Sandbox: malabsorption
Differential Diagnosis of Diarrhea
To review the differential diagnosis of diarrhea, click here.
To review the differential diagnosis of acute diarrhea, click here.
To review the differential diagnosis of chronic diarrhea, click here.
To review the differential diagnosis of traveler's diarrhea, click here.
To review the differential diagnosis of acute watery diarrhea, click here.
To review the differential diagnosis of acute bloody diarrhea, click here.
To review the differential diagnosis of acute fatty diarrhea, click here.
To review the differential diagnosis of chronic watery diarrhea, click here.
To review the differential diagnosis of chronic bloody diarrhea, click here.
To review the differential diagnosis of chronic fatty diarrhea, click here.
To review the differential diagnosis of acute diarrhea and fever, click here.
To review the differential diagnosis of chronic diarrhea and fever, click here.
To review the differential diagnosis of acute diarrhea and abdominal pain, click here.
To review the differential diagnosis of chronic diarrhea and abdominal pain, click here.
To review the differential diagnosis of acute diarrhea and weight loss, click here.
To review the differential diagnosis of chronic diarrhea and weight loss, click here.
Diarrhea
The following table outlines the major differential diagnoses of diarrhea.[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]
Abbreviations: GI: Gastrointestinal, CBC: Complete blood count, WBC: White blood cell, RBC: Red blood cell, Plt: Platelet, Hgb: Hemoglobin, ESR: Erythrocyte sedimentation rate, CRP: C–reactive protein, IgE: Immunoglobulin E, IgA: Immunoglobulin A, ETEC: Escherichia coli enteritis, EPEC: Enteropathogenic Escherichia coli, EIEC: Enteroinvasive Escherichia coli, EHEC: Enterohemorrhagic Escherichia coli, EAEC: Enteroaggregative Escherichia coli, Nl: Normal, ASCA: Anti saccharomyces cerevisiae antibodies, ANCA: Anti–neutrophil cytoplasmic antibody, DNA: Deoxyribonucleic acid, CFTR: Cystic fibrosis transmembrane conductance regulator, SLC10A2: Solute carrier family 10 member 2, SeHCAT: Selenium homocholic acid taurine or tauroselcholic acid, IEL: Intraepithelial lymphocytes, MRCP: Magnetic resonance cholangiopancreatography, ANA: Antinuclear antibodies, AMA: Anti-mitochondrial antibody, LDH: Lactate dehydrogenase, CPK: Creatine phosphokinase, PCR: Polymerase chain reaction, ELISA: Enzyme–linked immunosorbent assay, LT: Heat–labile enterotoxin, ST: Heat–stable enterotoxin, RT-PCR: Reverse–transcriptase polymerase chain reaction, CD4: Cluster of differentiation 4, HIV: Human immunodeficiency virus, RUQ: Right-upper quadrant, VIP: Vasoactive intestinal peptide, GI: Gastrointestinal, FAP: Familial adenomatous polyposis, HNPCC: Hereditary nonpolyposis colorectal cancer, MTP: Microsomal triglyceride transfer protein, Scl‑70: Anti–topoisomerase I, TSH: Thyroid-stimulating hormone, T4: Thyroxine, T3: Triiodothyronine, DTR: Deep tendon reflex, RNA: Ribonucleic acid
Categories | Cause | 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 | ||||||||||||
Gastrointestinal | Crohn's disease | – | + | + | + | + | ± | + | + |
|
+ | + | – | Nl | – | ↑ | ↓ | ↑ |
|
|
|
| ||
Ulcerative colitis | – | + | + | + | + | ± | + | + | + | + | – | Nl | – | ↑ | ↓ | ↑ |
|
|
| |||||
Celiac disease | – | + | ± | – | ± | – | + | + |
|
– | – | – | Nl |
|
Nl | ↓ | Nl |
|
| |||||
Cystic fibrosis | – | + | – | – | + | ± | + | + | – | – | – | Nl |
|
Nl | ↓ | Nl |
|
|
| |||||
Chronic pancreatitis | – | + | + | – | + | – | + | + | – | – | – | Nl |
|
Nl | Nl | Nl |
|
|||||||
Bile acid malabsorption | – | + | + | – | + | – | – | + | – | – | – | Nl |
|
Nl | Nl | Nl |
|
|
| |||||
Microscopic colitis | – | + | + | – | – | – | + | + | – | – | – | Nl | – | Nl | ↓ | Nl |
|
|
| |||||
Infective colitis | – | + | + | + | – | + | + | + |
|
+ | + | + | Nl |
|
↑ | ↓ | ↑ | |||||||
Ischemic colitis | + | + | + | + | – | + | + | + |
|
+ | + | – | Nl | – | ↑ | ↓ | ↑ |
|
|
| ||||
Lactose intolerance | + | + | + | – | – | – | + | – | – | – | – | ↑ | – | Nl | Nl | Nl |
|
|
| |||||
Irritable bowel syndrome | – | + | ± | – | ± | – | ± | – | – | – | – | Nl | – | Nl | Nl | Nl | Nl |
|
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Infection | Bacterial | Whipple's disease | – | + | + | – | + | ± | + | + | – | – | – | Nl |
|
↓ | ↓ | ↓/↑ |
|
| ||||
Tropical sprue | + | + | + | – | + | + | + | + |
|
+ | – | – | Nl |
|
Nl | ↓ | Nl |
| ||||||
Small bowel bacterial overgrowth | – | + | + | – | + | – | + | + | + | – | – | Nl |
|
Nl | ↓ | Nl |
|
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Pseudomembranous enterocolitis | + | – | + | ± | – | + | + | ± | + | + | – | Nl |
|
↑ | ↓ | ↓ |
|
|
| |||||
Campylobacteriosis | + | – | + | + | – | + | + | – |
|
+ | + | – | Nl |
|
↑ | Nl | Nl | Nl | ||||||
Salmonellosis | + | + | + | + | – | + | + | – | + | + | – | Nl |
|
↑ | Nl | ↑ | ||||||||
Shigellosis | + | – | + | + | – | + | + | – |
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+ | + | – | Nl |
|
↑/↓ | ↓ | ↓ |
|
||||||
Escherichia coli enteritis | ETEC | + | – | + | – | – | + | – | – |
|
+ | – | – | Nl |
|
↑ | Nl | Nl | – | – |
|
|||
EPEC | + | + | + | + | – | + | + | + |
|
+ | + | – | Nl |
|
↑ | Nl | Nl | – | – |
| ||||
EIEC | + | – | + | + | – | + | + | – |
|
+ | + | – | Nl |
|
↑ | Nl | Nl | – | – | |||||
EHEC | + | – | + | + | – | – | + | – |
|
+ | + | – | Nl |
|
↑ | ↓ | ↓ | |||||||
EAEC | + | + | + | + | – | – | + | – |
|
+ | + | – | Nl |
|
↑ | ↓ | ↓ | – |
|
|||||
Yersinia enterocolitica | + | – | + | + | – | + | + | – |
|
+ | + | – | Nl |
|
↑ | Nl | Nl | – | ||||||
Vibrio cholera | + | – | + | – | – | – | + | – | + | – | – | Nl |
|
↑ | Nl | Nl |
|
|||||||
Aeromonas | + | + | + | + | – | + | + | – |
|
+ | + | – | Nl |
|
↑ | Nl | Nl | – |
|
| ||||
Plesiomonas | + | – | + | + | – | + | + | – |
|
+ | + | – | Nl |
|
↑ | Nl | Nl | – |
|
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Mycobacterium avium complex | + | + | + | + | – | + | + | – | + | + | – | Nl | – | ↓ | ↓ | Nl |
|
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Food poisoning | + | – | + | ± | – | + | + | ± | + | ± | – | Nl |
|
↑ | Nl | Nl | – |
|
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Virus | Norovirus | + | – | + | – | – | + | + | – | – | – | – | Nl |
|
↓ | Nl | Nl | – |
| |||||
Rotavirus | + | – | + | – | – | + | – | – |
|
+ | – | – | Nl | – | Nl | Nl | Nl |
| ||||||
Echovirus | + | – | + | – | – | + | + | – | – | – | – | Nl | – | Nl | Nl | Nl | – |
| ||||||
Adenovirus | + | – | + | – | – | + | + | – | – | – | – | Nl |
|
Nl | Nl | Nl | – |
| ||||||
CMV colitis | + | + | – | + | – | ± | + | – |
|
+ | + | – | Nl |
|
↓ | Nl | Nl |
|
| |||||
HIV | – | + | + | – | – | + | + | + | + | – | – | Nl | – | ↓ | ↓ | Nl |
|
|
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Parasite | Entamoeba histolytica | + | + | + | + | – | + | + | – | + | + | + | Nl | – | ↑ | Nl | Nl | – |
|
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Giardia | – | + | + | – | + | – | + | + | – | – | + | Nl | – | Nl | Nl | Nl | – |
| ||||||
Cryptosporidium | – | + | + | – | – | – | + | + | – | – | + | Nl |
|
Nl | Nl | Nl |
|
|
| |||||
Microsporidia | + | + | + | – | – | + | + | – | – | – | + | Nl |
|
Nl | Nl | Nl |
|
| ||||||
Isospora | + | + | + | – | + | + | + | + | + | + | + | Nl |
|
↑ | Nl | Nl |
|
|
| |||||
Tumors | Carcinoid tumor | – | + | + | + | – | – | + | + | – | + | – | ↓ | – | Nl | Nl | Nl |
|
|
| ||||
VIPoma | + | + | + | – | + | – | + | + |
|
– | – | – | ↓ | – | Nl | Nl | Nl |
|
|
| ||||
Zollinger–Ellison syndrome | – | + | + | + | + | – | + | + | – | – | – | ↓ | – | Nl | ↓ | Nl |
|
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Somatostatinoma | – | + | + | – | – | – | + | + | – | – | – | ↓ | – | Nl | Nl | Nl |
|
|
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Lymphoma | – | + | + | + | – | + | + | + | – | + | – | Nl | – | Nl | ↓ | Nl |
|
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Colorectal cancer | – | + | + | + | + | – | + | + |
|
– | + | – | Nl | – | Nl | ↓ | Nl |
|
| |||||
Medication/Toxicity | Medications | + | + | + | – | ± | ± | + | + | – | – | – | ↑/↓ | – | ↑ | Nl | Nl |
|
– |
| ||||
Factitious diarrhea | + | + | + | – | – | – | + | + | – | – | – | ↑/↓ | – | Nl | Nl | Nl |
| |||||||
Heavy metal ingestion | – | + | + | – | – | – | + | + | – | – | – | Nl | – | Nl | Nl | Nl |
|
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Organophosphate poisoning | + | + | + | – | – | – | + | – | – | – | – | Nl | – | Nl | Nl | Nl |
|
|
|
| ||||
Opium withdrawal | + | + | + | – | – | – | + | – |
|
– | – | – | Nl | – | Nl | Nl | Nl |
| ||||||
Iatrogenic | Short bowel syndrome | + | + | + | – | + | – | – | + | – | – | – | Nl |
|
Nl | ↓ | ↑ |
|
|
|
| |||
Radiation enteritis | + | + | + | + | + | – | + | + | + | + | – | Nl |
|
Nl | ↓ | Nl |
|
|
| |||||
Dumping syndrome | – | + | + | – | + | – | – | + |
|
– | – | – | Nl | – | Nl | Nl | Nl |
|
| |||||
Others | Abetalipoproteinemia | – | + | + | – | + | – | + | + | – | – | – | Nl | – | Nl | Nl | Nl |
|
|
| ||||
Hyperthyroidism | – | + | + | – | – | ± | + | + | – | – | – | – | Nl |
|
Nl | Nl | Nl |
|
|
|||||
Diabetic neuropathy | – | + | + | – | + | – | + | + | – | – | – | Nl |
|
Nl | ↓ | Nl |
|
| ||||||
Systemic sclerosis | – | + | + | ± | + | – | + | + | – | + | – | Nl |
|
Nl | ↓ | Nl |
|
|
- ↑ Casburn-Jones, Anna C; Farthing, Michael Jg (2004). "Traveler's diarrhea". Journal of Gastroenterology and Hepatology. 19 (6): 610–618. doi:10.1111/j.1440-1746.2003.03287.x. ISSN 0815-9319.
- ↑ Kamat, Deepak; Mathur, Ambika (2006). "Prevention and Management of Travelers' Diarrhea". Disease-a-Month. 52 (7): 289–302. doi:10.1016/j.disamonth.2006.08.003. ISSN 0011-5029.
- ↑ Pfeiffer, Margaret L.; DuPont, Herbert L.; Ochoa, Theresa J. (2012). "The patient presenting with acute dysentery – A systematic review". Journal of Infection. 64 (4): 374–386. doi:10.1016/j.jinf.2012.01.006. ISSN 0163-4453.
- ↑ Barr W, Smith A (2014). "Acute diarrhea". Am Fam Physician. 89 (3): 180–9. PMID 24506120.
- ↑ Amil Dias J (2017). "Celiac Disease: What Do We Know in 2017?". GE Port J Gastroenterol. 24 (6): 275–278. doi:10.1159/000479881. PMID 29255768.
- ↑ Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi A (2017). "Shigellosis". Lancet. doi:10.1016/S0140-6736(17)33296-8. PMID 29254859. Vancouver style error: initials (help)
- ↑ Yamamoto-Furusho, J.K.; Bosques-Padilla, F.; de-Paula, J.; Galiano, M.T.; Ibañez, P.; Juliao, F.; Kotze, P.G.; Rocha, J.L.; Steinwurz, F.; Veitia, G.; Zaltman, C. (2017). "Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation". Revista de Gastroenterología de México. 82 (1): 46–84. doi:10.1016/j.rgmx.2016.07.003. ISSN 0375-0906.
- ↑ Borbély, Yves M; Osterwalder, Alice; Kröll, Dino; Nett, Philipp C; Inglin, Roman A (2017). "Diarrhea after bariatric procedures: Diagnosis and therapy". World Journal of Gastroenterology. 23 (26): 4689. doi:10.3748/wjg.v23.i26.4689. ISSN 1007-9327.
- ↑ Crawford, Sue E.; Ramani, Sasirekha; Tate, Jacqueline E.; Parashar, Umesh D.; Svensson, Lennart; Hagbom, Marie; Franco, Manuel A.; Greenberg, Harry B.; O'Ryan, Miguel; Kang, Gagandeep; Desselberger, Ulrich; Estes, Mary K. (2017). "Rotavirus infection". Nature Reviews Disease Primers. 3: 17083. doi:10.1038/nrdp.2017.83. ISSN 2056-676X.
- ↑ Kist M (2000). "[Chronic diarrhea: value of microbiology in diagnosis]". Praxis (Bern 1994) (in German). 89 (39): 1559–65. PMID 11068510.
- ↑ Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH (1985). "Evaluation and diagnosis of acute infectious diarrhea". Am. J. Med. 78 (6B): 91–8. PMID 4014291.
- ↑ López-Vélez R, Turrientes MC, Garrón C, Montilla P, Navajas R, Fenoy S, del Aguila C (1999). "Microsporidiosis in travelers with diarrhea from the tropics". J Travel Med. 6 (4): 223–7. PMID 10575169.
- ↑ Wahnschaffe, Ulrich; Ignatius, Ralf; Loddenkemper, Christoph; Liesenfeld, Oliver; Muehlen, Marion; Jelinek, Thomas; Burchard, Gerd Dieter; Weinke, Thomas; Harms, Gundel; Stein, Harald; Zeitz, Martin; Ullrich, Reiner; Schneider, Thomas (2009). "Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas". Scandinavian Journal of Gastroenterology. 42 (3): 391–396. doi:10.1080/00365520600881193. ISSN 0036-5521.
- ↑ Mena Bares LM, Carmona Asenjo E, García Sánchez MV, Moreno Ortega E, Maza Muret FR, Guiote Moreno MV, Santos Bueno AM, Iglesias Flores E, Benítez Cantero JM, Vallejo Casas JA (2017). "75SeHCAT scan in bile acid malabsorption in chronic diarrhoea". Rev Esp Med Nucl Imagen Mol. 36 (1): 37–47. doi:10.1016/j.remn.2016.08.005. PMID 27765536.
- ↑ Gibson RJ, Stringer AM (2009). "Chemotherapy-induced diarrhoea". Curr Opin Support Palliat Care. 3 (1): 31–5. doi:10.1097/SPC.0b013e32832531bb. PMID 19365159.
- ↑ Abraham BP, Sellin JH (2012). "Drug-induced, factitious, & idiopathic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 633–48. doi:10.1016/j.bpg.2012.11.007. PMID 23384808.
- ↑ Reintam Blaser A, Deane AM, Fruhwald S (2015). "Diarrhoea in the critically ill". Curr Opin Crit Care. 21 (2): 142–53. doi:10.1097/MCC.0000000000000188. PMID 25692805.
- ↑ McMahan ZH, DuPont HL (2007). "Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy". Aliment. Pharmacol. Ther. 25 (7): 759–69. doi:10.1111/j.1365-2036.2007.03261.x. PMID 17373914.
- ↑ Schiller LR (2012). "Definitions, pathophysiology, and evaluation of chronic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 551–62. doi:10.1016/j.bpg.2012.11.011. PMID 23384801.
- ↑ Giannella RA (1986). "Chronic diarrhea in travelers: diagnostic and therapeutic considerations". Rev. Infect. Dis. 8 Suppl 2: S223–6. PMID 3523719.