper abdominal quadrant
|
*
|
*[[Dehydration]]
*[[Lethargy]], [[muscle weakness]]
*[[Nausea]], [[vomiting]]
*[[Flushing]]
|
|
*Elevated [[VIP]] levels
*Followed by imaging
|-
|[[Irritable bowel syndrome]]
| +
| -
|
|
|
|
|
*[[Abdominal tenderness]]
*Hard stool in the rectal vault
|
|
*High [[dietary fiber]]
*[[Osmotic]] [[laxatives]] such as [[polyethylene glycol]], [[sorbitol]], and [[lactulose]]
*[[Antispasmodic]] drugs (e.g. [[Anticholinergic|anticholinergics]] such as [[hyoscyamine]] or [[dicyclomine]])
|
|
*[[Diagnosis|Clinical diagnosis]]
**ROME III criteria
**[[Pharmacological|Pharmacologic]] studies based criteria
|-
|[[lactose intolerance]]
| -
| +
|
|
|
|
|
*[[Abdominal]] [[tenderness ]]when palpated in severe [[disease]]
*[[Fever]]
*[[Hypotension]]
*[[Tachycardia]]
*[[Nausea and vomiting]]
|
*[[Bloating|Bloating,]]
*[[Flatulence]]
*Symptoms begin mainly after ingestion of [[lactose]]
|
|
|[[Hydrogen Breath Test|Lactose breath hydrogen test]]
|-
|[[Whipple's disease|Whipple disease]]
| -
| +
|
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
*
|
*[[Leukocytopenia]]
*[[Thrombocytopenia]]
|
*[[Skin hyperpigmentation]]
*[[Arthralgias]]
|
|Upper [[endoscopy]] with [[biopsies]] of the [[small intestine]] for ''[[Tropheryma whipplei|T. whipplei]]'' testing ([[histology]] with [[Periodic acid-Schiff stain|PAS staining]], [[polymerase chain reaction]] [[[PCR]]] testing, and [[immunohistochemistry]])
|-
|Allergic enteropathy/Food protein-induced enterocolitis syndrome (FPIES)
| +
| -
|Infancy
| +/-
| +/-
| +
|
*Nausea
*Vomiting
*Abdominal distention
|S/E:
*Blood-tinged and mucusy
*Polymorphonuclear leukocytes presence
|
*triggered by cow's milk protein
*profuse, repetitive vomiting
|
|oral food challenge (OFC)
|-
|[[Eosinophilic gastroenteritis]]
| +
| -
|3rd decade
| +/-
| +/-
| +
|
*Nausea
*Vomiting
*Abdominal distention
|
*elevated serum IgE levels
*abnormal D-xylose test
|
*one-half of patients have other allergic diseases
*associated with an identifiable dietary antigen
|
|eosinophilic infiltration of the gastrointestinal tract on biopsy
|-
|[[Microscopic colitis]]
| +
| -
|6th decde
| +
| -
| +
|
*Abdominal tenderness
|
*autoantibodies include:
**RF
**ANA
**AMA
**ANCA
|
*Fecal urgency
*Incontinence
*My be associated with extraintestinal symptoms, such as:
**Arthralgia
**Arthritis
**Uveitis
|
|
*A colonoscopy with mucosal biopsy with mononuclear infiltrates:
**Collagenous colitis is characterized by a colonic subepithelial collagen band >10 micrometers in diameter
**Lymphocytic colitis is characterized by ≥20 intraepithelial lymphocytes (IEL) per 100 surface epithelial cells
|-
|Congenital chloride diarrhea
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|Neonate
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
*Hyponatremia
*Hypochloremia
*Metabolic alkalosis
|
*History of polyhydramnios
*Mutations in the ''SLC26A3'' gene
**Encodes for an epithelial anion exchanger
|
|
*Excessive fecal secretion of chloride
|-
|Congenital sodium diarrhea
| +
| -
|Neonate
| +
| +
| -
| -
|S/E:
*Alkaline
*Fecal sodium concentrations
Serum:
*Metabolic acidosis
*Hyponatremia
|
*May be associated with choanal or anal atresia
|
|
|-
|Glucose-galactose malabsorption
| +
| -
|Infancy
| +
| +/-
| +
|Abdominal tenderness
|
|
*severe life-threatening diarrhea
*Dehydration
*Symptomatic as long as the diet includes lactose or its hydrolysis products, glucose and galactose
|
|
*positive glucose breath hydrogen test + normal intestinal biopsy
|-
|Abetalipoproteinemia
| -
| +
|Infancy
| +
| +
| +
|Abdominal distention
Impaired visual acuity and visual field defects
Dysarthria
|Low triglyceride
Low total cholesterol levels
Acanthocytes
Low vitamin E levels
|Clumsiness
vision impairment
Ataxia
|
* autosomal recessive disorder caused by mutations encoding the microsomal triglyceride transfer protein (MTP)
|Clinical findings and low triglyceride and cholesterol level
|-
|Primary bile acid malabsorption
| +
| +/-
|Childhood Adolescents
| +
| +
| +/-
| -
|
|Disease hetergenicity lead to varying presentation from chronic diarrhea without significant fat malabsorption to severe watery diarrhea and steatorrhea with malnutrition
|
* genetic defects in ''SLC10A2'' (solute carrier family 10 member 2 gene)
|
* Total and specific bile acids from stool
* Gamma emitter selenium-75-homocholic acid taurine (SeHCAT)
|-
! rowspan="2" |Cause
! colspan="2" |Diarrhea
! rowspan="2" |Age of onset
! colspan="3" |History
! rowspan="2" |Physical exam
! rowspan="2" |Lab findings
! rowspan="2" |Additional finding
! rowspan="2" |Cause
! rowspan="2" |Gold standard dignosis
|-
!Watery
!Fatty
!Weight loss
!FTT
!Abdominal pain
|-
|Gastrinoma (Zollinger-Ellison syndrome)
| +
| -
|between the ages of 20 and 50
| +
| +/-
| +
|Mild to moderate upper abdominal tenderness
|Positive secretin stimulation test
Elevated serum chromogranin A
|heartburn
|Gastrin producing tumor mainly in duodenum
|elevated basal or stimulated serum gastrin more than 1000 pg/mL
|}
BULLETED
BULLETED
   
   
Line 14: Line 455:
*[[Asymptomatic bacteriuria]]
*[[Asymptomatic bacteriuria]]
*[[Atrophic vaginitis]]
*[[Atrophic vaginitis]]
*[[Atypical gastroenteritis]]
*[[Bacterial endophthalmitis]]
*[[Bacterial endophthalmitis]]
*[[Bacterial gastroenteritis]]
*[[Bacterial gastroenteritis]]
Line 25: Line 465:
*[[Blepharitis]]
*[[Blepharitis]]
*[[Boil]]
*[[Boil]]
*[[Bone abscess]]
*[[Bourbon virus infection]]
*[[Bourbon virus infection]]
*[[Brain abscess]]
*[[Brain abscess]]
Line 37: Line 476:
*[[Cervicitis]]
*[[Cervicitis]]
*[[Chagas disease]]
*[[Chagas disease]]
*[[Chemical proctocolitis]]
*[[Chicken pox]]
*[[Chicken pox]]
*[[Chlamydia]]
*[[Chlamydia]]
Line 56: Line 494:
*[[Congenital toxoplasmosis]]
*[[Congenital toxoplasmosis]]
*[[Congenital varicella]]
*[[Congenital varicella]]
*[[Congenital zika]]
*[[Conjunctivitis]]
*[[Conjunctivitis]]
*[[Coxsackie a & b infections]]
*[[Coxsackie a virus]]
*[[Coxsackie a virus]]
*[[Coxsackie b]]
*[[Coxsackie b]]
*[[Coxsackie b & b4]]
*[[Coxsackie virus]]
*[[Coxsackie virus]]
*[[Cryptococcus]]
*[[Cryptococcus]]
Line 99: Line 534:
*[[Hantavirus infection]]
*[[Hantavirus infection]]
*[[Helicobacter pylori infection]]
*[[Helicobacter pylori infection]]
*[[Hepatitis b]]
*[[Hepatitis]]
*[[Hepatitis c]]
*[[Hepatitis A]]
*[[Hepatitis B]]
*[[Hepatitis c|Hepatitis C]]
*[[Hepatitis D]]
*[[Herpangina]]
*[[Herpangina]]
*[[Herpes simplex]]
*[[Herpes simplex]]
*[[Histoplasmosis]]
*[[Histoplasmosis]]
*[[Hiv]]
*[[Hiv]]
*[[Hpv]]
*[[HPV infection]]
*[[Impetigo]]
*[[Impetigo]]
*[[Infectious colitis]]
*[[Infectious colitis]]
Line 137: Line 575:
*[[Pelvic inflammatory disease]]
*[[Pelvic inflammatory disease]]
*[[Peritonitis]]
*[[Peritonitis]]
*[[Peritonitis lp]]
*[[Pharyngitis]]
*[[Pharyngitis]]
*[[Phlebitis]]
*[[Phlebitis]]
Line 157: Line 594:
*[[Rhinitis]]
*[[Rhinitis]]
*[[Rhinosinusitis]]
*[[Rhinosinusitis]]
*[[Roseola (exanthem subitum)]]
*[[Roseola|Roseola (exanthem subitum)]]
*[[Rotavirus infection]]
*[[Rotavirus infection]]
*[[Rubella]]
*[[Rubella]]
*[[Rubella infection]]
*[[Salmonella enterica]]
*[[Salmonella enterica]]
*[[Sbp]]
*[[Scabies]]
*[[Scabies]]
*[[Seborrheic dermatitis]]
*[[Seborrheic dermatitis]]
Line 171: Line 606:
*[[Spontaneous bacterial peritonitis]]
*[[Spontaneous bacterial peritonitis]]
*[[Staphylococcus aureus infection]]
*[[Staphylococcus aureus infection]]
*[[Std landing page]]
*[[Sexually transmitted disease|S]]TD
*[[Stomatitis]]
*[[Stomatitis]]
*[[Strep throat]]
*[[Strep throat]]
*[[Streptococcal pneumonia infection]]
*[[Strongyloides]]
*[[Strongyloidiasis]]
*[[Strongyloidiasis]]
*[[Syphilis]]
*[[Syphilis]]
Line 185: Line 618:
*[[Trench mouth]]
*[[Trench mouth]]
*[[Trichomonas]]
*[[Trichomonas]]
*[[Trichuriasis/whipworm]]
*[[Trichuriasis]]
*[[Tropical sprue]]
*[[Tropical sprue]]
*[[Trypanosomiasis]]
*[[Trypanosomiasis]]
*[[Tss]]
*[[Tuberculous abscess]]
*[[Typhoid fever]]
*[[Typhoid fever]]
*[[Typhus]]
*[[Typhus]]
*[[Ulcerative colitis]]
*[[Ulcerative colitis]]
*[[Ureaplasma urealyticum]]
*[[Ureaplasma urealyticum]]
*[[Ureaplasma urealyticum infection]]
*[[Urethritis]]
*[[Urethritis]]
*[[Uti]]
*[[Uti]]
Line 203: Line 633:
*[[Viral meningitis]]
*[[Viral meningitis]]
*[[Whip worm infection]]
*[[Whip worm infection]]
*[[Wool sorter's disease]]
*[[Wool Sorter's Disease|Wool sorter's disease]]
*[[Zika virus]]
*[[Zika virus]]

Revision as of 23:20, 12 September 2017

Cause Diarrhea Age of onset History Physical exam Lab findings Additional finding Cause Gold standard dignosis
Watery Fatty Weight loss FTT Abdominal pain
Celiac disease +/- +/- Childhood

Adult

+ + +
  • IgA endomysial antibody (IgA EMA)
  • IgA tissue transglutaminase antibody (IgA tTG)
  • IgG tissue transglutaminase antibody (IgG tTG)
  • IgA deamidated gliadin peptide (IgA DGP)
  • IgG deamidated gliadin peptide (IgG DGP)
  • HLA-DQ2 and/or DQ8 gene mutation
  • Innate responses to wheat proteins
  • Immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody
Lactose intolerance + - Adult - - +
  • Stool osmotic gap of >125 mOsm/kg
  • Stool pH <6
  • Acquired primary lactase deficiency
    • Adult-type hypolactasia
    • Lactase nonpersistence)
  • Lactose breath hydrogen test
Cystic fibrosis - + Infancy and childhood + + +
  • Digital clubbing
  • Respiratory rale, wheeze, and crunckles
  • Abdominal pain
  • Cyanosis
  • Positive DNA analysis for CFTR multimutation method
  • Evaluated nasal transepithelial potential difference (NPD)
  • Disease manifestations in multiple organ systems:
    • Diabetes
    • Recurrent upper and lower respiratory tract infections
    • Infertility
 Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein
  • Elevated sweat chloride ≥60 mmol/L
Laxative overuse + - After childhood +/- - +/-
  • enhanced gastrointestinal motility and gastrointestinal sound
  • Mild abdominal tenderness
  • Abdominal bloating
  • Hypokalemia
  • Metabolic alkalosis
  • Hypermagnesemia(in case of magnesium laxative usage)
 - Laxative drug abuse
  • laxative screening on a stool for:
    • Diphenolic laxatives (eg, bisacodyl)
    • Polyethylene glycol-containing laxatives
Crohns disease + - Young adults

(20th)

+ +
Hyperthyroidism + -
VIPoma + - +
  • Elevated VIP levels
  • Followed by imaging
Irritable bowel syndrome + -
lactose intolerance - + Lactose breath hydrogen test
Whipple disease - + + - +
Upper endoscopy with biopsies of the small intestine for T. whipplei testing (histology with PAS staining, polymerase chain reaction [[[PCR]]] testing, and immunohistochemistry)
Allergic enteropathy/Food protein-induced enterocolitis syndrome (FPIES) + - Infancy +/- +/- +
  • Nausea
  • Vomiting
  • Abdominal distention
 S/E:
  • Blood-tinged and mucusy
  • Polymorphonuclear leukocytes presence
  • triggered by cow's milk protein
  • profuse, repetitive vomiting
 oral food challenge (OFC)
Eosinophilic gastroenteritis + - 3rd decade +/- +/- +
  • Nausea
  • Vomiting
  • Abdominal distention
  • elevated serum IgE levels
  • abnormal D-xylose test
  • one-half of patients have other allergic diseases
  • associated with an identifiable dietary antigen
 eosinophilic infiltration of the gastrointestinal tract on biopsy
Microscopic colitis + - 6th decde + - +
  • Abdominal tenderness
  • autoantibodies include:
    • RF
    • ANA
    • AMA
    • ANCA
  • Fecal urgency
  • Incontinence
  • My be associated with extraintestinal symptoms, such as:
    • Arthralgia
    • Arthritis
    • Uveitis
  • A colonoscopy with mucosal biopsy with mononuclear infiltrates:
    • Collagenous colitis is characterized by a colonic subepithelial collagen band >10 micrometers in diameter
    • Lymphocytic colitis is characterized by ≥20 intraepithelial lymphocytes (IEL) per 100 surface epithelial cells
Congenital chloride diarrhea + - Neonate + + - -
  • Hyponatremia
  • Hypochloremia
  • Metabolic alkalosis
  • History of polyhydramnios
  • Mutations in the SLC26A3 gene
    • Encodes for an epithelial anion exchanger
  • Excessive fecal secretion of chloride
Congenital sodium diarrhea + - Neonate + + - - S/E:
  • Alkaline
  • Fecal sodium concentrations

Serum:

  • Metabolic acidosis
  • Hyponatremia
  • May be associated with choanal or anal atresia
Glucose-galactose malabsorption + - Infancy + +/- + Abdominal tenderness
  • severe life-threatening diarrhea
  • Dehydration
  • Symptomatic as long as the diet includes lactose or its hydrolysis products, glucose and galactose
  • positive glucose breath hydrogen test + normal intestinal biopsy
Abetalipoproteinemia - + Infancy + + + Abdominal distention

Impaired visual acuity and visual field defects

Dysarthria

Low triglyceride

Low total cholesterol levels

Acanthocytes

Low vitamin E levels

Clumsiness

vision impairment

Ataxia

  • autosomal recessive disorder caused by mutations encoding the microsomal triglyceride transfer protein (MTP)
 Clinical findings and low triglyceride and cholesterol level
Primary bile acid malabsorption + +/- Childhood Adolescents + + +/- - Disease hetergenicity lead to varying presentation from chronic diarrhea without significant fat malabsorption to severe watery diarrhea and steatorrhea with malnutrition
  • genetic defects in SLC10A2 (solute carrier family 10 member 2 gene)
  • Total and specific bile acids from stool
  • Gamma emitter selenium-75-homocholic acid taurine (SeHCAT)
Cause Diarrhea Age of onset History Physical exam Lab findings Additional finding Cause Gold standard dignosis
Watery Fatty Weight loss FTT Abdominal pain
Gastrinoma (Zollinger-Ellison syndrome) + - between the ages of 20 and 50 + +/- + Mild to moderate upper abdominal tenderness Positive secretin stimulation test

Elevated serum chromogranin A

heartburn Gastrin producing tumor mainly in duodenum elevated basal or stimulated serum gastrin more than 1000 pg/mL

BULLETED

Retrieved from "https://www.wikidoc.org/index.php?title=Sandbox_mir&oldid=1351238"