Chronic diarrhea differential diagnosis
Chronic diarrhea Microchapters |
Diagnosis |
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Treatment |
Case Studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
The differential diagnosis for chronic diarrhea is enormous, with a large number of diagnostic tests available that can be used to evaluate these patients. Classifying the patient with chronic diarrhea into a subcategory helps to direct the diagnostic work-up.
Differential diagnosis
The table below summarizes the findings that differentiate watery causes of chronic diarrhea
Cause | Osmotic gap | History | Physical exam | Gold standard | Treatment | |||
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< 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 |
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The table below summarizes the findings that differentiate fatty causes of chronic diarrhea
Cause | Osmotic gap | History | Physical exam | Gold standard | Treatment | |
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< 50
mOsm per kg |
> 50
mOsm per kg* | |||||
lactose intolerance | - | + |
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Lactose breath hydrogen test | Restriction of lactose and maintain calcium and vitamin D intake. |
Celiac sprue | - | + |
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Immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody followed by upper ebdoscopy with biopsy. | Dietary counseling, elimination of gluten in the diet. |
Whipple disease | - | + |
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Upper endoscopy with biopsies of the small intestine for T. whipplei testing (histology with PAS staining, polymerase chain reaction [PCR] testing, and immunohistochemistry) | Doxycycline and hydroxychloroquine was bactericidal |
The table below summarizes the findings that differentiate inflammatory causes of chronic diarrhea
Cause | History | Laboratory findings | Diagnosis | Treatment |
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Diverticulitis |
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Abdominal CT scan with oral and intravenous (IV) contrast | bowel rest, IV fluid resuscitation, and broad-spectrum antimicrobial therapy which covers anaerobic bacteria and gram-negative rods |
Ulcerative colitis |
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Endoscopy | Induction of remission with mesalamine and corticosteroids followed by the administration of sulfasalazine and 6-Mercaptopurine depending on the severity of the disease. See ... |
Entamoeba histolytica |
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cysts shed with the stool | detects ameba DNA in feces | Amebic dysentery ;
Luminal amebicides for E. histolytica in the colon:
For amebic liver abscess:
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