Sandbox:Cherry

Patient information

For the WikiDoc page for this topic, click here

Diarrhea
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Diarrhea?
Prevention
What to expect (Outlook/Prognosis)?
Diarrhea On the Web
Ongoing Trials at Clinical Trials.gov
Images of Diarrhea
Videos on Diarrhea
FDA on Diarrhea
CDC on Diarrhea
Diarrhea in the news
Blogs on Diarrhea
Directions to Hospitals Treating Diarrhea
Risk calculators and risk factors for Diarrhea

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-in-Chief: Meagan E. Doherty

Overview

Diarrhea is loose, watery stools. A person with diarrhea typically passes stool more than three times a day. People with diarrhea may pass more than a quart of stool a day. Acute diarrhea is a common problem that usually lasts 1 or 2 days and goes away on its own without special treatment. Prolonged diarrhea persisting for more than 2 days may be a sign of a more serious problem and poses the risk of dehydration. Chronic diarrhea may be a feature of a chronic disease. Diarrhea can cause dehydration, which means the body lacks enough fluid to function properly. Dehydration is particularly dangerous in children and older people, and it must be treated promptly to avoid serious health problems. People of all ages can get diarrhea and the average adult has a bout of acute diarrhea about four times a year. In the United States, each child will have had seven to 15 episodes of diarrhea by age 5.

What are the symptoms of Diarrhea?

Diarrhea may be accompanied by cramping, abdominal pain, bloating, nausea, or an urgent need to use the bathroom. Depending on the cause, a person may have a fever or bloody stools.

What are the causes of Diarrhea?

Acute diarrhea is usually related to a bacterial, viral, or parasitic infection. Chronic diarrhea is usually related to functional disorders such as irritable bowel syndrome or inflammatory bowel disease.

A few of the more common causes of diarrhea include the following:

• Bacterial infections. Several types of bacteria consumed through contaminated food or water can cause diarrhea. Common culprits include Campylobacter, Salmonella, Shigella, and Escherichia coli (E. coli).
• Viral infections. Many viruses cause diarrhea, including rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis.
• Food intolerances. Some people are unable to digest food components such as artificial sweeteners and lactose—the sugar found in milk.
• Parasites. Parasites can enter the body through food or water and settle in the digestive system. Parasites that cause diarrhea include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
• Reaction to medicines. Antibiotics, blood pressure medications, cancer drugs, and antacids containing magnesium can all cause diarrhea.
• Intestinal diseases. Inflammatory bowel disease, colitis, Crohn’s disease, and celiac disease often lead to diarrhea.
• Functional bowel disorders. Diarrhea can be a symptom of irritable bowel syndrome.

Some people develop diarrhea after stomach surgery or removal of the gallbladder. The reason may be a change in how quickly food moves through the digestive system after stomach surgery or an increase in bile in the colon after gallbladder surgery.

People who visit foreign countries are at risk for traveler’s diarrhea, which is caused by eating food or drinking water contaminated with bacteria, viruses, or parasites. Traveler’s diarrhea can be a problem for people visiting developing countries. Visitors to the United States, Canada, most European countries, Japan, Australia, and New Zealand do not face much risk for traveler’s diarrhea.

In many cases, the cause of diarrhea cannot be found. As long as diarrhea goes away on its own, an extensive search for the cause is not usually necessary.

Who is at risk for Diarrhea?

Anyone can get diarrhea. This common problem can last a day or two or for months or years, depending on the cause. Most people get better on their own, but diarrhea can be serious for babies and older people if lost fluids are not replaced. Many people throughout the world die from diarrhea because of the large volume of water lost and the accompanying loss of salts.

Diagnosis

Diagnostic tests to find the cause of diarrhea may include the following:

• Medical history and physical examination. The doctor will ask you about your eating habits and medication use and will examine you for signs of illness.
• Stool culture. A sample of stool is analyzed in a laboratory to check for bacteria, parasites, or other signs of disease and infection.
• Blood tests. Blood tests can be helpful in ruling out certain diseases.
• Fasting tests. To find out if a food intolerance or allergy is causing the diarrhea, the doctor may ask you to avoid lactose, carbohydrates, wheat, or other foods to see whether the diarrhea responds to a change in diet.
• Sigmoidoscopy. For this test, the doctor uses a special instrument to look at the inside of the rectum and lower part of the colon.
• Colonoscopy. This test is similar to a sigmoidoscopy, but it allows the doctor to view the entire colon.
• Imaging tests. These tests can rule out structural abnormalities as the cause of diarrhea.

When to seek urgent medical care

Diarrhea is not usually harmful, but it can become dangerous or signal a more serious problem. You should see the doctor if you experience any of the following:

• Diarrhea for more than 3 days
• Severe pain in the abdomen or rectum
• A fever of 102 degrees or higher
• Blood in your stool or black, tarry stools
• Signs of dehydration

Treatment options

In most cases of diarrhea, replacing lost fluid to prevent dehydration is the only treatment necessary. Medicines that stop diarrhea may be helpful, but they are not recommended for people whose diarrhea is caused by a bacterial infection or parasite. If you stop the diarrhea before having purged the bacteria or parasite, you will trap the organism in the intestines and prolong the problem. Rather, doctors usually prescribe antibiotics as a first-line treatment. Viral infections are either treated with medication or left to run their course, depending on the severity and type of virus.

Tips About Food

Until diarrhea subsides, try to avoid caffeine, milk products, and foods that are greasy, high in fiber, or very sweet. These foods tend to aggravate diarrhea.

As you improve, you can add soft, bland foods to your diet, including bananas, plain rice, boiled potatoes, toast, crackers, cooked carrots, and baked chicken without the skin or fat. For children, the pediatrician may also recommend a bland diet. Once the diarrhea has stopped, the pediatrician will likely encourage children to return to a normal and healthy diet if it can be tolerated.

Contraindicated medications

Patients diagnosed with Diarrhea should avoid using the following medications:

• Ethacrynic acid
  If you have been diagnosed with Diarrhea, consult your physician before starting or stopping any of these medications.

Where to find medical care for Diarrhea

Directions to Hospitals Treating Diarrhea

Prevention of Diarrhea

• Wash your hands often, especially after going to the bathroom and before eating.
• Teach children to not put objects in their mouth.
• When taking antibiotics, try eating food with Lactobacillus acidophilus, a healthy bacteria. This helps replenish the good bacteria that antibiotics can kill. Yogurt with active or live cultures is a good source of this healthy bacteria.
• Use alcohol-based hand gel frequently.

Traveler’s diarrhea happens when you consume food or water contaminated with bacteria, viruses, or parasites. You can take the following precautions to prevent traveler’s diarrhea when you travel outside of the United States:

• Do not drink tap water or use it to brush your teeth.
• Do not drink unpasteurized milk or dairy products.
• Do not use ice made from tap water.
• Avoid all raw fruits and vegetables, including lettuce and fruit salads, unless they can be peeled and you peel them yourself.
• Do not eat raw or rare meat and fish.
• Do not eat meat or shellfish that is not hot when served.
• Do not eat food from street vendors.

You can safely drink bottled water—if you are the one to break the seal—along with carbonated soft drinks, and hot drinks such as coffee or tea.

Depending on where you are going and how long you will stay, your doctor may recommend that you take antibiotics before leaving to protect you from possible infection.

What to expect (Outlook/Prognosis)

The Prognosis for diarrhea is usually good. Diarrhea is common and usually goes away on its own unless it is an underlying symptom of a chronic disease. It is important to replace lost fluid due to diarrhea because if you become severely dehydrated it can be fatal.

Sources

http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/

Pathophysiology Diarrhea

Normal fluid intake for an adult is about 2 L/d. The average amount of gastrointestinal secretions (composed of salivary glands, gastric, biliary, and pancreatic secretions) is 7-8 L/d, depending on the weight and age. The absorptive surface of the small intestine is formed by villis that reabsorb the majority of secreted water and electrolytes. The small intestine absorbs 75% of upper GI tract secretions. The rest of the secretions absorb in the large intestine. Colon absorbs 90% of its exposed volume, means that colon is the most effective absorbing organ in the GI system.
Decrease in the small intestine absorption, regardless of causes, may not cause diarrhea unless, there is a dysfunction in colon or the volume of the secretions exceeds the absorptive ability of the colon.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Acute appendicitis Acute kidney failure Acute pancreatitis Anaphylaxis Angioedema Carbon monoxide poisoning Digoxin toxicity Ergotism

Food poisoning Heavy metal poisoning Herbal extract overdose Infectious diarrhea Inflammatory bowel disease Insect bite allergy Intususception

Ischemic colitis Organophosphate poisoning Pesticide poisoning Pseudomembranous colitis Severe combined immunodeficiency Staphylococcal toxic shock syndrome Waterhouse-Friederichsen syndrome

Common Causes

ACE inhibitors Alcohol intoxication Alcohol withdrawal Amebiasis Anti retroviral agents Antifungals Bacillary dysentery Bacterial toxin Bile acid sequestrant Campylobacter jejuni Cephalosporins Chemotherapeutic agents

Cholestatic jaundice Citalopram Colitis Colorectal polyps Diabetic neuropathy Diverticulitis Doxycycline Entamoeba histolytica Escherichia coli Food poisoning Fosfomycin Helminthiasis Hepatitis A Hepatitis E

Inflammatory bowel disease Lactose intolerance Macrolides Malabsorption syndrome Opioid withdrawal Proton pump inhibitors Pseudomembranous colitis Radiation sickness Salmonellosis Statins Thiazide diuretics Triptans

Causes According to Pathophysiology

Osmotic Diarrhea

Abetalipoproteinaemia Alagille syndrome Alpha-glucosidase inhibitor Aminoglycosides Ampicillin Antacids Apolipoprotein B deficiency Ascariasis Auranofin Autoimmune polyendocrine syndrome Bacitracin Biguanides Billroth II procedure Blind loop syndrome Carcinoid syndrome Celiac disease Cholesteryl ester storage disease Cholestyramine Chronic granulomatous disease Chylomicron retention disease Colchicine Colestyramine

Common variable immunodeficiency Cronkhite-Canada disease Diabetic neuropathy Diffuse systemic sclerosis Dumping syndrome Eflornithine Fasciolopsiasis Fructose malabsorption Gastrointestinal amyloidosis Gastrointestinal lymphomas Giardiasis Glucose-galactose malabsorption HIV Kanamycin Kwashiorkor Lactose intolerance Magnesium salts Malabsorption syndrome Malassimilation Mannitol Mastocytosis Ménétrier's disease

Methyldopa Microsporidiosis Milk allergy Mixed connective tissue disease Neomycin Octreotide Orlistat Osmotic laxative Pearson syndrome Protein losing enteropathy Short bowel syndrome Shwachman-Diamond syndrome Small bowel bacterial overgrowth syndrome Somatostatinoma Sorbitol Strongyloidiasis Sucrase-isomaltase deficiency Sucrose intolerance Tetracyclines Tropical sprue Whipple disease

Secretory Diarrhea

Addison's disease Anaphylaxis Angioedema Anthraquinone Antidepressants Antineoplastic agents Auranofin Bacterial toxin Biguanides Bisacodyl Brainerd diarrhea Calcitonin Carcinoid syndrome Cardiac glycosides Cephalosporins Chenodeoxycholic acid Cholera Cholestatic jaundice Colchicine

Collagenous colitis Colorectal cancer Congenital chloride diarrhea Diabetic neuropathy Diacerein Diverticulitis Gastrinoma Graves disease Heavy metal poisoning Herbal extract poisoning Hyperthyroidism Hypoaldosteronism Inflammatory bowel disease Intestinal lymphoma IPEX (syndrome) Irritable bowel syndrome Lymphocytic colitis Macrolides Mastocytosis

Medullary carcinoma of thyroid Microvillous inclusion disease Mushroom poisoning NSAIDS Olsalazine Oxyphenisatin Penicillins Pesticide poisoning Phenolphthalein Postsympathectomy Postvagotomy Prostaglandins Ricinoleic acid Somatostatinoma Ticlopidine Vasculitis Villous adenoma VIPoma Zollinger-Ellison syndrome

Motility Related Diarrhea

Cephalosporins Cisapride Colchicine Diabetic neuropathy Erythromycin Hyperthyroidism

Levothyroxine Macrolides Penicillins Postileal resection Postvagotomy

Quinolones Short bowel syndrome Sulphonamides Tetracyclines Ticlopidine

Causes According to Duration

Acute Diarrhea

Addison's disease Appendicitis Bacterial: Aeromonas Campylobacter jejuni Chlamydia Clostridium difficile E.coli Enterobacter Klebsiella Neisseria gonorrhea Plesiomonas Salmonella Shigella Staphylococcus aureus Vibrio cholerae Yersinia enterocolitica Carcinoid syndrome C-cell carcinoma Chronic inflammatory bowel disease Colitis

Drugs: Abuse of laxatives Alcohol Antibiotics Biguanides Cefpodoxime Chemotherapeutics Chemotherapy Cholestyramin Digitalis Diuretics Ergotamine Hydralazine Hydrochlorothiazide Mercaptopurine Opiate withdrawal Parasympathomimetics Physostigmine Quinidine Rabeprazole Reserpine Warfarin Food: Bacillus cereus Clostridium perfringens Staphylococcus aureus

Food allergy Graft versus host reaction Heavy metal intoxication HIV Hyperthyroidism Irritable bowel syndrome (IBS) Lactose intolerance Neuroendocrine tumors Parasites: Cryptosporidium Entamoeba histolytica Giardia intestinalis Viral: Adenovirus Coxsackie virus Cytomegalovirus (CMV) Echovirus Influenza virus Norwalk virus Poliovirus Rotavirus

Chronic Diarrhea

Achylia Addison's Disease Amebiasis Amyloidosis Anxiety Autonomous neuropathy Bacterial gastroenteritis Bacterial toxin Behcet syndrome Bile acid malabsorption Biliary fistula Carcinoid syndrome Carcinoma of the pancreas Celiac Sprue Chronic inflammatory bowel disease Collagenous colitis Colon cancer Colorectal polyps Cryptosporidiosis Diabetic enteropathy Diverticular disease

Drugs: Antacids Anthraquinone Castor oil Elvitegravir Lactulose Levofloxacin Mannitol Sorbitol Dumping syndrome Excess coffee, tea Fecal impaction Gastrocolic fistula Giardia Hyperthyroidism HIV Idiopathic lymphangiectasis Irritable bowel syndrome Lymphocytic colitis Lymphomas Malabsorption Maldigestion Medullary thyroid carcinoma

Neuroendocrine tumors Nontropical sprue Obstructive jaundice Parasites: Ascariasis Hookworm Whipworm Pellagra Polyarteritis Postileal resection Postvagotomy Prostaglandins Radiation proctitis Rectal surgery Scleroderma Short bowel syndrome Tuberculosis Verner-Morrison syndrome Villous adenoma Villous carcinoma Whipple's disease

Causes by Organ System

Cardiovascular	Portal vein thrombosis, superior mesenteric artery syndrome
Chemical / poisoning	Acrodynia, Amlodipine besylate and Atorvastatin calcium trihydrate, acute zinc toxicity, arsenic poisoning, Azacitidine , Cabozantinib carbamate insecticide poisoning, carbon monoxide poisoning, chlordane toxicity, chloroform toxicity, copper toxicity, diazinon poisoning, glutaraldehyde toxicity, heavy metal poisoning, lead poisoning, mercury poisoning, metal fume fever, naphthalene poisoning, organophosphate poisoning, paraquat toxicity, selenium toxicity, thallium toxicity
Dermatologic	Acrodermatitis enteropathica, necrotizing fasciitis
Drug Side Effect	Ambenonium, 2C-B, 5-HT3 antagonist, 5-methoxy-diisopropyl tryptamine, abacavir, Acamprosate calcium, acarbose, acebutolol, Acetylcysteine, acyclovir, acitretin, aconitine, adefovir, afatinib, alatrofloxacin, albendazole, aldesleukin, Alemtuzumab, alendronate, aliskiren, allopurinol, alosetron, alpha-amanitin, alpha-glucosidase inhibitor, alprazolam, altretamine, ambenonium chloride, amifostine, amiloride, aminocaproic acid, aminophylline, amlexanox, amlodipine, Amlodipine besylate and Atorvastatin calcium trihydrate, ammonium lauryl sulfate, amoxicillin, amphetamine, amphotericin B, amprenavir, amitriptyline, anadenanthera peregrina, anagrelide, anakinra, anastrozole, Anidulafungin, anisindione, Apremilast, aprepitant, atazanavir, atenolol, atorvastatin, atovaquone, Atropine, auranofin, azithromycin, aztreonam, bacitracin, baclofen, barium nitrate, barium sulfate, Basiliximab, Benzphetamine, benazepril, bentiromide, bepridil, betaxolol, Bethanechol chloride, bevacizumab, bezafibrate, bicalutamide, biguanide, bisacodyl, bisoprolol, bortezomib, Bosutinib, bromocriptine, brompheniramine, bumetanide, buspirone, busulfan, candesartan, capecitabine, carbamazepine, carbidopa, carboplatin, carvedilol, cefaclor, cefadroxil, cefamandole nafate, cefazolin, cefazolin, cefdinir, Cefditoren, cefepime, Cefixime, cefoperazone, cefotaxime, cefotetan disodium, cefoxitin, cefpodoxime, Cefprozil, Ceftaroline fosamil, ceftazidime, Ceftibuten, ceftizoxime, ceftriaxone, cefuroxime, cephalexin, cephradine, Ceritinib, cerivastatin, cetuximab, cevimeline, Chenodiol, chloral hydrate, chlorambucil, chlordiazepoxide, chlorodyne, chlorothiazide, chlorpheniramine, Chlorpropamide, chlorthalidone, cholestyramine, ciclosporin, cidofovir, cilostazol,, cinacalcet, cisapride, citalopram, cladribine, clamoxyquine, clarithromycin, clavulanic acid, clindamycin, clofarabine, clofibrate, clomipramine, clonazepam, clopidogrel, clorazepate, Conjugated estrogens/bazedoxifene, colchicine, colistimethate, conjugated estrogens, Crizotinib, cyclophosphamide, cyproheptadine, cytarabine, dactinomycin, dalfopristin, dantrolene, daptomycin, darbepoetin alfa, darifenacin, darunavir, dasatinib, daunorubicin, deferasirox, delavirdine, demeclocycline, Denileukin diftitox deracoxib, desoxyn, Dexchlorpheniramine, dextroamphetamine, dextromethorphan, diacerein, diazepam, diclofenac, dicloxacillin, didanosine, diflunisal, digitoxin, digoxin, diltiazem, dipyridamole, dirithromycin, disopyramide, docetaxel, dofetilide, dolasetron, donepezil, doripenem, doxorubicin, doxycycline, DTPA, duloxetine, Ecallantide, eculizumab, efavirenz, Elvitegravir, emtricitabine, Emtricitabine, Rilpivirine Hydrochloride, And Tenofovir Disoproxil Fumarate enalapril, endosulfan, enoxacin, entacapone, Epirubicin hydrochloride, eplerenone, epoetin alfa, ergotamine, erlotinib, Eliglustat, erythromycin, esomeprazole, estazolam, estradiol, ethacrynic acid, ethosuximide, etidronate, etodolac, etoposide, exemestane, exenatide, ezetimibe, famciclovir, famotidine, felbamate, Ferric oxyhydroxide, fexofenadine, floxuridine, foscarnet sodium, fluconazole, flucytosine, fludarabine, fluoride, fluorouracil, fluoxetine, flurazepam, Flurbiprofen, flutamide, fluticasone, fluvastatin, fluvoxamine, fosamprenavir, foscarnet, fosinopril, frovatriptan, fulvestrant, gabapentin, galantamine, ganciclovir, gatifloxacin, gefitinib, gemcitabine, gemeprost, gemfibrozil, glatiramer, Glipizide, Glyburide and Metformin, glycopyrrolate, granisetron, griseofulvin, guanethidine, guanfacine, hydralazine, hydrochlorothiazide, hydroxychloroquine, Hydroxyprogesterone caproate hydroxyurea, hyoscyamine, ibandronate, Ibritumomab Tiuxetan ibuprofen, idarubicin, Idelalisib, Idursulfase, imatinib, Imiglucerase infliximab, interferon alfacon-1 , Interferon alfa-2b , interferon beta-1b, irinotecan hydrochloride, iron supplements, isocarboxazid, isradipine, itraconazole, Ivacaftor, Ivermectin, Ixabepilone, ketoconazole, Ketorolac tromethamine, Lactulose, lamivudine, lamotrigine, lanreotide, lansoprazole, lanthanum,Lapatinib, leflunomide, lenalidomide, letrozole, leuprolide, levalbuterol, levetiracetam, Lenvatinib, levocarnitine, levodopa, levofloxacin, Linaclotide, Lincomycin Hydrochloride, linezolid, liothyronine sodium, lisinopril, lithium, lomefloxacin, lopinavir, loracarbef, loratadine, lorazepam, loxapine, magnesium hydroxide, mebendazole, mechlorethamine, meclofenamate, Mercaptopurine, mefenamic acid, mefloquine, megestrol, Meloxicam, meprobamate, mercaptopurine, meropenem, mesalazine, mesna, mesoridazine, Metirosine, metformin, methamphetamine, methenamine, methotrexate, methoxychlor, methsuximide, methyclothiazide, methylergonovine, methyprylon, metoclopramide, metolachlor, metolazone, metoprolol, metronidazole, Micafungin sodium, miconazole, mifepristone, miglitol, Miglustat, miltefosine minocycline, misoprostol, mitotane, mitoxantrone, moclobemide, modafinil, moexipril, moricizine, moxifloxacin, mycophenolate, nabumetone, nafcillin, naltrexone, naphthalene, naproxen and esomeprazole magnesium, natalizumab, natamycin, nateglinide, nelfinavir, nevirapine, Niacin/simvastatin, niclosamide, Nilotinib, Nintedanib, nizatidine, norfloxacin, nystatin, ofloxacin, Olsalazine, omalizumab, omeprazole, ondansetron, oseltamivir, oxaliplatin, oxazepam, oxcarbazepine, oxtriphylline, oxybutynin, Palbociclib, palivizumab, pancrelipase, Panitumumab, pantoprazole, Paromomycin sulfate, Paroxetine, Pasireotide, pegaspargase, peginterferon alfa-2a, peginterferon alfa-2b, pemetrexed, pemoline, penbutolol, penicillin, pentamidine, pentostatin, pergolide, perindopril, perphenazine, Pertuzumab, phenazopyridine, Phenoxymethylpenicillin, phentermine, pilocarpine, pimecrolimus, pimozide, Pirfenidone, piroxicam, Plerixafor, Potassium iodide, plicamycin, polythiazide, posaconazole, Potassium chloride, Potassium citrate, pramipexole, pramlintide, prazepam, praziquantel, prazosin, procainamide, procarbazine, promethazine, propafenone, propranolol, permethrin, protriptyline, pseudoephedrine, Pyrantel pamoate, pyridostigmine, quinapril, quinidine, quinupristin, rabeprazole, Radium chloride, ramipril, Ramucirumab, ranitidine, rasagiline, Rasburicase, repaglinide, reserpine, retapamulin, ribavirin, rifabutin, rifampin, rilmenidine, riluzole, risedronate, risperidone, ritonavir, rituximab, rivastigmine, rizatriptan, Riluzole, roflumilast, Sacrosidase, salsalate, saquinavir mesylate, Saxagliptin hydrochloride and Metformin hydrochloride sargramostim, Secukinumab, selegiline, sevelamer, sildenafil, Siltuximab, simethicone, simvastatin, sirolimus, sitagliptin, sodium oxybate, sodium picosulfate, sodium polystyrene sulfonate, solanine, solifenacin, sorafenib, sotalol, sparfloxacin, spironolactone, stavudine, streptozocin, sulfadiazine, sulfasalazine, sulfisoxazole, sulfisoxazole, sulindac, sumatriptan, sunitinib, tacrine, Tacrolimus, tamsulosin, tedizolid, tegaserod, telbivudine, telithromycin, telmisartan, temozolomide, teniposide, tenofovir, terbinafine, teriparatide, tetraferric tricitrate decahydrate, Thallous Chloride Tl 201, theophylline, thiabendazole, thioguanine, thioridazine, thiothixene, thyroxine, ticlopidine, Tigecycline, tiludronate, tipranavir, tocopherol, tolcapone, Tolmetin, topiramate, topotecan, Trametinib dimethyl sulfoxide, trandolapril, tranylcypromine, trastuzumab, trazodone, treprostinil, Tretinoin, triamterene, triazolam, trifluoperazine, trihexyphenidyl, trimeprazine, trimethadione, trimethobenzamide, trimetrexate glucuronate, trimipramine, triprolidine, trovafloxacin, valacyclovir, valganciclovir, valproic acid, valsartan, verapamil, Vandetanib, Vilazodone, vinblastine, voriconazole, vorinostat, zanamivir, Zafirlukast, zidovudine, ziprasidone, zoledronic acid, zolmitriptan, Zoledronate
Ear Nose Throat	Otitis media in children
Endocrine	Addison's disease, carcinoid syndrome, diabetes insipidus, diabetic neuropathy, glucagonoma, Graves disease, hyperthyroidism, hypoaldosteronism, multiple endocrine neoplasia type 1 neuroendocrine tumors, somatostatinoma, subacute thyroiditis
Environmental	Abrus precatorious, agastache rugosa, alchornea castaneifolia, amanita phalloides poisoning, amnesic shellfish poisoning, azalea poisoning, bee stings, datura stramonium poisoning, endosulfan toxication, food poisoning, herbal extract overdose, honey intoxication, insect bite allergy, isomalt toxicity, lycorine, marine toxins, mushroom poisoning, narcissus pseudonarcissus, oleander poisoning, pesticide poisoning, phytohaemagglutinin poisoning, phytolacca americana toxicity, ricinus communis poisoning, snakebites, solanine poisoning
Gastroenterologic	Abdominal abscess, abdominal cancer, achlorhydria, acute appendicitis, acute gastritis, bile acid sequestrant, biliary atresia, biliary tract cancer, blind loop syndrome, caecitis, carcinoid syndrome, celiac disease, cholestatic jaundice, colitis, colonic inertia, colonic malakoplakia, colonic villous adenomata, colorectal cancer, colorectal polyps, Crohn's disease, diverticulitis, enteritis, enterocele, enterocolitis, food poisoning, fructose malabsorption, gastric dumping syndrome, gastrinoma, gastritis, gastro-enteropancreatic neuroendocrine tumor, gastroenteritis, gastrointestinal amyloidosis, glucose-galactose malabsorption, gluten sensitivity, Habba syndrome ileitis, inflammatory bowel disease, intestinal lymphangiectasis, intestinal pseudoobstruction, intususception, irritable bowel syndrome, ischemic colitis, lactose intolerance, listeriosis, malabsorption syndrome, malassimilation, Meckel diverticulitis, polyposis, proctitis, protein losing enteropathy, tropical sprue, ulcerative colitis, Whipple's disease, Zollinger-Ellison syndrome
Genetic	3-hydroxyacyl-coenzyme A dehydrogenase deficiency, 3-methylcrotonyl-CoA carboxylase deficiency, abetalipoproteinaemia, Arakawa's syndrome II, aromatic amino acid decarboxylase deficiency, aspartylglycosaminuria, Baber's syndrome, Brown-symmers disease, congenital adrenal hyperplasia, congenital disorder of glycosylation type 1B, congenital intrinsic factor deficiency, congenital short bowel syndrome, congenital toxoplasmosis, Cornelia de Lange syndrome 2, Cronkhite-Canada disease, dibasic aminoaciduria 2, Fabry's disease, familial amyloid polyneuropathy, galactosemia, Gardner's syndrome, Gilbert's syndrome, glutathione synthetase deficiency, Hartnup disease, hereditary angioedema, HNPCC, hyper IgM syndrome, hyperlipoproteinemia type I, inborn amino acid metabolism disorder, juvenile polyposis syndrome, lipoid congenital adrenal hyperplasia, malonic aciduria, malonyl-CoA decarboxylase deficiency, mucopolysaccharidosis, neuroblastoma, neurofibromatosis, Sanfilippo syndrome, Slone's disease, sphingolipidosis, sucrase-isomaltase deficiency, Turcot syndrome, very long-chain acyl-coenzyme A dehydrogenase deficiency, Von Gierke disease, Wiskott-Aldrich syndrome, X-linked agammaglobulinaemia
Hematologic	Amyloidosis, C1 esterase inhibitor, chronic myeloproliferative disorders, hyper IgM syndrome, idiopathic hypereosinophilic syndrome, megaloblastic anemia, myleofibrosis, neutropenia, porphyria Wiskott-Aldrich syndrome, X-linked agammaglobulinaemia
Iatrogenic	Adjustable gastric band, colonoscopy, dumping syndrome, graft versus host disease, percutaneous endoscopic gastrostomy, postileal resection, postvagotomy, radiation proctitis, rectal surgery, radiation sickness, short bowel syndrome, vaccination
Infectious Disease	Adenophorea, adenoviridae, aeromonas hydrophila, AIDS, amebiasis, ancylostoma duodenale, anguillulosis, anthrax, ascariasis, astrovirus, bacillary dysentery, bacillus cereus, bacterial toxin, balantidiasis, beef tapeworm, blastocystis hominis, borrelia anserina, botulism, campylobacter jejuni, candida, capillaria, cestoda, ciguatera poisoning, clostridium difficile, clostridium perfringens, clostridium sordellii, clostridium welchii, coccidia, cryptosporidiosis, cyclosporiasis, cysticercosis, cytomegalovirus, dientamoeba fragilis, diphyllobothrium infection, dipylidium caninum infection, Ebola, echinococcosis, ehrlichiosis, entamoeba histolytica, escherichia coli, fasciolopsiasis, filariasis, flavivirus, fusarium venenatum, giardia lamblia, hantavirus pulmonary syndrome, helminthiasis, hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E, hepatitis X, hookworm infection, isosporiasis, katayama fever, lassa fever, legionella pneumophila, legionnaires' disease, leptospirosis, lymphogranuloma venereum, malaria, marburg virus, measles, metagonimiasis, mycobacterium avium complex, norwalk gastroenteritis, opisthorchis infection, paragonimus infection, pelvic abscess, pseudomembranous colitis, psittacosis, Q fever, rhabditida, rotavirus, roundworm, salmonellosis, sarcocystis, schistosomiasis, secernentea, shigellosis, small bowel bacterial overgrowth syndrome, staphylococcal food poisoning, staphylococcal toxic shock syndrome, streptobacillus, streptococcal infections, strongyloides, tapeworms, trematoda, trichinella spiralis, trichinosis, trichuriasis, tularemia, typhoid fever, vancomycin, vibrio cholerae, vibrio mimicus, vibrio parahemolyticus, vibrio vulnificus, visceral leishmaniasis, Whipple disease, whipworm infection, yersinia enterocolitica
Musculoskeletal / Ortho	No underlying causes
Neurologic	Common migraine, neuroblastoma, Waterhouse-Friederichsen syndrome
Nutritional / Metabolic	Folate deficiency, food allergies, food intolerances, iron supplements, kwashiorkor, lactose intolerance, milk allergy, pellagra, pernicious anemia, protein losing enteropathy, sucrose intolerance, vitamin C toxicity, zinc deficiency
Obstetric/Gynecologic	Childbirth, endometriosis, neonatal sepsis, ovarian cancer, ovarian hyperstimulation syndrome
Oncologic	Adrenal tumor, carcinoid syndrome, colorectal cancer, Ewing's sarcoma, Gardner's syndrome, gastric cancer, HNPCC, juvenile polyposis syndrome, Kaposi's sarcoma, multiple endocrine neoplasia type 1, neuroendocrine tumors, pancreatic adenoma, peritoneal mesothelioma, neuroendocrine tumors, ovarian cancer, small bowel lymphoma, somatostatinoma, thymus cancer, Vipoma,
Opthalmologic	No underlying causes
Overdose / Toxicity	Carbon monoxide toxicity, carnitine overuse, colchicine toxicity, digoxin toxicity, ergotism, heavy metal ingestion, mazindol
Psychiatric	Anxiety-tension syndrome, chronic fatigue syndrome, dissociative disorder, panic attack
Pulmonary	Anthrax, cystic fibrosis, diffuse systemic sclerosis, legionellosis
Renal / Electrolyte	Acute kidney failure, chronic renal failure, hyperchloremia
Rheum / Immune / Allergy	Acquired angioedema, Amyloidosis, anaphylaxis, autoimmune adrenalitis, autoimmune enteropathy, autoimmune polyendocrine syndrome, autonomic neuropathy, C1 esterase inhibitor, chronic granulomatous disease, complement 5 deficiency, hereditary angioedema, hyper IgM syndrome, Kawasaki disease, Omenn syndrome, Reiter’s syndrome, Satoyoshi syndrome, severe combined immunodeficiency, Wiskott-Aldrich syndrome, X-linked agammaglobulinaemia
Trauma	No underlying causes
Urologic	Proctitis, Reiter’s syndrome
Miscellaneous	Alcohol intoxication, alcohol withdrawal, anopsology

Causes in Alphabetical Order

The unnamed parameter 2= is no longer supported. Please see the documentation for {{columns-list}}.

5

Differential Diagnosis of Diarrhea of other diseases

To review the differential diagnosis of diarrhea, click here.

To review the differential diagnosis of acute diarrhea, click here.

To review the differential diagnosis of chronic diarrhea, click here.

To review the differential diagnosis of traveler's diarrhea, click here.

To review the differential diagnosis of acute watery diarrhea, click here.

To review the differential diagnosis of acute bloody diarrhea, click here.

To review the differential diagnosis of acute fatty diarrhea, click here.

To review the differential diagnosis of chronic watery diarrhea, click here.

To review the differential diagnosis of chronic bloody diarrhea, click here.

To review the differential diagnosis of chronic fatty diarrhea, click here.

To review the differential diagnosis of acute diarrhea and fever, click here.

To review the differential diagnosis of chronic diarrhea and fever, click here.

To review the differential diagnosis of acute diarrhea and abdominal pain, click here.

To review the differential diagnosis of chronic diarrhea and abdominal pain, click here.

To review the differential diagnosis of acute diarrhea and weight loss, click here.

To review the differential diagnosis of chronic diarrhea and weight loss, click here.

To review the differential diagnosis of acute diarrhea, fever, and abdominal pain, click here.

To review the differential diagnosis of chronic diarrhea, fever, and abdominal pain, click here.

To review the differential diagnosis of acute diarrhea, abdominal pain, and weight loss, click here.

To review the differential diagnosis of chronic diarrhea, abdominal pain, and weight loss, click here.

Diarrhea

The following table outlines the major differential diagnoses of diarrhea.

Abbreviations: GI: Gastrointestinal, CBC: Complete blood count, WBC: White blood cell, RBC: Red blood cell, Plt: Platelet, Hgb: Hemoglobin, ESR: Erythrocyte sedimentation rate, CRP: C–reactive protein, IgE: Immunoglobulin E, IgA: Immunoglobulin A, ETEC: Escherichia coli enteritis, EPEC: Enteropathogenic Escherichia coli, EIEC: Enteroinvasive Escherichia coli, EHEC: Enterohemorrhagic Escherichia coli, EAEC: Enteroaggregative Escherichia coli, Nl: Normal, ASCA: Anti saccharomyces cerevisiae antibodies, ANCA: Anti–neutrophil cytoplasmic antibody, DNA: Deoxyribonucleic acid, CFTR: Cystic fibrosis transmembrane conductance regulator, SLC10A2: Solute carrier family 10 member 2, SeHCAT: Selenium homocholic acid taurine or tauroselcholic acid, IEL: Intraepithelial lymphocytes, MRCP: Magnetic resonance cholangiopancreatography, ANA: Antinuclear antibodies, AMA: Anti-mitochondrial antibody, LDH: Lactate dehydrogenase, CPK: Creatine phosphokinase, PCR: Polymerase chain reaction, ELISA: Enzyme–linked immunosorbent assay, LT: Heat–labile enterotoxin, ST: Heat–stable enterotoxin, RT-PCR: Reverse–transcriptase polymerase chain reaction, CD4: Cluster of differentiation 4, HIV: Human immunodeficiency virus, RUQ: Right-upper quadrant, VIP: Vasoactive intestinal peptide, GI: Gastrointestinal, FAP: Familial adenomatous polyposis, HNPCC: Hereditary nonpolyposis colorectal cancer, MTP: Microsomal triglyceride transfer protein, Scl‑70: Anti–topoisomerase I, TSH: Thyroid-stimulating hormone, T4: Thyroxine, T3: Triiodothyronine, DTR: Deep tendon reflex, RNA: Ribonucleic acid

Categories		Cause		Clinical manifestation									Lab findings									Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Symptoms								GI signs
				Duration		Diarrhea			Fever	Abdominal pain	Weight loss
													Stool exam					CBC			Other lab findings
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
Gastrointestinal		Crohn's disease		–	+	+	+	+	±	+	+	Abdominal tenderness Oral mucosal lesions	+	+	–	Nl	–	↑	↓	↑	Anti saccharomyces cerevisiae antibodies (ASCA) Vitamin B12 deficiency Elevated ESR Elevated CRP	Uveitis Arthritis Erythema nodosum Pyoderma gangrenosum Amyloidosis Venous and arterial thromboembolism Renal stones Bronchiectasis	Abnormal immune response to self antigens	Colonoscopy with biopsy
		Ulcerative colitis		–	+	+	+	+	±	+	+	Abdominal tenderness Blood on rectal examination	+	+	–	Nl	–	↑	↓	↑	Anti–neutrophil cytoplasmic antibody (P–ANCA) Hypoalbuminemia Hypokalemia Hypomagnesemia Elevated ESR Elevated CRP	Skin rash Iritis Uveitis Seronegative arthritis Clubbing Erythema nodosum	Abnormal immune response to self antigens	Colonoscopy with biopsy
		Celiac disease		–	+	±	–	±	–	+	+	Abdominal distention Increased bowel sounds Oral mucosal lesions Hepatosplenomegaly Ascites	–	–	–	Nl	Fat droplets on sudan stain	Nl	↓	Nl	IgA endomysial antibody Anti–tissue transglutaminase antibody Anti–gliadin antibody Fat soluble vitamins deficiency	Malabsorption Dementia Dermatitis herpetiformis	HLA–DQ2 HLA–DQ8 Innate responses to wheat proteins	IgA endomysial antibody Anti–tissue transglutaminase antibody
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
		Cystic fibrosis		–	+	–	–	+	±	+	+	Abdominal distention Hepatosplenomegaly Rectal prolapse	–	–	–	Nl	Fat droplets on sudan stain	Nl	↓	Nl	Positive DNA analysis for cystic fibrosis transmembrane conductance regulator (CFTR) Nasal transepithelial potential difference Fat soluble vitamins deficiency	Malabsorption Recurrent respiratory tract infection Bronchiectasis Diabetes mellitus Scoliosis Infertility	Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein	Positive genetic testing Elevated sweat chloride ≥60 mmol/L
		Chronic pancreatitis		–	+	+	–	+	–	+	+	Abdominal tenderness	–	–	–	Nl	Fat droplets on sudan stain Positive fecal elastase measurement	Nl	Nl	Nl	Slightly elevated amylase and lipase Abnormal pancreatic function test Secretin stimulation test	Malabsorption Diabetes mellitus Pancreatic pseudocyst	Toxins Recurrent acute pancreatitis Genetic predesposition Autoimmune	Magnetic resonance cholangiopancreatography (MRCP)
		Bile acid malabsorption		–	+	+	–	+	–	–	+		–	–	–	Nl	Fat droplets on sudan stain	Nl	Nl	Nl	Reduced cholesterol level	Malabsorption Hypotension Tachycardia	Genetic defects in SLC10A2	SeHCAT test
		Microscopic colitis		–	+	+	–	–	–	+	+	Abdominal tenderness Fecal incontinence	–	–	–	Nl	–	Nl	↓	Nl	Hypokalemia Elevated CRP Positive autoantibodies include: RF ANA AMA ANCA	Arthritis Uveitis Idiopathic thrombocytopenic purpura Pleuro pericarditis Hypothyroidism Psoriasis	Mucosal immune responses to luminal factors in a genetically predisposed individual Drug–induced	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
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
		Infective colitis		–	+	+	+	–	+	+	+	Rebound abdominal tenderness	+	+	+	Nl	Positive stool culture Positive fecal calprotectin Positive fecal lactoferrin	↑	↓	↑	Elevated CRP Elevated ESR	Arthritis Uveitis	Salmonella Shigella Campylobacter E. coli 0157:H7 Clostridium difficile Entamoeba histolytica Adenovirus Cytomegalovirus Herpes simplex virus	Stool culture Blood culture
		Ischemic colitis		+	+	+	+	–	+	+	+	Hyperactive then absent bowel sounds Abdominal tenderness	+	+	–	Nl	–	↑	↓	↑	Elevated CRP Elevated ESR Elevated serum lactate Elevated lactate dehydrogenase (LDH)  Elevated creatine phosphokinase (CPK) Elevated amylase Hypoalbuminemia	IgA vasculitis	Hypercoagulability  Nonocclusive colonic ischemia Embolic and thrombotic arterial occlusion Mesenteric vein thrombosis	Abdominal CT scan
		Lactose intolerance		+	+	+	–	–	–	+	–	Abdominal tenderness Abdominal distention	–	–	–	↑	–	Nl	Nl	Nl	Lactose tolerance test Genetic testing	Headache Vertigo Memory impairment Lethargy	Reduction of lactase enzyme activity or inability to produce persistent lactase Congenital lactase deficiency Secondary lactose malabsorption	Small bowel biopsy  Lactose breath hydrogen test
		Irritable bowel syndrome		–	+	±	–	±	–	±	–	Abdominal tenderness Abdominal distention Normal bowel sounds	–	–	–	Nl	–	Nl	Nl	Nl	Nl	Anxiety Palpitation	Unknown	Diagnosis of exclusion
Infection	Bacterial	Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
		Whipple's disease		–	+	+	–	+	±	+	+	Hepatosplenomegaly Ascites	–	–	–	Nl	Positive fecal fat	↓	↓	↓/↑	Hypoalbuminemia Fat soluble vitamins deficiency	Malabsorption Abnormal extraocular movement Lymphadenopathy Hyperpigmentation Uveitis Endocarditis Encephalitis Dementia Pleural effusion	Tropheryma whipplei	Small intestine biopsy for Tropheryma whipplei testing PCR testing
		Tropical sprue		+	+	+	–	+	+	+	+	Angular stomatitis Oral mucosal lesion	+	–	–	Nl	Positive stool culture	Nl	↓	Nl	Fat soluble vitamins deficiency Vitamin B12 deficiency Folate deficiency Hypokalemia	Myalgia Neuropathy Edema	Escherichia coli Klebsiella pneumoniae Enterobacter cloacae	Diagnosis of exclusion
		Small bowel bacterial overgrowth		–	+	+	–	+	–	+	+	Abdominal distention	+	–	–	Nl	Positive stool culture Positive fecal fat	Nl	↓	Nl	Hypoalbuminemia Abnormal hydrogen breath test Lactic acidosis	Malabsorption Rosacea	Excess bacteria in the small intestine Alterations in intestinal anatomy or GI motility	Diagnosis of exclusion
		Pseudomembranous enterocolitis		+	–	+	±	–	+	+	±	Generalized abdominal tenderness Abdominal distention Rebound abdominal tenderness	+	+	–	Nl	Enzyme–linked immunosorbent assay (ELISA) Polymerase chain reaction (PCR) assay or C. difficile antigen	↑	↓	↓	Elevated serum creatinine Hypoalbuminemia Elevated lactic acid	Dehydration Acute kidney injury Bacteremia Reactive arthritis Necrotizing fasciitis	Clostridium difficile Recent antibiotics use Recent surgery	Stool exam Pseudomembranes on colonoscopy
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
		Campylobacteriosis		+	–	+	+	–	+	+	–	Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	Nl	Toxic megacolon Sepsis Arthritis Endocarditis  Guillain–Barré syndrome	Campylobacter jejuni	Stool culture
		Salmonellosis		+	+	+	+	–	+	+	–	Abdominal distention Diffuse abdominal tenderness Hepatosplenomegaly	+	+	–	Nl	Positive stool culture Positive serologic testing	↑	Nl	↑	Hypokalemia Hypernatremia Hyponatremia Hypercalciuria Hypocitraturia	Post–infectious arthritis Obtundation Bacteremia Pericarditis Pyelonephritis Brain abscess	Salmonella	Stool culture
		Shigellosis		+	–	+	+	–	+	+	–	Abdominal distention Hyperactive bowel sounds Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑/↓	↓	↓	Elevated CRP Elevated ESR Hyponatremia Hypoglycemia Azotemia	Headache Lethargy Seizures Delirium Post–infectious arthritis Myocarditis	Shigella	Stool culture
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
		Escherichia coli enteritis	ETEC (Traveler's diarrhea)	+	–	+	–	–	+	–	–	Diffuse abdominal tenderness	+	–	–	Nl	Positive stool culture	↑	Nl	Nl	–	–	Enterotoxigenic escherichia coli Enterotoxins: Heat–labile enterotoxin (LT) Heat–stable enterotoxin (ST)	Stool culture
			EPEC	+	+	+	+	–	+	+	+	Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	–	–	Enteropathogenic E. coli	DNA probe or polymerase chain reaction (PCR) of the EPEC adherence factor Stool culture
			EIEC	+	–	+	+	–	+	+	–	Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	–	–	Enteroinvasive E. coli	DNA probe Stool culture
			EHEC	+	–	+	+	–	–	+	–	Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	↓	↓	Azotemia	Hemolytic uremic syndrome (HUS) Renal failure	Enterohemorrhagic E. coli  Shiga toxins	Stool culture
			EAEC	+	+	+	+	–	–	+	–	Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	↓	↓	–	Chronic infection in immunocompromised patients	Enteroaggregative E. coli	Stool culture
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
		Yersinia enterocolitica		+	–	+	+	–	+	+	–	Abdominal distention Hyperactive bowel sounds Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	–	Bacteremia Reactive arthritis Glomerulonephritis Endocarditis Erythema nodosum Abscess	Yersinia enterocolitica	Stool culture
		Vibrio cholera		+	–	+	–	–	–	+	–		+	–	–	Nl	Positive stool culture	↑	Nl	Nl	Azotemia	Severe dehydration Decreased skin turgor Oliguria Renal failure Muscle cramps Seizure Somnolence	Cholera toxin	Stool culture
		Aeromonas		+	+	+	+	–	+	+	–	Abdominal distention Hyperactive bowel sounds Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	–	Wound infection Bacteremia Hemolytic uremic syndrome  Meningitis Ocular infection Pneumonia  Urinary tract infection Osteomyelitis Peritonitis Acute cholecystitis Opportunistic infections in immunocompromised patients	Aeromonas virulence factors including endotoxins, hemolysins, enterotoxins, and adherence factors	Blood culture Wound culture
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
		Plesiomonas		+	–	+	+	–	+	+	–	Hyperactive bowel sounds Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	–	Opportunistic infections in immunocompromised patients or hepatobiliary disease Bacteremia Cellulitis and skin abscesses Peritonitis Meningoencephalitis Ocular infection Pneumonia Prosthetic joint infection  Septic abortion	Plesiomonas shigelloides	Blood culture
		Mycobacterium avium complex		+	+	+	+	–	+	+	–	Abdominal distention Hepatosplenomegaly	+	+	–	Nl	–	↓	↓	Nl	Elevated liver enzymes	Opportunistic infection in immunocompromised patients Pulmonary infection Adenopathy  Night sweats	Mycobacterium avium complex	Blood culture
		Food poisoning Staphylococcus aureus Bacillus cereus Clostridium perfringens		+	–	+	±	–	+	+	±	Abdominal distention	+	±	–	Nl	Positive stool culture	↑	Nl	Nl	–	History of travel or ingestion of infected food	Enterotoxins	Stool culture
	Virus	Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
		Norovirus		+	–	+	–	–	+	+	–	Abdominal distention	–	–	–	Nl	Positive stool reverse–transcriptase polymerase chain reaction (RT–PCR)	↓	Nl	Nl	–	Myalgia Headache  Seizure  Encephalopathy	Norovirus	Clinical diagnosis
		Rotavirus		+	–	+	–	–	+	–	–	Hyperactive bowel sounds Diffuse abdominal tenderness	+	–	–	Nl	–	Nl	Nl	Nl	Elevated blood urea nitrogen Hyperchloremic acidosis Hypocalcemia	Necrotizing enterocolitis Intussusception  Biliary atresia Central nervous system involvement	Rotavirus	Stool immune–based assays
		Echovirus		+	–	+	–	–	+	+	–	Abdominal distention	–	–	–	Nl	–	Nl	Nl	Nl	–	Liver failure Myocarditis	Echovirus	Clinical diagnosis
		Adenovirus		+	–	+	–	–	+	+	–	Abdominal distention	–	–	–	Nl	Viral antigen assay	Nl	Nl	Nl	–	Respiratory disease Follicular conjunctivitis Epidemic keratoconjunctivitis Hepatitis  Urethritis  Myocarditis  Meningitis  Bacteremia	Adenovirus	Clinical diagnosis
		CMV colitis		+	+	–	+	–	±	+	–	Diffuse abdominal tenderness	+	+	–	Nl	Viral antigen assay	↓	Nl	Nl	Decreased CD4 level Abnormal liver function test	Encephalitis  Guillain–Barré syndrome Pneumonia  Retinitis Pericarditis and myocarditis Atherosclerosis  Venous thrombosis	Cytomegalovirus	Quantitative PCR tests
		HIV		–	+	+	–	–	+	+	+	Abdominal distention Diffuse abdominal tenderness	+	–	–	Nl	–	↓	↓	Nl	Decreased CD4 level Electrolyte imbalance	Lymphadenopathy Disseminated infection	HIV	HIV virologic (viral load) test Immunoassay
	Parasite	Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
		Entamoeba histolytica		+	+	+	+	–	+	+	–	Abdominal distention Diffuse abdominal tenderness	+	+	+	Nl	–	↑	Nl	Nl	–	Liver abscess Pleuropulmonary infection Cardiac infection Brain abscess Cutaneous infection	Entamoeba histolytica	Antigen testing Serology
		Giardia		–	+	+	–	+	–	+	+	Abdominal distention Diffuse abdominal tenderness	–	–	+	Nl	–	Nl	Nl	Nl	–	Malabsorption Urticaria Depression	Giardia lamblia	Antigen detection assays
		Cryptosporidium		–	+	+	–	–	–	+	+	Abdominal distention Diffuse abdominal tenderness	–	–	+	Nl	Positive stool microscopy	Nl	Nl	Nl	Elevated alkaline phosphatase	Chronic, life–threatening illness in immunocompromised patients	Cryptosporidium	Polymerase chain reaction
		Microsporidia		+	+	+	–	–	+	+	–	Abdominal distention Diffuse abdominal tenderness	–	–	+	Nl	Positive stool microscopy	Nl	Nl	Nl	Decreased CD4 count	Malabsorption Keratitis  Seizure Myositis	Microsporidia	Antigen detection assays
		Isospora		+	+	+	–	+	+	+	+	Abdominal distention Diffuse abdominal tenderness	+	+	+	Nl	Positive stool microscopy Positive fecal fat	↑	Nl	Nl	Elevated eosinophils  Hypokalemia Increased creatinine	Chronic illness in immunocompromised patients	Isospora	Detecting oocysts in the feces
Tumors		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
		Carcinoid tumor		–	+	+	+	–	–	+	+	Abdominal distention	–	+	–	↓	–	Nl	Nl	Nl	Elevated urinary 5–hydroxyindoleacetic acid (5–HIAA) level High chromogranin A	Facial flushing Jaundice Edema Valvular heart disease Right–sided heart failure	Well–differentiated neuroendocrine tumor	Blood chromogranin A level
		VIPoma		+	+	+	–	+	–	+	+	Abdominal distention Abdominal RUQ tenderness Nausea Vomiting	–	–	–	↓	–	Nl	Nl	Nl	Elevated VIP level Hypokalemia Hypochlorhydria or achlorhydria Low osmotic gap (<50 mOsm/kg)	Rash Facial flushing Dehydration Lethargy Muscle weakness	Primary secretory tumor	Blood VIP levels Followed by imaging
		Zollinger–Ellison syndrome		–	+	+	+	+	–	+	+	Epigastric tenderness	–	–	–	↓	–	Nl	↓	Nl	Positive secretin stimulation test Elevated serum chromogranin A	Jaundice	Gastrin producing tumor mainly in duodenum	Secretin stimulation test
		Somatostatinoma		–	+	+	–	–	–	+	+	Epigastric tenderness	–	–	–	↓	–	Nl	Nl	Nl	Elevated fasting plasma somatostatin	Diabetes mellitus Cholelithiasis Jaundice	Neuroendocrine tumors of D–cell origin	Plasma somatostatin level Followed by imaging
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
		Lymphoma		–	+	+	+	–	+	+	+	Diffuse abdominal tenderness Hepatosplenomegaly	–	+	–	Nl	–	Nl	↓	Nl	Paraproteinemia	Malabsorption Lactose intolerance Ascites	Primary tumor of GI tract	Colonoscopy with biopsy
		Colorectal cancer		–	+	+	+	+	–	+	+	Diffuse abdominal tenderness	–	+	–	Nl	–	Nl	↓	Nl	Positive carcinoembryonic antigen	Metastasis	FAP gene HNPCC gene	Colonoscopy and biopsy
Medication/Toxicity		Medications ACE inhibitors Digoxin Cephalosporins Statins Thiazide diuretics Triptans Lactulose Anti retroviral agents Chemotherapeutic agents Antifungals Magnesium		+	+	+	–	±	±	+	+	Abdominal distention Dehydration	–	–	–	↑/↓	–	↑	Nl	Nl	Elevated plasma level of drug	–	Inflammation Pseudomembranous colitis	Clinical evaluation after discontinuation of the drugs
		Factitious diarrhea		+	+	+	–	–	–	+	+	Abdominal distention	–	–	–	↑/↓	–	Nl	Nl	Nl	Hypokalemia  Metabolic alkalosis Hypermagnesemia	Malabsorption Lethargy Generalized weakness Acute renal failure	Medications	Clinical evaluation after discontinuation of the drugs
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
		Heavy metal ingestion		–	+	+	–	–	–	+	+	Abdominal distention	–	–	–	Nl	–	Nl	Nl	Nl	Elevated plasma heavy metal level	Headache Numbness Alopecia Vertigo	Heavy metal ingestion	Plasma level of heavy metal
		Organophosphate poisoning		+	+	+	–	–	–	+	–	Salivation Vomiting	–	–	–	Nl	–	Nl	Nl	Nl	Reduced RBC acetylcholinesterase Plasma cholinesterase activity	Autonomic dysfunction Motor deficit Sensory deficit Bronchospasm Urination Miosis Bradycardia Lacrimation Sweating Cardiac arrhythmias Acute renal injury	Neurotoxins bind to acetylcholinesterase (AChE)	Clinical diagnosis
		Opium withdrawal		+	+	+	–	–	–	+	–	Hyperactive bowel sounds	–	–	–	Nl	–	Nl	Nl	Nl	Azotemia Hypokalemia Metabolic alkalosis	Dysphoria  Restlessness Sweating Rhinorrhea Lacrimation Myalgia Arthralgia	Opium withdrawal	Clinical diagnosis following opium withdrawal
Iatrogenic		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
		Short bowel syndrome		+	+	+	–	+	–	–	+	Abdominal distention Abdominal tenderness	–	–	–	Nl	Positive fecal fat	Nl	↓	↑	Hypoalbuminemia High level of acute phase reactant Abnormal liver function tests	Prior intestinal surgery Malabsorption Crohn's disease Malignancy Peripheral edema Muscle atrophy	Surgical bowel resection	Clinical diagnosis following bowel resection
		Radiation enteritis		+	+	+	+	+	–	+	+	Abdominal tenderness	+	+	–	Nl	Positive fecal fat	Nl	↓	Nl	Vitamin B12 deficiency Hypoalbuminemia	Prior history of malignancy and radiation therapy Malabsorption Telangiectasias	Radiation	Segmental bowel inflammation on endoscopy or colonoscopy
		Dumping syndrome		–	+	+	–	+	–	–	+	Hyperactive bowel sound	–	–	–	Nl	–	Nl	Nl	Nl	Hypoglycemia Hydrogen breath test	Malnutrition Fat soluble vitamin deficiency	Postgastrectomy	Clinical diagnosis following gastrectomy
Others		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
		Abetalipoproteinemia		–	+	+	–	+	–	+	+	Abdominal distension	–	–	–	Nl	–	Nl	Nl	Nl	Low triglyceride Low total cholesterol levels  Acanthocytes Low vitamin E levels	Ataxia Visual field defect Dysarthria	Autosomal recessive disorder caused by mutations encoding the microsomal triglyceride transfer protein (MTP)	Clinical findings and low triglyceride and cholesterol level
		Hyperthyroidism		–	+	+	–	–	±	+	+	–	–	–	–	Nl	Positive fecal fat	Nl	Nl	Nl	Elevated T4 Elevated T3 Decreased TSH High serum alkaline phosphatase	Lump in the neck Lid lag Malabsorption Sweating Hyperpigmentation Proptosis Tremor Increased DTR	Graves' disease Hashimoto's thyroiditis Toxic adenoma	TSH
		Diabetic neuropathy		–	+	+	–	+	–	+	+	Fecal incontinence	–	–	–	Nl	Positive fecal fat	Nl	↓	Nl	Hyperglycemia Azotemia Hypokalemia	Malabsorption	Unclear Disordered motility Increased intestinal secretion Small intestinal bacterial overgrowth	Clinical diagnosis in a patient with long lasting diabetes mellitus
		Systemic sclerosis		–	+	+	±	+	–	+	+	Epigastric tenderness Fecal incontinence	–	+	–	Nl	Positive fecal fat	Nl	↓	Nl	Anti–topoisomerase I (Scl‑70) antibodies Antinuclear antibodies (ANA) Anti–centromere antibodies Anti–RNA polymerase III antibody	Malabsorption Skin changes Raynaud phenomenon Pulmonary hypertension Arthritis Telangiectasia Chronic renal failure	Autoimmune reaction	Clinical diagnosis Followed by serologic tests

Risk Factors

• Antibiotic use
• High-risk sexual behavior (STDs)
• Immunosuppression
• Recent travel to endemic area

Pathophysiology prev

https://https://www.youtube.com/watch?v=5szNmKtyBW4%7C350}}

Cirrhosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Cirrhosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Tertiary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case studies
Case #1
Sandbox:Cherry On the Web
Most recent articles
cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Sandbox:Cherry All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Sandbox:Cherry
CDC on Sandbox:Cherry
Sandbox:Cherry in the news
Blogs on Sandbox:Cherry
Directions to Hospitals Treating Cirrhosis
Risk calculators and risk factors for Sandbox:Cherry

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief:

Risk Factors

• Antibiotic use
• High-risk sexual behavior (STDs)
• Immunosuppression
• Recent travel to endemic area

Pathophysiology prev

https://https://www.youtube.com/watch?v=5szNmKtyBW4%7C350}}

Cirrhosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Cirrhosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Tertiary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case studies
Case #1
Sandbox:Cherry On the Web
Most recent articles
cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Sandbox:Cherry All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Sandbox:Cherry
CDC on Sandbox:Cherry
Sandbox:Cherry in the news
Blogs on Sandbox:Cherry
Directions to Hospitals Treating Cirrhosis
Risk calculators and risk factors for Sandbox:Cherry

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Associate Editor(s)-in-Chief:

Risk Factors

• Antibiotic use
• High-risk sexual behavior (STDs)
• Immunosuppression
• Recent travel to endemic area

History and Symptoms

• History should include:
  • Appearance of bowel movements
  • Travel history
  • Associated symptoms
  • Immune status
  • Woodland exposure

Lab findings

Overview

Laboratory Findings

• Complete blood count (CBC)
• Glucose
• White blood cells (WBC)
• Urinalysis
• Calcium
• Thyroid stimulating hormone (TSH)
• Liver function tests (LFTs)
• Blood urea nitrogen (BUN) / creatinine
• Hepatitis serologies
• Stool examinations:
  • Stool cultures
  • Stool electrolytes
  • Stool osmolality
  • Ova and parasites
  • Fecal lactoferrin
  • Fecal leukocytes
  • Test for C. difficile

Endoscopic Examination and Mucosal Biopsy

Sigmoidoscopy and Colonoscopy

• A strong history and complete examination determine which scopes to be used and chronic conditions like melanosis coli, ulceration, polyps, tumors, Crohn's disease, ulcerative colitis, and amebiasis can be diagnosed by inspection of the colonic mucosa.
• Diseases such as microscopic colitis (lymphocytic and collagenous colitis), amyloidosis, Whipple's disease, granulomatous infections, and schistosomiasis, where the mucosa appears normal need mucosal biopsy and can be diagnosed histologically.

Upper Tract Endoscopy

• The presence of steatorrhea makes a small intestinal malabsorptive disorder to be the likely etiology and an endoscope that allows specimens to be obtained from the proximal and distal duodenum and/or proximal jejunum would be the best investigation of choice.
• Crohn's disease, giardiasis, celiac sprue, intestinal lymphoma, eosinophilic gastroenteritis, hypogammaglobulinemic sprue, Whipple's disease, lymphangiectasia, abetalipoproteinemia, amyloidosis, mastocytosis, and various mycobacterial, fungal, protozoal, and parasitic infections can be diagnosed through upper GI scopy and biopsy.
• An aspirate of small intestinal contents can be sent for quantitative aerobic and anaerobic bacterial culture if bacterial overgrowth is suspected and for microscopic examination for parasites.

Tests for Bacterial Overgrowth

• The gold standard for diagnosis of bacterial overgrowth has been quantitative culture of an aspirate of luminal fluid and specifically a positive jejunal culture (>106 organisms/mL) in chronic diarrhea patients can be considered evidence of clinically significant bacterial overgrowth in the upper small intestine.

• A breath test using [14C] glycocholate is used to test bacterial overgrowth. The radiolabeled conjugated bile acid is deconjugated by the bacteria, and the 14C in the side chain is metabolized to 14CO2, which is exhaled.

• Another 14C-breath test using [14C] xylose, nonradioactive glucose and nonradioactive lactulose have been developed to test bacterial overgrowth.

• An elevated concentration of hydrogen in breath after overnight fasting also has been proposed as an insensitive but specific marker of small intestinal bacterial overgrowth. This elevated hydrogen concentration may also be seen in patients with malabsorption syndrome.

• An abnormal Schilling II test result (radiolabeled B12 given with intrinsic factor) that normalizes after therapy with broad-spectrum antibiotics has also been considered as a test for small intestinal bacterial overgrowth (the so-called Schilling III test).

References

Other Imaging Findings

• Endoscopy
• Barium enema
• Colonoscopy
• Sigmoidoscopy

Other diagnostic studies

Other Diagnostic Studies

• Breath hydrogen test

• HIV testing for those patients suspected of having HIV

==

Overview

Medical Therapy

• Fluid resuscitation (oral, if not IV)
• Patients should be advised to do the following until symptoms subside:
  • Hydrate with liquids that are caffeine free and contain glucose
  • Avoid lactose
  • Chew gum that is free of sorbitol
  • Eat raw fruit
• For patients with lactose intolerance, a lactose-free diet is advised
• For patients with malabsorption diseases, a gluten free diet is advised
• Consultation with oncology, surgery and/or gastroenterology may be required for intestinal neoplasm
• Control blood sugar (diabetic neuropathy)

Empirical Therapy

Empirical therapy is used as an initial treatment before diagnostic testing or after diagnostic testing has failed to confirm a diagnosis or when there is no specific treatment or when specific treatment fails to effect a cure.

• Empirical trials of antimicrobial therapy like metronidazole for protozoal diarrhea or fluoroquinolone for enteric bacterial diarrhea if the prevalence of bacterial or protozoal infection is high in a specific community or situation.

• Most cases of diarrhea, except for high-volume secretory states, respond to a sufficiently high dose of opium or morphine. Codeine, synthetic opioids diphenoxylate and loperamide are less potent. However loperamide is generally used because of its less abuse potential.

• The somatostatin analogue octreotide has proven effectiveness in carcinoid tumors and other peptide-secreting tumors, dumping syndrome, and chemotherapy-induced diarrhea.

• Intraluminal agents include adsorbants, such as activated charcoal, and binding resins like bismuth and stool modifiers, such as medicinal fiber.

Pharmacotherapy

• Antibiotics (malabsorption diseases)
• Anticholinergics (IBS)
• Antimolality agents
• Antibiotic therapy (severe disease)
• Metoclopramide (diabetic neuropathy)
• Nonspecific antidiarrheal agents

Symptomatic Treatment

• Symptomatic treatment for diarrhea involves the patient consuming adequate amounts of water to replace that loss, preferably mixed with electrolytes to provide essential salts and some amount of nutrients. For many people, further treatment is unnecessary.
• The following types of diarrhea indicate medical supervision is required:
  • Diarrhea in infants;
  • Moderate or severe diarrhea in young children;
  • Diarrhea associated with blood;
  • Diarrhea that continues for more than two weeks;
  • Diarrhea that is associated with more general illness such as non-cramping abdominal pain, fever, weight loss, etc;
  • Diarrhea in travelers, since they are more likely to have exotic infections such as parasites;
  • Diarrhea in food handlers, because of the potential to infect others;
  • Diarrhea in institutions such as hospitals, child care centers, or geriatric and convalescent homes.

A severity score is used to aid diagnosis.

Pathogen Specific

Immunocompetent

• Bacterial

• 1. Shigella species

• Preferred regimen (1):

• Adult dose: TMP-SMZ, 160 and 800 mg, respectively bid for 3 days (if susceptible ) OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, OR 500 mg Ciprofloxacin bid for 3 days)
• Pediatric dose: TMP-SMZ, 5 and 25 mg/kg, respectively bid for 3 days

• Preferred regimen (2):

• Adult dose: Nalidixic acid 1 g/d for 5 days OR Ceftriaxone; Azithromycin
• Pediatric dose: Nalidixic acid, 55 mg/kg/d for 5 days

• 2. Non-typhi species of Salmonella

• Preferred regimen: Not recommended routinely, but if severe or patient is younger than 6 monthes or older than 50 year old or has prostheses, valvular heart disease, severe atherosclerosis, malignancy, or uremia, TMP-SMZ (if susceptible) OR Fluoroquinolone, bid for 5 to 7 days; Ceftriaxone, 100 mg/kg/d in 1 or 2 divided doses

• 3. Campylobacter species

• Preferred regimen: Erythromycin 500 mg bid for 5 days

• 4. Escherichia coli species

• 4.1. Enterotoxigenic

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid, for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

• 4.2. Enteropathogenic

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid, for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

• 4.3. Enteroinvasive

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid, for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

• 4.4. Enterohemorrhagic

• Preferred regimen: Avoid antimotility drugs; role of antibiotics unclear, and administration should be avoided.

• 5. Aeromonas/Plesiomonas

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days (if susceptible), Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

• 6. Yersinia species

• Preferred regimen: Antibiotics are not usually required; Deferoxamine therapy should be withheld; for severe infections or associated bacteremia treat as for immunocompromised hosts, using combination therapy with Doxycycline, Aminoglycoside, TMP-SMZ, OR Fluoroquinolone

• 7. Vibrio cholerae O1 or O139

• Preferred regimen (1): Doxycycline 300-mg single dose
• Preferred regimen (2): Tetracycline 500 mg qid for 3 days
• Preferred regimen (3): TMP-SMZ 160 and 800 mg, respectively, bid for 3 days
• Preferred regimen (4): single-dose Fluoroquinolone

• 8. Toxigenic Clostridium difficile

• Preferred regimen: Offending antibiotic should be withdrawn if possible; Metronidazole, 250 mg qid to 500 mg tid for 3 to 10 days

• Parasites

• 1. Giardia

• Preferred regimen: Metronidazole 250-750 mg tid for 7-10 days

• 2. Cryptosporidium species

• Preferred regimen: If severe, consider Paromomycin, 500 mg tid for 7 days

• 3. Isospora species

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 7 to 10 days

• 4. Cyclospora species

• Preferred regimen: TMP/SMZ, 160 and 800 mg, respectively, bid for 7 days

• 5. Microsporidium species

• Preferred regimen: Not determined

• 6. Entamoeba histolytica

• Preferred regimen (1): Metronidazole 750 mg tid for 5 to 10 days AND Diiodohydroxyquin 650 mg tid for 20 days
• Preferred regimen (2): Metronidazole 750 mg tid for 5 to 10 days AND Paromomycin 500 mg tid for 7 days

Immunocompromised

• Bacterial

• 1. Shigella species:

• Preferred regimen (1):

• Adult dose: TMP-SMZ, 160 and 800 mg, respectively bid for 7 to 10 days (if susceptible ) OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, OR 500 mg Ciprofloxacin bid for 7 to 10 days)
• Pediatric dose:TMP-SMZ, 5 and 25 mg/kg, respectively bid for 7 to 10 days

• Preferred regimen (2):

• Adult dose: Nalidixic acid 1 g/d for 7 to 10 days OR Ceftriaxone; Azithromycin
• Pediatric dose: Nalidixic acid, 55 mg/kg/d for 7 to 10 days

• 2. Non-typhi species of Salmonella

• Preferred regimen: Not recommended routinely, but if severe or patient is younger than 6 monthes or older than 50 old or has prostheses, valvular heart disease, severe atherosclerosis, malignancy, or uremia, TMP-SMZ (if susceptible) OR Fluoroquinolone, bid for 14 days (or longer if relapsing); ceftriaxone, 100 mg/kg/d in 1 or 2 divided doses

• 3. Campylobacter species

• Preferred regimen: Erythromycin, 500 mg bid for 5 days (may require prolonged treatment)

• 4. Escherichia coli species

• 4.1. Enterotoxigenic

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days) (Consider fluoroquinolone as for enterotoxigenic E. coli)

• 4.2. Enteropathogenic

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid,for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

• 4.3. Enteroinvasive

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid,for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

• 4.4. Enterohemorrhagic

• Preferred regimen: Avoid antimotility drugs; role of antibiotics unclear, and administration should be avoided.

• 5. Aeromonas/Plesiomonas

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days (if susceptible), Fluoroquinolone (e.g., 300 mg ofloxacin, 400 mg norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

• 6. Yersinia species

• Preferred regimen: Doxycycline, Aminoglycoside (in combination) or TMP-SMZ or Fluoroquinolone

• 7. Vibrio cholerae O1 or O139

• Preferred regimen: Doxycycline, 300-mg single dose; or Tetracycline, 500 mg qid for 3 days; or TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days; or single-dose Fluoroquinolone

• 8. Toxigenic Clostridium difficile

• Preferred regimen: Offending antibiotic should be withdrawn if possible; Metronidazole, 250 mg qid to 500 mg tid for 3 to 10 days

• Parasites

• 1. Giardia

• Preferred regimen: Metronidazole, 250-750 mg tid for 7-10 days

• 2. Cryptosporidium species

• Preferred regimen: Paromomycin, 500 mg tid for 14 to 28 days, then bid if needed; highly active antiretroviral therapy including a protease inhibitor is warranted for patients with AIDS

• 3. Isospora species

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, qid for 10 days, followed by TMP-SMZ thrice weekly, or weekly Sulfadoxine (500 mg) and Pyrimethamine (25 mg) indefinitely for patients with AIDS

• 4. Cyclospora species

• Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, qid for 10 days, followed by TMP-SMZ thrice weekly indefinitely

• 5. Microsporidium species

• Preferred regimen: Albendazole, 400 mg bid for 3 weeks; highly active antiretroviral therapy including a protease inhibitor is warranted for patients with AIDS

• 6. Entamoeba histolytica

• Preferred regimen: Metronidazole, 750 mg tid for 5 to 10 days, plus either Diiodohydroxyquin, 650 mg tid for 20 days, or Paromomycin, 500 mg tid for 7 days

Contraindicated medications

Diarrhea is considered an absolute contraindication to the use of the following medications:

• Ethacrynic acid

References

Pathophysiology prev

https://https://www.youtube.com/watch?v=5szNmKtyBW4%7C350}}

Cirrhosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Cirrhosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Tertiary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case studies
Case #1
Sandbox:Cherry On the Web
Most recent articles
cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Sandbox:Cherry All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Sandbox:Cherry
CDC on Sandbox:Cherry
Sandbox:Cherry in the news
Blogs on Sandbox:Cherry
Directions to Hospitals Treating Cirrhosis
Risk calculators and risk factors for Sandbox:Cherry

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Associate Editor(s)-in-Chief:

Video codes

Normal video

{{#ev:youtube|x6e9Pk6inYI}} {{#ev:youtube|4uSSvD1BAHg}} {{#ev:youtube|PQXb5D-5UZw}} {{#ev:youtube|UVJYQlUm2A8}}

Video in table

{{#ev:youtube|5ucSlgqGAno}}

Floating video

Title

https://https://www.youtube.com/watch?v=ypYI_lmLD7g%7C350}}

Redirect

1. REDIRECTEsophageal web

synonym website

https://mq.b2i.sg/snow-owl/#!terminology/snomed/10743008

Image

Normal versus Abnormal Barium study of esophagus with varices

Image to the right

C. burnetii, the Q fever causing agent

Image and text to the right

<figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline> Recent out break of leptospirosis is reported in Bronx, New York and found 3 cases in the months January and February, 2017.

Gallery

• 

  Histopathology of a pancreatic endocrine tumor (insulinoma). Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas

• 

  Histopathology of a pancreatic endocrine tumor (insulinoma). Chromogranin A immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas

• 

  Histopathology of a pancreatic endocrine tumor (insulinoma). Insulin immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas

References

REFERENCES