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| ==Historical Perspective==
| | Pancoast syndrome (Pancoast’s syndrome) typically results when a malignant neoplasm of the superior sulcus of the lung (lung cancer) leads to destructive lesions of the thoracic inlet and involvement of the brachial plexus and cervical sympathetic nerves (stellate ganglion). [1, 2, 3] This is accompanied by the following: |
| *Small intestinal bacterial overgrowth (SIBO) was first discovered by Barber and Hummel in 1939.
| |
| *In 2000, Pimentel et all at Cedars-Sinai Medical Center were first identified that SIBO was present in 78% of patients with irritable bowel syndrome (IBS), and that treatment with antibiotics improved symptoms.
| |
| *In May 2015, U.S. Food and Drug Administration (FDA) approved rifaximin to treat SIBO.
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|
| ==Classification==
| | Severe pain in the shoulder region radiating toward the axilla and scapula, with later extension along the ulnar aspect of the arm to the hand |
| *There is no established system for the classification of small intestinal bacterial overgrowth(SIBO).
| | Atrophy of hand and arm muscles |
| | Horner syndrome ( ptosis, miosis, hemianhidrosis, enophthalmos) |
| | Compression of the blood vessels with edema |
| | Most Pancoast tumors are squamous cell carcinomas (SCCs) or adenocarcinomas; only 3-5% are small cell carcinomas. Squamous cell carcinoma occurs more frequently, although large cell and undifferentiated types are also common. Adenocarcinoma is sometimes found in this location and can even be metastatic. Involvement of the phrenic or recurrent laryngeal nerve or superior vena cava obstruction is not representative of the classic Pancoast tumor. |
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| ==Pathophysiology==
| | Once universally fatal, Pancoast tumors are currently treatable with outcomes similar to those of other stage-matched non–small cell lung cancers. [4] Careful assessment and appropriate staging are performed before surgery, and selected patients are administered preoperative irradiation of 30 Gy over 2 weeks. After an interval of 2-4 weeks, surgical resection of the chest wall and lower brachial plexus and en bloc lung resection produces a 5-year survival rate of 30%. Contraindications to surgical management include the following: |
| *The pathogenesis of small intestinal bacterial overgrowth (SIBO) is characterized by an increased microbial load in the small intestine.
| |
| *A healthy individual has less than 103 organisms/mL in the upper small intestine, and the majority of these organisms are gram-positive bacteria.
| |
| *Body's homeostatic mechanisms protect against excessive small intestinal colonization by bacteria include :
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| **Gastric acid and bile eradicate micro-organisms before they leave the stomach
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| **Migrating motor complex clears the excess unwanted bacteria of upper intestine
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| **Intestinal mucosa serves as a protective layer for the gut wall.
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| **Normal intestinal flora (eg, Lactobacillus) maintains a low pH that prevents bacterial overgrowth.
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| **Physical barrier of the ileocecal valve that prevents retrograde translocation of bacteria from colon to the small intestine.
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| *Disruption of these protective homeostatic mechanisms can increase the risk of SIBO.
| |
| *Bacterial colonization causes an inflammatory response in the intestinal mucosa.
| |
| *Damage to the intestinal mucosa leads to malabsorption of bile acids, carbohydrates, proteins and vitamins resulting in symptoms of diarrhea and weightloss.
| |
| *On gross pathology, mucosal edema, loss of normal vascular pattern, patchy erythema, friability and ulceration of the small intestinal wall is associated with small intestinal bacterial overgrowth (SIBO).
| |
| *On microscopic histopathological analysis small intestine and colon is normal in most patients with SIBO. Findings include:
| |
| **Blunting of the intestinal villi
| |
| **Thinning of the mucosa and crypts
| |
| **Increased intraepithelial lymphocytes
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|
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|
| ==Causes==
| | Extension of the tumor into the neck or vertebrae |
| *Small intestinal bacterial overgrowth (SIBO) may be caused by disruption of the protective homeostatic mechanisms that control enteric bacteria population.
| | Presence of substantial mediastinal lymph nodes |
| *Causes of small intestinal bacterial overgrowth (SIBO) include:
| | Peripheral tumor dissemination |
| **Irregular small intestinal motility
| | Protocols that use combinations of radiation therapy, chemotherapy, and surgery are currently being studied to determine the best therapy. |
| ***Diabetic autonomic neuropathy
| |
| ***Scleroderma
| |
| ***Pseudo-obstruction
| |
| ***Amyloidosis
| |
| ***Neurological diseases (eg, myotonic dystrophy, Parkinson disease)
| |
| ***Radiation enteritis
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| ***Crohn disease
| |
| ***Hypothyroidism
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| **Blind pouches in the gastrointestinal tract
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| ***Side-to-side or end-to-side anastomoses
| |
| ***Duodenal or jejunal diverticula
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| ***Segmental dilatation of the ileum
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| ***Blind loop syndrome
| |
| ***Biliopancreatic diversion
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| ***Chagasic megacolon
| |
| **Fistula
| |
| ***Gastrocolic fistulae
| |
| ***Jejunal-colic fistulae
| |
| **Partial Obstruction
| |
| ***Strictures
| |
| ***Adhesions
| |
| ***Abdominal masses
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| ***Leiomyosarcoma
| |
| **Decreased gastric acid secretion
| |
| ***Achlorhydria
| |
| ***Vagotomy
| |
| ***Long-term proton pump inhibitor therapy
| |
| | |
| ==Differentiating [disease name] from other Diseases==
| |
| *Small intestinal bacterial overgrowth (SIBO) must be differentiated from other diseases that cause chronic diarrhea.
| |
| '''The following table outlines the major differential diagnoses of chronic diarrhea.'''<ref name="Casburn-JonesFarthing2004">{{cite journal|last1=Casburn-Jones|first1=Anna C|last2=Farthing|first2=Michael Jg|title=Traveler's diarrhea|journal=Journal of Gastroenterology and Hepatology|volume=19|issue=6|year=2004|pages=610–618|issn=0815-9319|doi=10.1111/j.1440-1746.2003.03287.x}}</ref><ref name="KamatMathur2006">{{cite journal|last1=Kamat|first1=Deepak|last2=Mathur|first2=Ambika|title=Prevention and Management of Travelers’ Diarrhea|journal=Disease-a-Month|volume=52|issue=7|year=2006|pages=289–302|issn=00115029|doi=10.1016/j.disamonth.2006.08.003}}</ref><ref name="PfeifferDuPont2012">{{cite journal|last1=Pfeiffer|first1=Margaret L.|last2=DuPont|first2=Herbert L.|last3=Ochoa|first3=Theresa J.|title=The patient presenting with acute dysentery – A systematic review|journal=Journal of Infection|volume=64|issue=4|year=2012|pages=374–386|issn=01634453|doi=10.1016/j.jinf.2012.01.006}}</ref><ref name="pmid24506120">{{cite journal |vauthors=Barr W, Smith A |title=Acute diarrhea |journal=Am Fam Physician |volume=89 |issue=3 |pages=180–9 |year=2014 |pmid=24506120 |doi= |url=}}</ref><ref name="pmid29255768">{{cite journal |vauthors=Amil Dias J |title=Celiac Disease: What Do We Know in 2017? |journal=GE Port J Gastroenterol |volume=24 |issue=6 |pages=275–278 |year=2017 |pmid=29255768 |doi=10.1159/000479881 |url=}}</ref><ref name="pmid29254859">{{cite journal |vauthors=Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi AKM |title=Shigellosis |journal=Lancet |volume= |issue= |pages= |year=2017 |pmid=29254859 |doi=10.1016/S0140-6736(17)33296-8 |url=}}</ref><ref name="Yamamoto-FurushoBosques-Padilla2017">{{cite journal|last1=Yamamoto-Furusho|first1=J.K.|last2=Bosques-Padilla|first2=F.|last3=de-Paula|first3=J.|last4=Galiano|first4=M.T.|last5=Ibañez|first5=P.|last6=Juliao|first6=F.|last7=Kotze|first7=P.G.|last8=Rocha|first8=J.L.|last9=Steinwurz|first9=F.|last10=Veitia|first10=G.|last11=Zaltman|first11=C.|title=Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation|journal=Revista de Gastroenterología de México|volume=82|issue=1|year=2017|pages=46–84|issn=03750906|doi=10.1016/j.rgmx.2016.07.003}}</ref><ref name="BorbélyOsterwalder2017">{{cite journal|last1=Borbély|first1=Yves M|last2=Osterwalder|first2=Alice|last3=Kröll|first3=Dino|last4=Nett|first4=Philipp C|last5=Inglin|first5=Roman A|title=Diarrhea after bariatric procedures: Diagnosis and therapy|journal=World Journal of Gastroenterology|volume=23|issue=26|year=2017|pages=4689|issn=1007-9327|doi=10.3748/wjg.v23.i26.4689}}</ref><ref name="CrawfordRamani2017">{{cite journal|last1=Crawford|first1=Sue E.|last2=Ramani|first2=Sasirekha|last3=Tate|first3=Jacqueline E.|last4=Parashar|first4=Umesh D.|last5=Svensson|first5=Lennart|last6=Hagbom|first6=Marie|last7=Franco|first7=Manuel A.|last8=Greenberg|first8=Harry B.|last9=O'Ryan|first9=Miguel|last10=Kang|first10=Gagandeep|last11=Desselberger|first11=Ulrich|last12=Estes|first12=Mary K.|title=Rotavirus infection|journal=Nature Reviews Disease Primers|volume=3|year=2017|pages=17083|issn=2056-676X|doi=10.1038/nrdp.2017.83}}</ref><ref name="pmid11068510">{{cite journal |vauthors=Kist M |title=[Chronic diarrhea: value of microbiology in diagnosis] |language=German |journal=Praxis (Bern 1994) |volume=89 |issue=39 |pages=1559–65 |year=2000 |pmid=11068510 |doi= |url=}}</ref><ref name="pmid4014291">{{cite journal |vauthors=Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH |title=Evaluation and diagnosis of acute infectious diarrhea |journal=Am. 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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><ref name="pmid8209928">{{cite journal| author=Konvolinka CW| title=Acute diverticulitis under age forty. | journal=Am J Surg | year= 1994 | volume= 167 | issue= 6 | pages= 562-5 | pmid=8209928 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8209928 }} </ref><ref name="pmid16698746">{{cite journal| author=Satsangi J, Silverberg MS, Vermeire S, Colombel JF| title=The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. | journal=Gut | year= 2006 | volume= 55 | issue= 6 | pages= 749-53 | pmid=16698746 | doi=10.1136/gut.2005.082909 | pmc=1856208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16698746 }} </ref><ref name="pmid12700377">{{cite journal| author=Haque R, Huston CD, Hughes M, Houpt E, Petri WA| title=Amebiasis. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 16 | pages= 1565-73 | pmid=12700377 | doi=10.1056/NEJMra022710 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700377 }} </ref><ref name="pmid8694025">{{cite journal| author=Hertzler SR, Savaiano DA| title=Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. | journal=Am J Clin Nutr | year= 1996 | volume= 64 | issue= 2 | pages= 232-6 | pmid=8694025 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8694025 }} </ref><ref name="pmid9414969">{{cite journal| author=Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC| title=Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect? | journal=Gut | year= 1997 | volume= 41 | issue= 5 | pages= 632-5 | pmid=9414969 | doi= | pmc=1891556 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9414969 }} </ref><ref name="pmid15391722">{{cite journal| author=BLACK-SCHAFFER B| title=The tinctoral demonstration of a glycoprotein in Whipple's disease. | journal=Proc Soc Exp Biol Med | year= 1949 | volume= 72 | issue= 1 | pages= 225-7 | pmid=15391722 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15391722 }} </ref>
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| <span style="font-size:85%">'''Abbreviations:''' '''GI:''' [[Gastrointestinal tract|Gastrointestinal]], '''CBC''': [[Complete blood count]], '''WBC:''' [[White blood cells|White blood cell]], '''RBC''': [[Red blood cell]], '''Plt:''' [[Platelet]], '''Hgb:''' [[Hemoglobin]], '''ESR''': [[Erythrocyte sedimentation rate]], '''CRP''': [[C-reactive protein|C–reactive protein]], '''IgE:''' [[Immunoglobulin E]], '''IgA:''' [[Immunoglobulin A]], '''ETEC:''' [[Escherichia coli enteritis]], '''EPEC''': [[Escherichia coli|Enteropathogenic Escherichia coli]], '''EIEC''': [[Escherichia coli enteritis|Enteroinvasive Escherichia coli]], '''EHEC''': [[Escherichia coli|Enterohemorrhagic Escherichia coli]], '''EAEC''': [[Escherichia coli enteritis|Enteroaggregative Escherichia coli]], '''Nl''': Normal, '''ASCA''': [[Anti saccharomyces cerevisiae antibodies]], '''ANCA''': [[Anti-neutrophil cytoplasmic antibody|Anti–neutrophil cytoplasmic antibody]], '''DNA''': [[DNA|Deoxyribonucleic acid]], '''CFTR''': [[Cystic fibrosis transmembrane conductance regulator]], '''SLC10A2''': [[SLC10A2|Solute carrier family 10 member 2]], '''SeHCAT''': [[SeHCAT|Selenium homocholic acid taurine or tauroselcholic acid]], '''IEL''': Intraepithelial [[Lymphocyte|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 (ELISA)|Enzyme–linked immunosorbent assay]], '''LT''': Heat–labile [[enterotoxin]], ST: Heat–stable [[enterotoxin]], '''RT-PCR''': Reverse–transcriptase [[polymerase chain reaction]], '''CD4:''' [[CD4|Cluster of differentiation 4]], '''HIV''': [[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]], '''RUQ''': [[RUQ|Right-upper quadrant]], '''VIP''': [[Vasoactive intestinal peptide]], '''GI:''' [[Gastrointestinal tract|Gastrointestinal]], '''FAP''': [[Familial adenomatous polyposis]], '''HNPCC''': [[Hereditary nonpolyposis colorectal cancer]], '''MTP''': [[Microsomal triglyceride transfer protein]], '''Scl‑70''': Anti–[[Type I topoisomerase|topoisomerase I]], '''TSH''': [[Thyroid-stimulating hormone]], '''T4''': [[Thyroxine]], '''T3''': [[Triiodothyronine]], '''DTR''': [[Deep tendon reflex]], '''RNA''': [[RNA|Ribonucleic acid]]</span>
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| {| class="wikitable" style="border: 0px; font-size: 100%; margin: 3px;" align="center"
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| ! colspan="2" rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| |
| | colspan="9" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestation'''
| |
| ! colspan="9" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Lab findings'''
| |
| ! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
| |
| ! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
| |
| ! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
| |
| |-
| |
| ! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" |Symptoms
| |
| ! rowspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
| |
| |-
| |
| ! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
| |
| ! colspan="3" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
| |
| ! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
| |
| ! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
| |
| ! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| |
| |-
| |
| ! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
| |
| | colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |'''CBC'''
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
| |
| |-
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
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| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Crohns disease|Crohn's disease]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Abdominal tenderness]]
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| * Oral [[mucosal]] lesions
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Anti saccharomyces cerevisiae antibodies]] (ASCA)
| |
| * [[Vitamin B12]] deficiency
| |
| * Elevated [[erythrocyte sedimentation rate|ESR]]
| |
| * Elevated [[C-reactive protein|CRP]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Uveitis]]
| |
| * [[Arthritis]]
| |
| * [[Erythema nodosum]]
| |
| * [[Pyoderma gangrenosum]]
| |
| * [[Amyloidosis]]
| |
| * Venous and arterial [[thromboembolism]]
| |
| * [[Kidney stone|Renal stones]]
| |
| * [[Bronchiectasis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Abnormal immune response to self [[antigens]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Colonoscopy]] with [[biopsy]]
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Ulcerative colitis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Abdominal tenderness]]
| |
| * [[Blood]] on [[rectal examination]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Anti-neutrophil cytoplasmic antibody|Anti–neutrophil cytoplasmic antibody]] ([[P-ANCA|P–ANCA]])
| |
| * [[Hypoalbuminemia]]
| |
| * [[Hypokalemia]]
| |
| * [[Hypomagnesemia]]
| |
| * Elevated [[Erythrocyte sedimentation rate|ESR]]
| |
| * Elevated [[C-reactive protein|CRP]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Skin rash]]
| |
| * [[Iritis]]
| |
| * [[Uveitis]]
| |
| * Seronegative [[arthritis]]
| |
| * [[Clubbing]]
| |
| * [[Erythema nodosum]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Abnormal immune response to self [[antigens]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Colonoscopy]] with [[biopsy]]
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Celiac disease]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Abdominal distention]]
| |
| * Increased [[bowel]] sounds
| |
| * Oral [[Mucous membrane|mucosal]] lesions
| |
| * [[Hepatosplenomegaly]]
| |
| * [[Ascites]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Fat droplets on [[sudan stain]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | ↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[IgA]] endomysial [[antibody]]
| |
| * Anti–tissue [[transglutaminase]] [[antibody]]
| |
| * [[Anti-gliadin antibodies|Anti–gliadin antibody]]
| |
| * [[Fat soluble vitamins]] deficiency
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Malabsorption]]
| |
| * [[Dementia]]
| |
| * [[Dermatitis herpetiformis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[HLA-DQ2|HLA–DQ2]]
| |
| * [[HLA-DQ8|HLA–DQ8]]
| |
| * Innate responses to wheat [[Protein|proteins]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[IgA]] endomysial [[antibody]]
| |
| * Anti–tissue [[transglutaminase]] [[antibody]]
| |
| |-
| |
| ! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| |
| ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
| |
| ! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
| |
| |-
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Cystic fibrosis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Abdominal distension|Abdominal distention]]
| |
| *[[Hepatosplenomegaly]]
| |
| *[[Rectal prolapse]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Fat droplets on [[sudan stain]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Positive [[DNA]] analysis for [[CFTR|cystic fibrosis transmembrane conductance regulator]] [[CFTR|(CFTR)]]
| |
| * Nasal transepithelial potential difference
| |
| * [[Fat soluble vitamins]] deficiency
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Malabsorption]]
| |
| * Recurrent [[respiratory tract infection]]
| |
| * [[Bronchiectasis]]
| |
| * [[Diabetes mellitus]]
| |
| * [[Scoliosis]]
| |
| * [[Infertility]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Mutations in the [[cystic fibrosis transmembrane conductance regulator]] ([[CFTR]]) protein
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Positive [[genetic testing]]
| |
| * Elevated [[Sweat chloride test|sweat chloride]] ≥60 mmol/L
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Chronic pancreatitis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Tenderness (medicine)|Abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Fat droplets on [[sudan stain]]
| |
| * Positive [[fecal elastase]] measurement
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Slightly elevated [[amylase]] and [[lipase]]
| |
| * Abnormal pancreatic function test
| |
| * [[Secretin]] stimulation test
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Malabsorption]]
| |
| * [[Diabetes mellitus]]
| |
| * [[Pancreatic pseudocyst]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Toxin|Toxins]]
| |
| * Recurrent [[acute pancreatitis]]
| |
| * [[Genetics|Genetic]] predesposition
| |
| * [[Autoimmunity|Autoimmune]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Magnetic resonance cholangiopancreatography]] ([[Magnetic resonance cholangiopancreatography|MRCP]])
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Bile acid malabsorption]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Fat droplets on [[sudan stain]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Reduced [[cholesterol]] level
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Malabsorption]]
| |
| *[[Hypotension]]
| |
| *[[Tachycardia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Genetic defects in ''[[SLC10A2]]''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[SeHCAT]] test
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Microscopic colitis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Abdominal tenderness]]
| |
| * Fecal [[incontinence]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Hypokalemia]]
| |
| * Elevated [[C-reactive protein|CRP]]
| |
| * Positive [[autoantibodies]] include:
| |
| **RF
| |
| **[[ANA]]
| |
| **[[Anti-mitochondrial antibody|AMA]]
| |
| **[[ANCA]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Arthritis]]
| |
| * [[Uveitis]]
| |
| * [[Idiopathic thrombocytopenic purpura]]
| |
| * Pleuro [[pericarditis]]
| |
| * [[Hypothyroidism]]
| |
| * [[Psoriasis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Mucosal]] [[immune responses]] to luminal factors in a genetically predisposed individual
| |
| * Drug–induced
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[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
| |
| |-
| |
| ! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| |
| ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
| |
| ! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
| |
| |-
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Infective colitis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *Rebound [[Tenderness (medicine)|abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Positive [[stool culture]]
| |
| *Positive fecal calprotectin
| |
| *Positive fecal [[lactoferrin]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Elevated [[C-reactive protein|CRP]]
| |
| *Elevated [[Erythrocyte sedimentation rate|ESR]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Arthritis]]
| |
| * [[Uveitis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Salmonella|''Salmonella'']]
| |
| *[[Shigella|''Shigella'']]
| |
| *[[Campylobacter|''Campylobacter'']]
| |
| *''[[Escherichia coli|E. coli 0157:H7]]''
| |
| *[[Clostridium difficile|''Clostridium difficile'']]
| |
| *[[Entamoeba histolytica|''Entamoeba histolytica'']]
| |
| *[[Adenoviridae|''Adenovirus'']]
| |
| *[[Cytomegalovirus|''Cytomegalovirus'']]
| |
| *[[Herpes simplex virus|''Herpes simplex virus'']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Stool culture]]
| |
| *[[Blood culture]]
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Ischemic colitis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *Hyperactive then absent [[Stomach rumble|bowel sounds]]
| |
| *[[Tenderness (medicine)|Abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Elevated [[C-reactive protein|CRP]]
| |
| *Elevated [[Erythrocyte sedimentation rate|ESR]]
| |
| *Elevated serum [[Lactic acid|lactate]]
| |
| *Elevated [[lactate dehydrogenase]] ([[Lactate dehydrogenase|LDH]])
| |
| *Elevated [[Creatine kinase|creatine phosphokinase]] ([[Creatine kinase|CPK]])
| |
| *Elevated [[amylase]]
| |
| *[[Hypoalbuminemia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Henoch-Schönlein purpura|IgA vasculitis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Thrombophilia|Hypercoagulability]]
| |
| *Nonocclusive [[Ischemic colitis|colonic ischemia]]
| |
| *[[Embolism|Embolic]] and [[Thrombosis|thrombotic]] arterial occlusion
| |
| *[[Mesenteric vein thrombosis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Abdominal [[Computed tomography|CT scan]]
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Lactose intolerance]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Abdominal tenderness ]]
| |
| * [[Abdominal distention]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Lactose tolerance test
| |
| * Genetic testing
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Headache]]
| |
| * [[Vertigo]]
| |
| * [[Memory impairment]]
| |
| * [[Lethargy]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Reduction of lactase enzyme activity or inability to produce persistent [[lactase]]
| |
| * Congenital [[lactase deficiency]]
| |
| * Secondary lactose malabsorption
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Small bowel]] [[biopsy]]
| |
| * Lactose breath hydrogen test
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Irritable bowel syndrome]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Abdominal tenderness]]
| |
| * [[Abdominal distention]]
| |
| * Normal [[Stomach rumble|bowel sounds]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Anxiety]]
| |
| *[[Palpitation]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Unknown
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Diagnosis of exclusion
| |
| |-
| |
| ! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| |
| ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
| |
| ! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
| |
| |-
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Whipple's disease]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Hepatosplenomegaly]]
| |
| * [[Ascites]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Positive [[fecal fat]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓/↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Hypoalbuminemia]]
| |
| *[[Fat soluble vitamins]] deficiency
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Malabsorption]]
| |
| * [[Ocular motility disorders|Abnormal extraocular movement]]
| |
| * [[Lymphadenopathy]]
| |
| * [[Hyperpigmentation]]
| |
| * [[Uveitis]]
| |
| * [[Endocarditis]]
| |
| * [[Encephalitis]]
| |
| * [[Dementia]]
| |
| * [[Pleural effusion]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Tropheryma whipplei|''Tropheryma whipplei'']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Small intestine]] [[biopsy]] for [[Tropheryma whipplei]] testing
| |
| * [[PCR]] testing
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Tropical sprue]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Angular [[stomatitis]]
| |
| * Oral mucosal lesion
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Positive [[stool culture]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | ↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Fat soluble vitamins]] deficiency
| |
| * [[Vitamin B12 deficiency]]
| |
| * [[Folate deficiency]]
| |
| * [[Hypokalemia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Myalgia]]
| |
| *[[Neuropathy]]
| |
| *[[Edema]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * ''[[Escherichia coli]]''
| |
| * ''[[Klebsiella pneumoniae]]''
| |
| * ''[[Enterobacter cloacae]]''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Diagnosis of exclusion
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Small bowel bacterial overgrowth syndrome|Small bowel bacterial overgrowth]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Abdominal distension|Abdominal distention]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Positive [[stool culture]]
| |
| *Positive [[fecal fat]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Hypoalbuminemia]]
| |
| * Abnormal [[Hydrogen Breath Test|hydrogen breath test]]
| |
| * [[Lactic acidosis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Malabsorption]]
| |
| * [[Rosacea]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Excess bacteria in the [[small intestine]]
| |
| * Alterations in [[Intestine|intestinal]] [[anatomy]] or GI motility
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Diagnosis of exclusion
| |
| |-
| |
| ! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| |
| ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
| |
| ! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
| |
| |-
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Salmonellosis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *[[Abdominal distention]]
| |
| *Diffuse [[abdominal tenderness]]
| |
| *[[Hepatosplenomegaly]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Positive [[stool culture]]
| |
| *Positive serologic testing
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Hypokalemia]]
| |
| *[[Hypernatremia]]
| |
| *[[Hyponatremia]]
| |
| * [[Hypercalciuria]]
| |
| * [[Hypocitraturia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Post-infectious arthritis|Post–infectious arthritis]]
| |
| * [[Obtundation]]
| |
| * [[Bacteremia]]
| |
| * [[Pericarditis]]
| |
| * [[Pyelonephritis]]
| |
| *[[Brain abscess]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Salmonella|''Salmonella'']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Stool culture]]
| |
| |-
| |
| ! rowspan="2" style="background:#DCDCDC;" align="center" |[[Escherichia coli enteritis]]
| |
| | style="background:#DCDCDC;" align="center" |[[EPEC|'''EPEC''']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *Diffuse [[abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Positive [[stool culture]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *''[[Enteropathogenic E. coli]]''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Hybridization probe|DNA probe]] or [[polymerase chain reaction]] ([[Polymerase chain reaction|PCR]]) of the ''EPEC'' adherence factor
| |
| *[[Stool culture]]
| |
| |-
| |
| | style="background:#DCDCDC;" align="center" |[[EAEC|'''EAEC''']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *Diffuse [[abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Positive [[stool culture]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Chronic infection in [[Immunodeficiency|immunocompromised]] patients
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Escherichia coli enteritis|''Enteroaggregative E. coli'']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Stool culture]]
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Aeromonas]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| * [[Abdominal distention]]
| |
| * Hyperactive [[Stomach rumble|bowel sounds]]
| |
| * Diffuse [[abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Positive [[stool culture]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Wound [[infection]]
| |
| *[[Bacteremia]]
| |
| *[[Hemolytic-uremic syndrome|Hemolytic uremic syndrome]]
| |
| *[[Meningitis]]
| |
| *[[Ocular]] infection
| |
| *[[Pneumonia]]
| |
| *[[Urinary tract infection]]
| |
| *[[Osteomyelitis]]
| |
| *[[Peritonitis]]
| |
| *[[Acute cholecystitis]]
| |
| *[[Opportunistic infection|Opportunistic infections]] in [[Immunodeficiency|immunocompromised]] patients
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *''[[Aeromonas]]'' virulence factors including [[Endotoxin|endotoxins]], [[Hemolysin|hemolysins]], [[Enterotoxin|enterotoxins]], and adherence factors
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Blood culture]]
| |
| *Wound [[Culture collection|culture]]
| |
| |-
| |
| ! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| |
| ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
| |
| ! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
| |
| |-
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Mycobacterium avium complex]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Abdominal distension|Abdominal distention]]
| |
| *[[Hepatosplenomegaly]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Elevated [[Liver function tests|liver enzymes]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Opportunistic infection]] in [[Immunodeficiency|immunocompromised]] patients
| |
| *[[Pulmonary]] [[infection]]
| |
| *[[Lymphadenopathy|Adenopathy]]
| |
| *[[Sleep hyperhidrosis|Night sweats]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Mycobacterium avium complex|''Mycobacterium avium complex'']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Blood culture]]
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[CMV colitis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Diffuse [[Tenderness (medicine)|abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Viral antigen assay
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Decreased [[CD4]] level
| |
| *Abnormal [[Liver function tests|liver function test]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Encephalitis]]
| |
| *[[Guillain-Barré syndrome|Guillain–Barré syndrome]]
| |
| *[[Pneumonia]]
| |
| *[[Retinitis]]
| |
| *[[Pericarditis]] and [[myocarditis]]
| |
| *[[Atherosclerosis]]
| |
| *[[Venous thromboembolism|Venous thrombosis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Cytomegalovirus|''Cytomegalovirus'']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Quantitative polymerase chain reaction|Quantitative PCR]] tests
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Human Immunodeficiency Virus (HIV)|HIV]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *[[Abdominal distension|Abdominal distention]]
| |
| *Diffuse [[Tenderness (medicine)|abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Decreased [[CD4]] level
| |
| *[[Electrolyte disturbance|Electrolyte imbalance]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Lymphadenopathy]]
| |
| *Disseminated [[infection]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Human Immunodeficiency Virus (HIV)|''HIV'']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *HIV virologic (viral load) test
| |
| *Immunoassay
| |
| |-
| |
| ! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| |
| ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
| |
| ! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
| |
| |-
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Entamoeba histolytica]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *[[Abdominal distension|Abdominal distention]]
| |
| *Diffuse [[Tenderness (medicine)|abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Liver abscess]]
| |
| *Pleuropulmonary infection
| |
| *[[Cardiac]] [[infection]]
| |
| *[[Brain abscess]]
| |
| *[[Skin and soft-tissue infections|Cutaneous infection]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Entamoeba histolytica|''Entamoeba histolytica'']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Antigen testing
| |
| *Serology
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Giardia lamblia|Giardia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *[[Abdominal distension|Abdominal distention]]
| |
| *Diffuse [[Tenderness (medicine)|abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Malabsorption]]
| |
| *[[Urticaria]]
| |
| *[[Depression]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *''[[Giardia lamblia]]''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Antigen detection assays
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Cryptosporidium]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *[[Abdominal distension|Abdominal distention]]
| |
| *Diffuse [[Tenderness (medicine)|abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Positive stool microscopy
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Elevated [[alkaline phosphatase]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Chronic, life–threatening illness in [[Immunodeficiency|immunocompromised]] patients
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Cryptosporidium|''Cryptosporidium'']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Polymerase chain reaction
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Microsporidia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *[[Abdominal distension|Abdominal distention]]
| |
| *Diffuse [[Tenderness (medicine)|abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Positive stool microscopy
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Decreased [[CD4]] count
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Malabsorption]]
| |
| *[[Keratitis]]
| |
| *[[Seizure]]
| |
| *[[Myositis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Microsporidia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Antigen detection assays
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Isospora]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Abdominal distension|Abdominal distention]]
| |
| *Diffuse [[Tenderness (medicine)|abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Positive stool microscopy
| |
| *Positive [[fecal fat]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Elevated [[Eosinophil granulocyte|eosinophils]]
| |
| *[[Hypokalemia]]
| |
| *Increased [[creatinine]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Chronic illness in [[Immunodeficiency|immunocompromised]] patients
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Isospora|''Isospora'']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Detecting oocysts in the feces
| |
| |-
| |
| ! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| |
| ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
| |
| ! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
| |
| |-
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Carcinoid syndrome|Carcinoid tumor]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| * [[Abdominal distention]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Elevated urinary [[5-Hydroxyindoleacetic acid|5–hydroxyindoleacetic acid]] ([[5-Hydroxyindoleacetic acid|5–HIAA]]) level
| |
| *High [[chromogranin A]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Flushing|Facial flushing]]
| |
| *[[Jaundice]]
| |
| *[[Edema]]
| |
| *[[Valvular heart disease]]
| |
| *[[Congestive heart failure|Right–sided heart failure]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Well–differentiated [[Neuroendocrine tumors|neuroendocrine tumor]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Blood [[chromogranin A]] level
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[VIPoma]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| * [[Abdominal distention]]
| |
| * Abdominal [[RUQ]] [[tenderness]]
| |
| * [[Nausea]]
| |
| * [[Vomiting]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Elevated [[VIP]] level
| |
| *[[Hypokalemia]]
| |
| *[[Hypochlorhydria]] or [[achlorhydria]]
| |
| *Low osmotic gap (<50 mOsm/kg)
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Rash]]
| |
| * [[Facial flushing]]
| |
| * [[Dehydration]]
| |
| * [[Lethargy]]
| |
| * [[Muscle weakness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Primary secretory tumor
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Blood [[VIP]] levels
| |
| * Followed by imaging
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Zollinger-Ellison syndrome|Zollinger–Ellison syndrome]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| ** [[Tenderness|Epigastric tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Positive [[secretin]] stimulation test
| |
| * Elevated serum [[chromogranin A]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| ** [[Jaundice]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Gastrin]] producing [[tumor]] mainly in [[duodenum]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Secretin]] stimulation test
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Neuroendocrine tumors|Somatostatinoma]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| ** [[Tenderness|Epigastric tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Elevated fasting plasma [[somatostatin]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| ** [[Diabetes mellitus]]
| |
| ** [[Gallstone disease|Cholelithiasis]]
| |
| ** [[Jaundice]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Neuroendocrine tumors]] of D–cell origin
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Plasma [[somatostatin]] level
| |
| *Followed by imaging
| |
| |-
| |
| ! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| |
| ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
| |
| ! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
| |
| |-
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Lymphoma]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *Diffuse [[Tenderness (medicine)|abdominal tenderness]]
| |
| *[[Hepatosplenomegaly]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Paraproteinemia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Malabsorption]]
| |
| * [[Lactose intolerance]]
| |
| * [[Ascites]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Primary [[tumor]] of GI tract
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Colonoscopy]] with [[biopsy]]
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Colorectal cancer]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Diffuse [[Tenderness (medicine)|abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Positive [[carcinoembryonic antigen]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Metastasis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[FAP|FAP gene]]
| |
| *[[Hereditary nonpolyposis colorectal cancer|HNPCC gene]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| ** [[Colonoscopy]] and [[biopsy]]
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |Medications
| |
| * [[ACE inhibitor|ACE inhibitors]]
| |
| * [[Digoxin]]
| |
| * [[Cephalosporin|Cephalosporins]]
| |
| * [[Statins]]
| |
| * [[Thiazide|Thiazide diuretics]]
| |
| * [[Triptans]]
| |
| * [[Lactulose]]
| |
| * [[HIV AIDS medical therapy|Anti retroviral agents]]
| |
| * [[Chemotherapy|Chemotherapeutic agents]]
| |
| * [[Antifungal drug|Antifungals]]
| |
| * [[Magnesium]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *[[Abdominal distention]]
| |
| *[[Dehydration]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Elevated plasma level of drug
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Inflammation]]
| |
| *[[Pseudomembranous enterocolitis|Pseudomembranous colitis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Clinical evaluation after discontinuation of the drugs
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |Factitious diarrhea
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *[[Abdominal distention]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Hypokalemia]]
| |
| *[[Metabolic alkalosis]]
| |
| *[[Hypermagnesemia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Malabsorption]]
| |
| *[[Lethargy]]
| |
| *[[Generalized weakness]]
| |
| *[[Acute kidney injury|Acute renal failure]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Medication|Medications]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Clinical evaluation after discontinuation of the drugs
| |
| |-
| |
| ! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| |
| ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
| |
| ! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
| |
| |-
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Heavy metal ingestion]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *[[Abdominal distention]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Elevated plasma heavy metal level
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Headache]]
| |
| *[[Paresthesia|Numbness]]
| |
| *[[Alopecia]]
| |
| *[[Vertigo]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Heavy metal ingestion]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Plasma level of heavy metal
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Organophosphate poisoning]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *[[Saliva|Salivation]]
| |
| *[[Nausea and vomiting|Vomiting]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Reduced RBC acetylcholinesterase
| |
| *Plasma [[cholinesterase]] activity
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Dysautonomia|Autonomic dysfunction]]
| |
| *Motor deficit
| |
| *Sensory deficit
| |
| *[[Bronchospasm]]
| |
| *[[Urination]]
| |
| *[[Miosis]]
| |
| *[[Bradycardia]]
| |
| *[[Lacrimation]]
| |
| *[[Sweating]]
| |
| *[[Cardiac arrhythmia|Cardiac arrhythmias]]
| |
| *[[Acute kidney injury|Acute renal injury]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Neurotoxin|Neurotoxins]] bind to [[ACHE|acetylcholinesterase]] (AChE)
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Clinical diagnosis
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Opium withdrawal]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *Hyperactive [[Stomach rumble|bowel sounds]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Azotemia]]
| |
| *[[Hypokalemia]]
| |
| *[[Metabolic alkalosis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Dysphoria]]
| |
| *[[Agitation (emotion)|Restlessness]]
| |
| *[[Perspiration|Sweating]]
| |
| *[[Rhinorrhea]]
| |
| *[[Tears|Lacrimation]]
| |
| *[[Myalgia]]
| |
| *[[Arthralgia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Opium|Opium withdrawal]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Clinical diagnosis following [[opium withdrawal]]
| |
| |-
| |
| ! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| |
| ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
| |
| ! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
| |
| |-
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Short bowel syndrome]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Abdominal distension|Abdominal distention]]
| |
| * [[Tenderness (medicine)|Abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Positive [[fecal fat]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | ↑
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Hypoalbuminemia]]
| |
| * High level of [[Acute phase protein|acute phase reactant]]
| |
| * Abnormal [[liver function tests]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Prior [[Intestine|intestinal]] surgery
| |
| * [[Malabsorption]]
| |
| * [[Crohn's disease]]
| |
| * [[Cancer|Malignancy]]
| |
| * Peripheral [[edema]]
| |
| * [[Muscle atrophy]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Surgical [[bowel resection]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Clinical diagnosis following [[bowel resection]]
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Radiation enteropathy|Radiation enteritis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| * [[Tenderness (medicine)|Abdominal tenderness]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Positive [[fecal fat]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Vitamin B12 deficiency
| |
| *[[Hypoalbuminemia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Prior history of [[Cancer|malignancy]] and [[radiation therapy]]
| |
| *[[Malabsorption]]
| |
| *[[Telangiectasia|Telangiectasias]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Radiation therapy|Radiation]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Segmental bowel [[inflammation]] on [[endoscopy]] or [[colonoscopy]]
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Gastric dumping syndrome|Dumping syndrome]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *Hyperactive [[bowel sound]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Hypoglycemia]]
| |
| * [[Hydrogen Breath Test|Hydrogen breath test]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Malnutrition]]
| |
| *[[Fat soluble vitamins|Fat soluble vitamin]] deficiency
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Post operative complications|Postgastrectomy]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Clinical diagnosis following [[gastrectomy]]
| |
| |-
| |
| ! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| |
| ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
| |
| ! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
| |
| ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
| |
| ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
| |
| |-
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
| |
| ! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Abetalipoproteinemia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Abdominal distension]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Low [[triglyceride]]
| |
| * Low total [[cholesterol]] levels
| |
| * [[Acanthocytes]]
| |
| * Low [[vitamin E]] levels
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Ataxia]]
| |
| * [[Visual field defect]]
| |
| * [[Dysarthria]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Autosomal recessive]] disorder caused by mutations encoding the [[microsomal triglyceride transfer protein]] (MTP)
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Clinical findings and low [[triglyceride]] and [[cholesterol]] level
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Hyperthyroidism]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Positive [[fecal fat]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Elevated [[T4]]
| |
| * Elevated [[T3]]
| |
| * Decreased [[TSH]]
| |
| * High serum [[alkaline phosphatase]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * Lump in the neck
| |
| * Lid lag
| |
| * [[Malabsorption]]
| |
| * [[Sweating]]
| |
| * [[Hyperpigmentation]]
| |
| * [[Proptosis]]
| |
| * [[Tremor]]
| |
| * Increased [[Deep tendon reflex|DTR]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[Graves' disease]]
| |
| * [[Hashimoto's thyroiditis]]
| |
| * [[Toxic adenoma]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| * [[TSH]]
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Diabetic neuropathy]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| |
| *[[Fecal incontinence]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Positive [[fecal fat]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Hyperglycemia]]
| |
| *[[Azotemia]]
| |
| *[[Hypokalemia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *[[Malabsorption]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Unclear
| |
| *Disordered [[motility]]
| |
| *Increased [[Intestine|intestinal]] secretion
| |
| *[[Small intestinal bacterial overgrowth]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| *Clinical diagnosis in a patient with long lasting [[diabetes mellitus]]
| |
| |-
| |
| ! colspan="2" style="background:#DCDCDC;" align="center" |[[Scleroderma|Systemic sclerosis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| |
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| *[[Abdominal pain|Epigastric tenderness]]
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| *[[Fecal incontinence]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
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| *Positive [[fecal fat]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
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| | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
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| * Anti–[[Type I topoisomerase|topoisomerase I]] (Scl‑70) antibodies
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| * [[Antinuclear antibodies]] ([[Antinuclear antibodies|ANA]])
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| * [[Anti-centromere antibodies|Anti–centromere antibodies]]
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| * Anti–[[RNA polymerase III]] antibody
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| *[[Malabsorption]]
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| *[[Skin changes]]
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| *[[Raynaud's phenomenon|Raynaud phenomenon]]
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| *[[Pulmonary hypertension]]
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| *[[Arthritis]]
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| *[[Telangiectasia]]
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| *[[Chronic renal failure]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| *[[Autoimmunity|Autoimmune reaction]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| *Clinical diagnosis
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| *Followed by serologic tests
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| |- }
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| |}
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| | |
| ==Epidemiology and Demographics==
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| *The prevalence of SIBO is unknown.
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| ===Age===
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| *Small intestinal bacterial overgrowth is more commonly observed among elderly patients.
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| ===Gender===
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| *Small intestinal bacterial overgrowth (SIBO) affects men and women equally.
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| ===Race===
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| *There is no racial predilection for small intestinal bacterial overgrowth (SIBO).
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| | |
| ==Risk Factors==
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| *Common risk factors in the development of small intestinal bacterial overgrowth (SIBO) are :
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| **Intestinal tract surgery
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| **Irritable bowel syndrome
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| **Liver cirrhosis
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| **Celiac disease
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| **Immune deficiency (eg, AIDS, IGA deficiency, severe malnutrition)
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| **Short bowel syndrome
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| **End-stage renal disease
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| **Gastrojejunal anastomosis
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| **Antral resection
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| **Pancreatic exocrine insufficiency
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| | |
| == Natural History, Complications and Prognosis==
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| *Early clinical features include bloating, flatulence, abdominal pain.
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| *If left untreated, patients with small intestinal bacterial overgrowth (SIBO) may progress to develop diarrhea, dyspepsia and weight loss.
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| *Common complications of small intestinal bacterial overgrowth (SIBO) include:
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| **Iron deficiency resulting in microcytic anemia
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| **Vitamin B-12/ folate deficiency resulting in macrocytic anemia
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| **Vitamin B-12 deficiency associated polyneuropathy
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| **Steatorrhea
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| **Hypocalcemia
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| **Vitamin A deficiency resulting in night blindness
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| **Selenium deficiency causing dermatitis
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| **Rosacea
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| **Cachexia as a result of protein-energy malnutrition
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| *Prognosis is generally good and associated with frequent relapses and symptom-free periods.
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| | |
| == Diagnosis ==
| |
| ===Diagnostic Criteria===
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| *The diagnosis of small intestinal bacterial overgrowth (SIBO) is made when at least one of the following diagnostic criteria are met:
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| :*A positive carbohydrate breath test
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| :*Bacterial concentration of >103 units/mL in a jejunal aspirate culture
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| | |
| === Symptoms ===
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| *Symptoms of small intestinal bacterial overdose (SIBO) may include the following:
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| :*Bloating
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| :*Flatulence
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| :*Abdominal discomfort
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| :*Chronic watery diarrhea
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| :*Weight loss
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| | |
| === Physical Examination ===
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| *Patients with small intestinal bacterial overgrowth (SIBO) usually appear normal.
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| *Physical examination may be remarkable for:
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| :*Distended abdomen with positive succussion splash as a result of distended bowel loops
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| :*Peripheral edema due to malabsorption
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| | |
| === Laboratory Findings ===
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| *A positive carbohydrate breath test is diagnostic of small intestinal bacterial overgrowth (SIBO).
| |
| *An elevated concentration of bacterial colony forming units >103/mL in jejunal aspirate culture is diagnostic of small intestinal bacterial overgrowth (SIBO).
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| *Other laboratory findings consistent with the diagnosis of small intestinal bacterial overgrowth (SIBO) include
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| **Macrocytic anemia
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| **B12 deficiency
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| **Presence of fecal fat on stool examination.
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| **Low levels of thiamine and niacin
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| **Elevated serum folate and vitamin K levels
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| | |
| ===Imaging Findings===
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| *In CT abdomen/MRI may demonstrate associated strictures, malrotation, fistulae.
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| | |
| ===Other Diagnostic Studies===
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| ====Breath Tests====
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| *Small intestinal bacterial obstruction(SIBO) may also be diagnosed using breath tests.
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| *Breath tests have the advantage of being easy to perform, noninvasive and inexpensive. Breath tests are based on the principle that carbohydrates are metabolized by bacteria in the gut to produce hydrogen or methane that is absorbed and excreted in breath.
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| *The findings on carbohydrate breath test diagnostic of small intestinal bacterial obstruction(SIBO) include:
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| **An increase in hydrogen by ≥20 ppm above baseline within 90 minutes.
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| **A methane level ≥10 ppm regardless of the time during the breath test.
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| | |
| == Treatment ==
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| ===Medical Therapy===
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| *The mainstay of therapy for small intestinal bacterial overgrowth(SIBO) is antibiotic therapy.
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| *Antibiotics acts by eliminating the bacterial overgrowth.
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| * Rifaximin is the antibiotic of choice for the treatment of small intestinal bacterial overgrowth(SIBO).
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| **Preferred regimen: Rifaximin 550 mg PO 8h for 14 days.
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| *Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
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|
| |
| === Surgery ===
| |
| *Surgery is the mainstay of therapy for [disease name].
| |
| *[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
| |
| *[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
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|
| |
| === Prevention ===
| |
| *There are no primary preventive measures available for [disease name].
| |
|
| |
| *Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
| |
| | |
| *Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
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| | |
| ==Clinical presentation==
| |
| [[Image:Cobalmin.png|left|thumb|Deficiency of [[vitamin B12]] can occur in bacterial overgrowth]]
| |
| Bacterial overgrowth can cause a variety of [[symptom]]s, many of which are also found in other conditions, making the [[diagnosis]] challenging at times.<!--
| |
| --><ref name=Quigley/><ref name=Teo>{{cite journal | author = Teo M, Chung S, Chitti L, Tran C, Kritas S, Butler R, Cummins A | title = Small bowel bacterial overgrowth is a common cause of chronic diarrhea. | journal = J Gastroenterol Hepatol | volume = 19 | issue = 8 | pages = 904-9 | year = 2004 | id = PMID 15242494}}</ref> <!--
| |
| -->Many of the symptoms are due to [[malabsorption]] of nutrients due to the effects of bacteria which either metabolize nutrients or cause inflammation of the small bowel impairing absorption. The symptoms of bacterial overgrowth include [[nausea]], [[bloating]], [[flatus]], and [[chronic]] [[diarrhea]]. Some patients may develop abdominal discomfort and lose weight. Children with bacterial overgrowth may develop [[malnutrition]] have difficulty attaining [[failure to thrive|proper growth]]. [[Steatorrhea]] is a sticky type of diarrhea, where [[lipid]]s are malabsorbed and spill into the stool.<!--
| |
| --><ref name=Kirsch>{{cite journal | author = Kirsch M | title = Bacterial overgrowth. | journal = Am J Gastroenterol | volume = 85 | issue = 3 | pages = 231-7 | year = 1990 | id = PMID 2178395}}</ref><!--
| |
| -->
| |
| | |
| Patients with bacterial overgrowth that is longstanding can develop complications of their illness as a result of malabsorption of nutrients. [[Anemia]] may occur from a variety of mechanisms, as many of the nutrients involved in production of [[red blood cell]]s are absorbed in the affected small bowel. [[Iron]] is absorbed in the more proximal parts of the small bowel, the [[duodenum]] and [[jejunum]], and patients with malabsorption of iron can develop a [[microcytic anemia]], with small red blood cells. [[Vitamin B12]] is absorbed in the last part of the small bowel, the [[ileum]], and patients who malabsorb vitamin B12 can develop a [[megaloblastic anemia]] with large red blood cells.<ref name=Kirsch/>
| |
| | |
| ==Pathophysiology==
| |
| [[Image:E coli at 10000x, original.jpg|left|thumb|''E. coli'', shown in this electron micrograph, is commonly isolated in patients with bacterial overgrowth]]
| |
| | |
| Certain species of bacteria are more commonly found in aspirates of the [[jejunum]] taken from patients with bacterial overgrowth. The most common isolates are ''[[Escherichia coli]]'', ''[[Streptococcus]]'', ''[[Lactobacillus]]'', ''[[Bacteroides]]'', and ''[[Enterococcus]]'' species.<!--
| |
| --><ref name=Bouhnik>{{cite journal | author = Bouhnik Y, Alain S, Attar A, Flourié B, Raskine L, Sanson-Le Pors M, Rambaud J | title = Bacterial populations contaminating the upper gut in patients with small intestinal bacterial overgrowth syndrome. | journal = Am J Gastroenterol | volume = 94 | issue = 5 | pages = 1327-31 | year = 1999 | id = PMID 10235214}}</ref> <!--
| |
| -->
| |
| | |
| Soon after birth, the [[gastrointestinal tract]] is colonized with bacteria, which, on the basis of models with animals raised in a germ-free environment, have beneficial effects on function of the gastrointestinal tract. There are 500-1000 different species of bacteria that reside in the bowel.<!--
| |
| --><ref name=Germ>{{cite journal | author = Hao W, Lee Y | title = Microflora of the gastrointestinal tract: a review. | journal = Methods Mol Biol | volume = 268 | issue = | pages = 491-502 | year = | id = PMID 15156063}}</ref> <!--
| |
| -->However, if the flora of the small bowel is altered, inflammation or altered digestion can occur, leading to symptoms. Many patients with chronic diarrhea have bacterial overgrowth as a cause or a contributor to their symptoms.<ref name=Teo/> While the consensus definition of chronic diarrhea varies, in general it is considered to be an alteration in stool consistency or increased frequency, that occurs for over three weeks. Various mechanisms are involved in the development of diarrhea in bacterial overgrowth. First, the excessive bacterial concentrations can cause direct inflammation of the small bowel cells, leading to an ''inflammatory'' diarrhea. The malabsorption of [[lipid]]s, [[protein]]s and [[carbohydrate]]s may cause poorly digestible products to enter into the [[colon (anatomy)|colon]]. This can cause diarrhea by the [[osmosis|osmotic drive]] of these molecules, but can also stimulate the secretory mechanisms of colonic cells, leading to a ''secretory diarrhea''.<ref name=Kirsch/>
| |
| | |
| ==Risk factors and causes==
| |
| [[Image:Ileocecal valve.jpg|thumb|left|The [[ileo-cecal valve]] prevents reflux of bacteria from the colon into the small bowel. Resection of the valve can lead to bacterial overgrowth]]
| |
| | |
| Certain patients are more predisposed to the development of bacterial overgrowth because of certain risk factors. These factors can be grouped into three categories: (1) disordered [[motility]] or movement of the small bowel or anatomical changes that lead to [[stasis]], (2) disorders in the [[immune system]] and (3) conditions that cause more bacteria from the [[colon (anatomy)|colon]] to enter the [[small bowel]].<ref name=Quigley/>
| |
| | |
| Problems with motility may either be diffuse, or localized to particular areas. Diseases like [[scleroderma]]<!--
| |
| --><ref name=Scleroreview>{{cite journal | author = Rose S, Young M, Reynolds J | title = Gastrointestinal manifestations of scleroderma. | journal = Gastroenterol Clin North Am | volume = 27 | issue = 3 | pages = 563-94 | year = 1998 | id = PMID 9891698}}</ref> <!--
| |
| -->and possibly [[celiac disease]]<!--
| |
| --><ref name=Tursi>{{cite journal | author = Tursi A, Brandimarte G, Giorgetti G | title = High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal. | journal = Am J Gastroenterol | volume = 98 | issue = 4 | pages = 839-43 | year = 2003 | id = PMID 12738465}}</ref> <!--
| |
| -->cause diffuse slowing of the bowel, leading to increased bacterial concentrations. More commonly, the small bowel may have anatomical problems, such as out-pouchings known as [[diverticula]] that can cause bacteria to accumulate.<!--
| |
| --><ref name=Kongara>{{cite journal | author = Kongara K, Soffer E | title = Intestinal motility in small bowel diverticulosis: a case report and review of the literature. | journal = J Clin Gastroenterol | volume = 30 | issue = 1 | pages = 84-6 | year = 2000 | id = PMID 10636218}} </ref><!--
| |
| --> After surgery involving the [[stomach]] and [[duodenum]] (most commonly with [[Billroth II]] antrectomy), a ''blind loop'' may be formed, leading to stasis of flow of intestinal contents. This can cause overgrowth, and is termed ''blind loop syndrome''.<!--
| |
| --><ref name=Kim>{{cite journal | author = Isaacs P, Kim Y | title = Blind loop syndrome and small bowel bacterial contamination. | journal = Clin Gastroenterol | volume = 12 | issue = 2 | pages = 395-414 | year = 1983 | id = PMID 6347463}}</ref><!--
| |
| -->
| |
| | |
| Disorders of the immune system can cause bacterial overgrowth. Chronic [[pancreatitis]], or inflammation of the [[pancreas]] can cause bacterial overgrowth through mechanisms linked to this.<!--
| |
| --><ref>{{cite journal | author = Trespi E, Ferrieri A | title = Intestinal bacterial overgrowth during chronic pancreatitis. | journal = Curr Med Res Opin | volume = 15 | issue = 1 | pages = 47-52 | year = 1999 | id = PMID 10216811}}</ref> <!--
| |
| -->The use of [[immunosuppressant]] medications to treat other conditions can cause this, as evidenced from animal models.<!--
| |
| --><ref name=Marshall>{{cite journal | author = Marshall J, Christou N, Meakins J | title = Small-bowel bacterial overgrowth and systemic immunosuppression in experimental peritonitis. | journal = Surgery | volume = 104 | issue = 2 | pages = 404-11 | year = 1988 | id = PMID 3041643}}</ref> <!--
| |
| --> Other causes include inherited immunodeficiency conditions, such as [[combined variable immunodeficiency]], IgA deficiency, and [[hypogammaglobulinemia]].<!--
| |
| --><ref name=Pediatrics>{{cite journal | author = Pignata C, Budillon G, Monaco G, Nani E, Cuomo R, Parrilli G, Ciccimarra F | title = Jejunal bacterial overgrowth and intestinal permeability in children with immunodeficiency syndromes. | journal = Gut | volume = 31 | issue = 8 | pages = 879-82 | year = 1990 | id = PMID 2387510}}</ref><!--
| |
| -->
| |
| | |
| Finally, abnormal connections between the [[bacteria]]-rich colon and the small bowel can increase the bacterial load in the small bowel. Patients with [[Crohn's disease]] or other diseases of the [[ileum]] may require surgery that removes the [[ileo-cecal valve]] connecting the small and large bowel; this leads to an increased reflux of bacteria into the small bowel.<!--
| |
| --><ref name-Kholoussy>{{cite journal | author = Kholoussy A, Yang Y, Bonacquisti K, Witkowski T, Takenaka K, Matsumoto T | title = The competence and bacteriologic effect of the telescoped intestinal valve after small bowel resection. | journal = Am Surg | volume = 52 | issue = 10 | pages = 555-9 | year = 1986 | id = PMID 3767143}}</ref> <!--
| |
| --> After [[bariatric surgery]] for obesity, connections between the stomach and the [[ileum]] can be formed, which may increase bacterial load in the small bowel.<!--
| |
| --><ref name=AJS>{{cite journal | author = Abell T, Minocha A | title = Gastrointestinal complications of bariatric surgery: diagnosis and therapy. | journal = Am J Med Sci | volume = 331 | issue = 4 | pages = 214-8 | year = 2006 | id = PMID 16617237}}</ref> <!--
| |
| -->[[Proton pump inhibitor]] medications that decrease acid in the [[stomach]] cause bacterial overgrowth by a similar mechanism, as they prevent the anti-bacterial effects of acid in the stomach. The clinical significance of this in causing symptoms is unclear.<!--
| |
| --><ref name=PPI>{{cite journal | author = Laine L, Ahnen D, McClain C, Solcia E, Walsh J | title = Review article: potential gastrointestinal effects of long-term acid suppression with proton pump inhibitors. | journal = Aliment Pharmacol Ther | volume = 14 | issue = 6 | pages = 651-68 | year = 2000 | id = PMID 10848649}}</ref><ref name=PPI2>{{cite journal | author = Williams C, McColl K | title = Review article: proton pump inhibitors and bacterial overgrowth. | journal = Aliment Pharmacol Ther | volume = 23 | issue = 1 | pages = 3-10 | year = 2006 | id = PMID 16393275}}</ref>
| |
| | |
| ==Diagnosis==
| |
| [[Image:Agar plate with colonies.jpg|left|thumb|Aspiration of from the [[jejunum]] is the gold standard for diagnosis. A bacterial load of greater than 10<sup>5</sup> bacteria per milillitre is diagnostic for bacterial overgrowth]]
| |
| | |
| The diagnosis of bacterial overgrowth can be made by physicians in various ways. [[Malabsorption]] can be detected by a test called the ''D-xylose'' test. [[Xylose]] is a sugar that does not require enzymes to be digested. The D-xylose test involves having a patient to drink a certain quantity of D-xylose, and measuring levels in the [[urine]] and [[blood]]; if there is no evidence of D-xylose in the [[urine]] and [[blood]], it suggests that the small bowel is not absorbing properly (as opposed to problems with enzymes required for digestion).<!--
| |
| --><ref name=Dxylose>{{cite journal | author = Craig R, Atkinson A | title = D-xylose testing: a review. | journal = Gastroenterology | volume = 95 | issue = 1 | pages = 223-31 | year = 1988 | id = PMID 3286361}}</ref><!--
| |
| -->
| |
| | |
| The gold standard for detection of bacterial overgrowth is the aspiration of more than 10<sup>5</sup> bacteria per millilitre from the small bowel. The normal small bowel has less than 10<sup>4</sup> bacteria per millilitre.<!--
| |
| --><ref name=Corazza>{{cite journal | author = Corazza G, Menozzi M, Strocchi A, Rasciti L, Vaira D, Lecchini R, Avanzini P, Chezzi C, Gasbarrini G | title = The diagnosis of small bowel bacterial overgrowth. Reliability of jejunal culture and inadequacy of breath hydrogen testing. | journal = Gastroenterology | volume = 98 | issue = 2 | pages = 302-9 | year = 1990 | id = PMID 2295385}}</ref><!--
| |
| -->
| |
| | |
| [[Image:Coeliac path.jpg|thumb|left|Biopsies of the small bowel in bacterial overgrowth can mimic [[celiac disease]], with partial [[villi|villous]] atrophy.]]
| |
| Breath tests have been developed to test for bacterial overgrowth, based on bacterial metabolism of [[carbohydrates]] to [[hydrogen]], or based on the detection of by-products of digestion of carbohydrates that are not usually metabolized. The hydrogen breath test involves giving patients a load of carbohydrate (usually in the form of [[rice]]) and measuring expired hydrogen concentrations after a certain time. It compares well to jejunal aspirates in making the diagnosis of bacterial overgrowth.<!--
| |
| --><ref name=Kerlin>{{cite journal | author = Kerlin P, Wong L | title = Breath hydrogen testing in bacterial overgrowth of the small intestine. |
| |
| journal = Gastroenterology | volume = 95 | issue = 4 | pages = 982-8 | year = 1988 | id = PMID 3410238}}</ref> <!--
| |
| --><sup>13</sup>C and <sup>14</sup>C based tests have also been developed based on the bacterial metabolism of D-xylose. Increased bacterial concentrations are also involved in the deconjugation of bile acids. The glycocholic acid breath test involves the administration of the bile acid <sup>14</sup>C glychocholic acid, and the detection of <sup>14</sup>CO<sub>2</sub>, which would be elevated in bacterial overgrowth.<!--
| |
| --><ref name=Geri>{{cite journal | author = Donald I, Kitchingmam G, Donald F, Kupfer R | title = The diagnosis of small bowel bacterial overgrowth in elderly patients. | journal = J Am Geriatr Soc | volume = 40 | issue = 7 | pages = 692-6 | year = 1992 | id = PMID 1607585}}</ref> <!--
| |
| -->
| |
| | |
| Some patients with symptoms of [[bacterial overgrowth]] will undergo [[gastroscopy]], or visualization of the stomach and duodenum with an endoscopic [[camera]]. Biopsies of the small bowel in [[bacterial overgrowth]] can mimic those of [[celiac disease]], making the diagnosis more challenging. Findings include blunting of [[villi]], hyperplasia of crypts and an increased number of [[lymphocyte]]s in the [[lamina propria]].<!--
| |
| --><ref name=Toskes>{{cite journal | author = Toskes P, Giannella R, Jervis H, Rout W, Takeuchi A | title = Small intestinal mucosal injury in the experimental blind loop syndrome. Light- and electron-microscopic and histochemical studies. | journal = Gastroenterology | volume = 68 | issue = 5 Pt 1 | pages = 1193-203 | year = 1975 | id = PMID 1126607}}</ref><!--
| |
| -->
| |
| | |
| However, some physicians suggest that if the suspicion of bacterial overgrowth is high enough, the best diagnostic test is a trial of treatment. If the symptoms improve, an empiric diagnosis of bacterial overgrowth can be made.<!--
| |
| --><ref name=Singh>{{cite journal | author = Singh VV, Toskes PP | title = Small Bowel Bacterial Overgrowth: Presentation, Diagnosis, and Treatment. | journal = Curr Treat Options Gastroenterol | volume = 7 | issue = 1 | pages = 19-28 | year = 2004 | id = PMID 14723835}}</ref>
| |
| | |
| ==Treatment==
| |
| Bacterial overgrowth is usually treated with a course of antibiotics. A variety of antibiotics, including [[neomycin]], [[rifaximin]], [[amoxicillin-clavulanate]], [[fluoroquinolone]] antibiotics and [[tetracycline]] have been used; however, the best evidence is for the use of [[norfloxacin]] and [[amoxicillin-clavulanate]].<!--
| |
| --><ref name=RCT>{{cite journal | author = Attar A, Flourié B, Rambaud J, Franchisseur C, Ruszniewski P, Bouhnik Y | title = Antibiotic efficacy in small intestinal bacterial overgrowth-related chronic diarrhea: a crossover, randomized trial. | journal = Gastroenterology | volume = 117 | issue = 4 | pages = 794-7 | year = 1999 | id = PMID 10500060}}</ref>
| |
| | |
| A course of one week of antibiotics is usually sufficient to treat the condition. However, if the condition recurs, antibiotics can be given in a cyclical fashion in order to prevent tolerance. For example, antibiotics may be given for a week, followed by three weeks off antibiotics, followed by another week of treatment. Alternatively, the choice of antibiotic used can be cycled.<ref name=Singh/>
| |
| | |
| The condition that predisposed the patient to bacterial overgrowth should also be treated. For example, if the bacterial overgrowth is caused by [[chronic pancreatitis]], the patient should be treated with coated pancreatic [[enzyme]] supplements.
| |
| | |
| [[Probiotic]]s are bacterial preparations that alter the bacterial flora in the bowel to cause a beneficial effect. Their role in bacterial overgrowth is somewhat uncertain.<ref name=Quigley/>
| |
| ==Overveiw==
| |
| '''Small bowel bacterial overgrowth syndrome''' ('''SBBOS'''), or '''small intestinal bacterial overgrowth''' ('''SIBO'''), also termed '''bacterial overgrowth'''; is a disorder of excessive bacterial growth in the [[small intestine]]. Unlike the [[colon (anatomy)|colon]] (or large bowel), which is rich with [[bacteria]], the small bowel usually has less than 10<sup>4</sup> organisms per millilitre.<!--
| |
| --><ref name=Quigley>{{cite journal | author = Quigley E, Quera R | title = Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics, and probiotics. | journal = Gastroenterology | volume = 130 | issue = 2 Suppl 1 | pages = S78-90 | year = 2006 | id = PMID 16473077}}</ref> <!--
| |
| -->Patients with bacterial overgrowth typically develop symptoms including [[nausea]], [[bloating]], [[vomiting]] and [[diarrhea]], which is caused by a number of mechanisms. The [[diagnosis]] of bacterial overgrowth is made by a number of techniques, with the [[gold standard (test)|gold standard]] diagnosis being an [[Needle aspiration biopsy|aspirate]] from the [[jejunum]] that grows in excess of 10<sup>5</sup> [[bacteria]] per millilitre. [[Risk factor]]s for the development of bacterial overgrowth include the use of medications including [[proton pump inhibitors]], [[anatomy|anatomical]] disturbances in the bowel, including [[fistula]]e, [[diverticula]] and blind loops created after surgery, and resection of the [[ileo-cecal valve]]. Small bowel bacterial overgrowth syndrome is treated with [[antibiotic]]s, which may be given in a cyclic fashion to prevent tolerance to the antibiotics.
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| | |
| ==References==
| |
| {{Reflist|2}}
| |