Sandbox:Mazia: Difference between revisions

Latest revision as of 19:11, 16 February 2018

Overview

History Patients with Pancoast syndrome may present with referred pain over the scapula to the shoulder as the result of damage to the afferent pain fibers of the sympathetic trunk. The symptoms are typical of the location of the tumor in the superior sulcus or thoracic inlet adjacent to the eighth cervical nerve roots, the first and second thoracic trunk distribution, the sympathetic chain, and the stellate ganglion.

Initially, localized pain occurs in the shoulder and vertebral border of the scapula. Pain may later extend along an ulnar nerve distribution of the arm to the elbow and, ultimately, to the ulnar surface of the forearm and to the small and ring fingers of the hand (C8). If the tumor extends to the sympathetic chain and stellate ganglion, Horner syndrome and anhidrosis develop on the ipsilateral side of the face and upper extremity.

The pain is frequently relentless and unremitting, and adequate relief often requires administration of narcotics. The patient usually supports the elbow of the affected arm in the hand of the opposite upper extremity to ease the tension on the shoulder and upper arm.

The hand muscles may become weak and atrophic, and the triceps reflex may be absent. The first or second rib or vertebrae may be involved by tumor extension and intensify the severity of pain. The spinal canal and spinal cord may be invaded or compressed, with subsequent symptoms of spinal cord tumor or cervical disk disease.

Many patients are initially treated for presumed local musculoskeletal conditions such as bursitis and vertebral osteoarthritis with radicular pain. Symptoms may persist for many months before evaluation for progression reveals the cause. In a 1994 series by Maggi et al, symptoms lasted 2-36 months, with a mean of 9.7 months. [7] In 1997, Muscolino described plexopathy or radicular symptoms in 53% of 15 patients. [24]

Historical Perspective

[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

Classification

[Disease name] may be classified according to [classification method] into [number] subtypes/groups:

[group1]
[group2]
[group3]

Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

Pathophysiology

The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Causes

[Disease name] may be caused by either [cause1], [cause2], or [cause3].
[Disease name] is caused by a mutation in the [gene1], [gene2], or [gene3] gene[s].
There are no established causes for [disease name].

Differentiating [disease name] from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:

[Differential dx1]
[Differential dx2]
[Differential dx3]

Epidemiology and Demographics

The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

Age

Patients of all age groups may develop [disease name].

[Disease name] is more commonly observed among patients aged [age range] years old.
[Disease name] is more commonly observed among [elderly patients/young patients/children].

Gender

[Disease name] affects men and women equally.

[Gender 1] are more commonly affected with [disease name] than [gender 2].
The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

Race

There is no racial predilection for [disease name].

[Disease name] usually affects individuals of the [race 1] race.
[Race 2] individuals are less likely to develop [disease name].

Risk Factors

Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

The majority of patients with [disease name] remain asymptomatic for [duration/years].
Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:

[criterion 1]
[criterion 2]
[criterion 3]
[criterion 4]

Symptoms

[Disease name] is usually asymptomatic.
Symptoms of [disease name] may include the following:

[symptom 1]
[symptom 2]
[symptom 3]
[symptom 4]
[symptom 5]
[symptom 6]

Physical Examination

Patients with [disease name] usually appear [general appearance].
Physical examination may be remarkable for:

[finding 1]
[finding 2]
[finding 3]
[finding 4]
[finding 5]
[finding 6]

Laboratory Findings

There are no specific laboratory findings associated with [disease name].

A [positive/negative] [test name] is diagnostic of [disease name].
An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Imaging Findings

There are no [imaging study] findings associated with [disease name].

[Imaging study 1] is the imaging modality of choice for [disease name].
On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

[Disease name] may also be diagnosed using [diagnostic study name].
Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
[Medical therapy 1] acts by [mechanism of action 1].
Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

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].

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].

References

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:

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 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.

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:

Extension of the tumor into the neck or vertebrae Presence of substantial mediastinal lymph nodes Peripheral tumor dissemination Protocols that use combinations of radiation therapy, chemotherapy, and surgery are currently being studied to determine the best therapy.

Pathophysiology Pancoast tumors are a subset of lung cancers that invade the apical chest wall. Because of their location in the pleural apex, they invade adjoining tissue. Although other tumors may have a similar clinical presentation because of their location at the thoracic inlet, the most common cause is believed to be a bronchogenic carcinoma arising in or near the superior sulcus and invading adjacent extrathoracic structures by direct extension. Location, rather than pathology or histology of origin, is significant in producing the tumor’s characteristic clinical pattern. [5]

The bulk of a true Pancoast tumor is extrathoracic, originating in an extreme peripheral location with a plaquelike extension over the lung apex and principally involving the chest wall structures rather than the underlying lung parenchyma. Bronchogenic carcinomas occurring in the narrow confines of the thoracic inlet invade the lymphatic vessels in the endothoracic fascia and include, by direct extension, the following structures:

Intercostal nerves Lower roots of the brachial plexus Stellate ganglion Sympathetic chain Adjacent ribs and vertebrae. Carcinomas in the superior pulmonary sulcus produce Pancoast syndrome, thus causing pain in the shoulder and along the ulnar nerve distribution of the arm and hand. [6] (These carcinomas also cause Horner syndrome.) These apical lung tumors tend to be locally invasive early. In the absence of metastases and regional nodal involvement, these apical cancers can be successfully treated.

The tumor may invade the bony structures of the chest, including the first or second thoracic vertebra or the first, second, or third rib. In a review of 60 patients with Pancoast tumors, Maggi et al found radiographic evidence of rib erosion in 50%; an almost equal percentage demonstrated involvement of the first or second rib, and 20% had involvement of the third rib. One patient had involvement of all 3 ribs. [7]

The tumor can also invade the first or second thoracic vertebral bodies or intervertebral foramina. From this point, it can extend to the spinal cord and result in cord compression. The subclavian vein or artery may also be invaded.

Etiology The overwhelming majority of cases of Pancoast syndrome are non–small cell lung carcinoma (NSCLC), with more than 95% located in the superior sulcus. The most common varieties are SCC and adenocarcinoma; large cell carcinoma has also been reported.

Although quite rare (responsible for fewer than 5% percent of cases in most series), small cell carcinoma is also observed. Maggi et al reported small cell carcinoma in only 3 of the 60 patients in their series. [7] More typically, small cell carcinoma manifests in a central rather than a peripheral location.

Although NSCLC is by far the most common cause of Pancoast syndrome, the list of differential diagnoses is broad. Because of the wide variety of diseases that can produce Pancoast syndrome, a histologic diagnosis is mandatory before definitive treatment is initiated.

Rare causes include the following:

Desmoid tumors [8] Hemangiopericytoma [9] Adenoid cystic carcinoma [10] Metastatic carcinoma [11] Lymphoma [12] Thyroid carcinoma [13] Bacterial [14, 15] and fungal infections [16, 17] Lymphomatoid granulomatosis Vascular aneurysms Amyloid nodules Cervical rib syndrome Inflammatory pseudotumor (plasma cell granuloma) Mycotic subclavian artery aneurysm Carotid pseudoaneurysm in a child (caused by a hydatid cyst) Risk factors are similar for almost all lung cancers and include the following:

Prolonged asbestos exposure Exposure to industrial elements (eg, gold, nickel) Tobacco smoking Secondary smoke exposure Epidemiology Overall, Pancoast tumors are much less common than other lung cancers, accounting for fewer than 5% of these cancers (1-3% in various previous series). [18, 19] Originally deemed universally fatal, Pancoast tumors are now amenable to curative treatment because of improvements in combined modality therapy and development of new techniques for resection.

Prognosis The prognosis for patients with Pancoast syndrome is stage dependent. Adverse prognostic factors include the following:

Presence of Horner syndrome Involvement of mediastinal lymph nodes Incomplete resection Involvement of supraclavicular lymph node Vertebral body invasion To date, no patient with the first 3 prognostic factors has survived for 5 years.

Distant disease limits survival. Treatment failure is especially frequent in patients with involvement of the brain. The authors recommend careful surveillance for brain metastasis during and after the therapy. The authors also recommend obtaining brain imaging prior to surgery in patients receiving induction therapy for the primary tumor.

Mortality and survival Attar et al reported a median survival of 36.8 months in patients with T3 lesions undergoing combined modality treatment; median survival was only 6.4 months if the patient had T4 disease. [20]

Overall survival data were summarized by Detterbeck, who noted that 5-year survival rates ranged from 15% to 56%. [21] Of the 104 patients treated by Attar and coworkers, 7 (~7%) were 5-year survivors and 3 (~3%) were 10-year survivors. [20] Another study demonstrated surgical morbidity rates of 7-38%, with mortality ranging from 5% to 10%. [22]

For neoplastic causes, predictors of 5-year survival are weight loss, supraclavicular fossa or vertebral body involvement, disease stage, and surgical treatment. A study by an MD Anderson group reported the following findings [23] :

For patients with stage IIB disease, the 5-year survival rate was 47%, whereas for those with stage IIIA and IIIB disease, it was 14% and 16%, respectively In patients with stage IIB disease, surgical treatment and weight loss were significant independent predictors of 5-year survival Among patients with stage IIIA disease, the only predictor of survival was the Karnofsky performance score In patients with stage IIIB disease, the only independent predictor of survival was a right superior sulcus location, which was associated with a worse 5-year survival rate than a left superior sulcus location Compared with patients who had squamous cell tumors, more patients with adenocarcinoma had cerebral metastases within 5 years Relapse Locoregional relapse is common despite preoperative or postoperative radiation therapy. Muscolino et al found locoregional recurrence in 60% of patients treated with a combined radiosurgical approach. Ginsberg et al found that 94 of their 124 patients had recurrence of disease, with 72% of these cases being locoregional at initial recurrence. In two thirds of patients who underwent complete resection, local recurrences were the first site of relapse. [18]

This distribution of relapses was noted in several studies reviewed by Detterbeck. In many of these studies, patients received preoperative radiation therapy. [21] In the Memorial Sloan-Kettering experience, additional postoperative brachytherapy was administered to achieve maximal possible local control; despite these measures, local relapses and, ultimately, distant relapses were frequent. [18]

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:

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 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.

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:

Extension of the tumor into the neck or vertebrae Presence of substantial mediastinal lymph nodes Peripheral tumor dissemination Protocols that use combinations of radiation therapy, chemotherapy, and surgery are currently being studied to determine the best therapy. Pathophysiology Pancoast tumors are a subset of lung cancers that invade the apical chest wall. Because of their location in the pleural apex, they invade adjoining tissue. Although other tumors may have a similar clinical presentation because of their location at the thoracic inlet, the most common cause is believed to be a bronchogenic carcinoma arising in or near the superior sulcus and invading adjacent extrathoracic structures by direct extension. Location, rather than pathology or histology of origin, is significant in producing the tumor’s characteristic clinical pattern. [5]

The bulk of a true Pancoast tumor is extrathoracic, originating in an extreme peripheral location with a plaquelike extension over the lung apex and principally involving the chest wall structures rather than the underlying lung parenchyma. Bronchogenic carcinomas occurring in the narrow confines of the thoracic inlet invade the lymphatic vessels in the endothoracic fascia and include, by direct extension, the following structures:

Intercostal nerves Lower roots of the brachial plexus Stellate ganglion Sympathetic chain Adjacent ribs and vertebrae. Carcinomas in the superior pulmonary sulcus produce Pancoast syndrome, thus causing pain in the shoulder and along the ulnar nerve distribution of the arm and hand. [6] (These carcinomas also cause Horner syndrome.) These apical lung tumors tend to be locally invasive early. In the absence of metastases and regional nodal involvement, these apical cancers can be successfully treated.

The tumor may invade the bony structures of the chest, including the first or second thoracic vertebra or the first, second, or third rib. In a review of 60 patients with Pancoast tumors, Maggi et al found radiographic evidence of rib erosion in 50%; an almost equal percentage demonstrated involvement of the first or second rib, and 20% had involvement of the third rib. One patient had involvement of all 3 ribs. [7]

The tumor can also invade the first or second thoracic vertebral bodies or intervertebral foramina. From this point, it can extend to the spinal cord and result in cord compression. The subclavian vein or artery may also be invaded.

@@ Line 1: / Line 1: @@
 __NOTOC__
+==Overview==
+History
+Patients with Pancoast syndrome may present with referred pain over the scapula to the shoulder as the result of damage to the afferent pain fibers of the sympathetic trunk. The symptoms are typical of the location of the tumor in the superior sulcus or thoracic inlet adjacent to the eighth cervical nerve roots, the first and second thoracic trunk distribution, the sympathetic chain, and the stellate ganglion.
+Initially, localized pain occurs in the shoulder and vertebral border of the scapula. Pain may later extend along an ulnar nerve distribution of the arm to the elbow and, ultimately, to the ulnar surface of the forearm and to the small and ring fingers of the hand (C8). If the tumor extends to the sympathetic chain and stellate ganglion, Horner syndrome and anhidrosis develop on the ipsilateral side of the face and upper extremity.
+The pain is frequently relentless and unremitting, and adequate relief often requires administration of narcotics. The patient usually supports the elbow of the affected arm in the hand of the opposite upper extremity to ease the tension on the shoulder and upper arm.
+The hand muscles may become weak and atrophic, and the triceps reflex may be absent. The first or second rib or vertebrae may be involved by tumor extension and intensify the severity of pain. The spinal canal and spinal cord may be invaded or compressed, with subsequent symptoms of spinal cord tumor or cervical disk disease.
+Many patients are initially treated for presumed local musculoskeletal conditions such as bursitis and vertebral osteoarthritis with radicular pain. Symptoms may persist for many months before evaluation for progression reveals the cause. In a 1994 series by Maggi et al, symptoms lasted 2-36 months, with a mean of 9.7 months. [7] In 1997, Muscolino described plexopathy or radicular symptoms in 53% of 15 patients. [24]
 ==Historical Perspective==
-*Small intestinal bacterial overgrowth (SIBO) was first discovered by  Barber and Hummel in 1939.
+*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
-*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 [year], [gene] mutations were first identified in the pathogenesis of [disease name].
-*In May 2015,  U.S. Food and Drug Administration (FDA) approved rifaximin to treat SIBO.
+*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
 ==Classification==
-*There is no established system for the classification of small intestinal bacterial overgrowth(SIBO).
+*[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
+:*[group1]
+:*[group2]
+:*[group3]
+*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
 ==Pathophysiology==
-*The pathogenesis of small intestinal bacterial overgrowth (SIBO) is characterized by an increased microbial load in the small intestine.
+*The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
-*A healthy individual has less than 103 organisms/mL in the upper small intestine, and the majority of these organisms are gram-positive bacteria.
+*The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
-*Body's homeostatic mechanisms protect against excessive small intestinal colonization by bacteria include :
+*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
-**Gastric acid and bile eradicate micro-organisms before they leave the stomach
+*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
-**Migrating motor complex clears the excess unwanted bacteria of upper intestine
-**Intestinal mucosa serves as a protective layer for the gut wall.
-**Normal intestinal flora (eg, Lactobacillus) maintains a low pH that prevents bacterial overgrowth.
-**Physical barrier of the ileocecal valve that prevents retrograde translocation of bacteria from colon to the small intestine.
-*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 microscopic histopathological analysis, blunting of the intestinal villi, thinning of the mucosa and crypts, and increased intraepithelial lymphocytes are observed as findings of SIBO.
 ==Causes==
-*Small intestinal bacterial overgrowth (SIBO) may be caused by disruption of the protective homeostatic mechanisms that control enteric bacteria population.
+* [Disease name] may be caused by either [cause1], [cause2], or [cause3].
-*Causes of small intestinal bacterial overgrowth (SIBO) include:
+* [Disease name] is caused by a mutation in the [gene1], [gene2], or [gene3] gene[s].
-**Irregular small intestinal motility
+* There are no established causes for [disease name].
-***Diabetic autonomic neuropathy
-***Scleroderma
-***Pseudo-obstruction
-***Amyloidosis
-***Neurological diseases (eg, myotonic dystrophy, Parkinson disease)
-***Radiation enteritis
-***Crohn disease
-***Hypothyroidism
-**Blind pouches in the gastrointestinal tract
-***Side-to-side or end-to-side anastomoses
-***Duodenal or jejunal diverticula
-***Segmental dilatation of the ileum
-***Blind loop syndrome
-***Biliopancreatic diversion
-***Chagasic megacolon
-**Fistula
-***Gastrocolic fistulae
-***Jejunal-colic fistulae
-**Partial Obstruction
-***Strictures
-***Adhesions
-***Abdominal masses
-***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.
+*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
-'''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. J. 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+:*[Differential dx1]
+:*[Differential dx2]
-<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>
+:*[Differential dx3]
-{| class="wikitable" style="border: 0px; font-size: 100%; margin: 3px;" align="center"
-! 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
-! 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]]
-* 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" | +
-| style="padding: 5px 5px; background: #F5F5F5;" align="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 pain|Epigastric 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" |
-*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" |
-* Anti–[[Type I topoisomerase|topoisomerase I]] (Scl‑70) antibodies
-* [[Antinuclear antibodies]] ([[Antinuclear antibodies|ANA]])
-* [[Anti-centromere antibodies|Anti–centromere antibodies]]
-* Anti–[[RNA polymerase III]] antibody
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Malabsorption]]
-*[[Skin changes]]
-*[[Raynaud's phenomenon|Raynaud phenomenon]]
-*[[Pulmonary hypertension]]
-*[[Arthritis]]
-*[[Telangiectasia]]
-*[[Chronic renal failure]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Autoimmunity|Autoimmune reaction]]
-| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Clinical diagnosis
-*Followed by serologic tests
-|- }
-|}
 ==Epidemiology and Demographics==
-*The prevalence of SIBO is unknown.
+* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
+* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
 ===Age===
-*Small intestinal bacterial overgrowth is more commonly observed among elderly patients.
+*Patients of all age groups may develop [disease name].
+*[Disease name] is more commonly observed among patients aged [age range] years old.
+*[Disease name] is more commonly observed among [elderly patients/young patients/children].
 ===Gender===
-*Small intestinal bacterial overgrowth (SIBO) affects men and women equally.
+*[Disease name] affects men and women equally.
+*[Gender 1] are more commonly affected with [disease name] than [gender 2].
+* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
 ===Race===
-*There is no racial predilection for small intestinal bacterial overgrowth (SIBO).
+*There is no racial predilection for [disease name].
+*[Disease name] usually affects individuals of the [race 1] race.
+*[Race 2] individuals are less likely to develop [disease name].
 ==Risk Factors==
-*Common risk factors in the development of small intestinal bacterial overgrowth (SIBO) are :
+*Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
-**Intestinal tract surgery
-**Irritable bowel syndrome
+== Natural History, Complications and Prognosis==
-**Liver cirrhosis
+*The majority of patients with [disease name] remain asymptomatic for [duration/years].
-**Celiac disease
+*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
-**Immune deficiency (eg, AIDS, IGA deficiency, severe malnutrition)
+*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
-**Short bowel syndrome
+*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
-**End-stage renal disease
+*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].
-**Gastrojejunal anastomosis
-**Antral resection
-**Pancreatic exocrine insufficiency
-== Natural History, Complications and Prognosis==
-*Early clinical features include bloating, flatulence, abdominal pain.
-*If left untreated, patients with small intestinal bacterial overgrowth (SIBO) may progress to develop diarrhea, dyspepsia and weight loss.
-*Common complications of small intestinal bacterial overgrowth (SIBO) include:
-**Iron deficiency resulting in microcytic anemia
-**Vitamin B-12/ folate deficiency resulting in macrocytic anemia
-**Vitamin B-12 deficiency associated polyneuropathy
-**Steatorrhea
-**Hypocalcemia
-**Vitamin A deficiency resulting in night blindness
-**Selenium deficiency causing dermatitis
-**Rosacea
-**Cachexia as a result of protein-energy malnutrition
-*Prognosis is generally good and associated with frequent relapses and symptom-free periods.
 == Diagnosis ==
 ===Diagnostic Criteria===
-*The diagnosis of small intestinal bacterial overgrowth (SIBO) is made when at least one of the following diagnostic criteria are met:
+*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
-:*A positive carbohydrate breath test
+:*[criterion 1]
-:*Bacterial concentration of >103 units/mL in a jejunal aspirate culture
+:*[criterion 2]
+:*[criterion 3]
+:*[criterion 4]
 === Symptoms ===
-*Symptoms of small intestinal bacterial overdose (SIBO) may include the following:
+*[Disease name] is usually asymptomatic.
-:*Bloating
+*Symptoms of [disease name] may include the following:
-:*Flatulence
+:*[symptom 1]
-:*Abdominal discomfort
+:*[symptom 2]
-:*Chronic watery diarrhea
+:*[symptom 3]
-:*Weight loss
+:*[symptom 4]
+:*[symptom 5]
+:*[symptom 6]
 === Physical Examination ===
 *Patients with [disease name] usually appear [general appearance].
@@ Line 2,046: / Line 140: @@
 *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].
 ==References==
-{{Reflist|2}}
+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:
+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
+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.
+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:
+Extension of the tumor into the neck or vertebrae
+Presence of substantial mediastinal lymph nodes
+Peripheral tumor dissemination
+Protocols that use combinations of radiation therapy, chemotherapy, and surgery are currently being studied to determine the best therapy.
+Pathophysiology
+Pancoast tumors are a subset of lung cancers that invade the apical chest wall. Because of their location in the pleural apex, they invade adjoining tissue. Although other tumors may have a similar clinical presentation because of their location at the thoracic inlet, the most common cause is believed to be a bronchogenic carcinoma arising in or near the superior sulcus and invading adjacent extrathoracic structures by direct extension. Location, rather than pathology or histology of origin, is significant in producing the tumor’s characteristic clinical pattern. [5]
+The bulk of a true Pancoast tumor is extrathoracic, originating in an extreme peripheral location with a plaquelike extension over the lung apex and principally involving the chest wall structures rather than the underlying lung parenchyma. Bronchogenic carcinomas occurring in the narrow confines of the thoracic inlet invade the lymphatic vessels in the endothoracic fascia and include, by direct extension, the following structures:
+Intercostal nerves
+Lower roots of the brachial plexus
+Stellate ganglion
+Sympathetic chain
+Adjacent ribs and vertebrae.
+Carcinomas in the superior pulmonary sulcus produce Pancoast syndrome, thus causing pain in the shoulder and along the ulnar nerve distribution of the arm and hand. [6] (These carcinomas also cause Horner syndrome.) These apical lung tumors tend to be locally invasive early. In the absence of metastases and regional nodal involvement, these apical cancers can be successfully treated.
+The tumor may invade the bony structures of the chest, including the first or second thoracic vertebra or the first, second, or third rib. In a review of 60 patients with Pancoast tumors, Maggi et al found radiographic evidence of rib erosion in 50%; an almost equal percentage demonstrated involvement of the first or second rib, and 20% had involvement of the third rib. One patient had involvement of all 3 ribs. [7]
+The tumor can also invade the first or second thoracic vertebral bodies or intervertebral foramina. From this point, it can extend to the spinal cord and result in cord compression. The subclavian vein or artery may also be invaded.
+Etiology
+The overwhelming majority of cases of Pancoast syndrome are non–small cell lung carcinoma (NSCLC), with more than 95% located in the superior sulcus. The most common varieties are SCC and adenocarcinoma; large cell carcinoma has also been reported.
+Although quite rare (responsible for fewer than 5% percent of cases in most series), small cell carcinoma is also observed. Maggi et al reported small cell carcinoma in only 3 of the 60 patients in their series. [7] More typically, small cell carcinoma manifests in a central rather than a peripheral location.
+Although NSCLC is by far the most common cause of Pancoast syndrome, the list of differential diagnoses is broad. Because of the wide variety of diseases that can produce Pancoast syndrome, a histologic diagnosis is mandatory before definitive treatment is initiated.
+Rare causes include the following:
+Desmoid tumors [8]
+Hemangiopericytoma [9]
+Adenoid cystic carcinoma [10]
+Metastatic carcinoma [11]
+Lymphoma [12]
+Thyroid carcinoma [13]
+Bacterial [14, 15] and fungal infections [16, 17]
+Lymphomatoid granulomatosis
+Vascular aneurysms
+Amyloid nodules
+Cervical rib syndrome
+Inflammatory pseudotumor (plasma cell granuloma)
+Mycotic subclavian artery aneurysm
+Carotid pseudoaneurysm in a child (caused by a hydatid cyst)
+Risk factors are similar for almost all lung cancers and include the following:
+Prolonged asbestos exposure
+Exposure to industrial elements (eg, gold, nickel)
+Tobacco smoking
+Secondary smoke exposure
+Epidemiology
+Overall, Pancoast tumors are much less common than other lung cancers, accounting for fewer than 5% of these cancers (1-3% in various previous series). [18, 19] Originally deemed universally fatal, Pancoast tumors are now amenable to curative treatment because of improvements in combined modality therapy and development of new techniques for resection.
+Prognosis
+The prognosis for patients with Pancoast syndrome is stage dependent. Adverse prognostic factors include the following:
+Presence of Horner syndrome
+Involvement of mediastinal lymph nodes
+Incomplete resection
+Involvement of supraclavicular lymph node
+Vertebral body invasion
+To date, no patient with the first 3 prognostic factors has survived for 5 years.
+Distant disease limits survival. Treatment failure is especially frequent in patients with involvement of the brain. The authors recommend careful surveillance for brain metastasis during and after the therapy. The authors also recommend obtaining brain imaging prior to surgery in patients receiving induction therapy for the primary tumor.
+Mortality and survival
+Attar et al reported a median survival of 36.8 months in patients with T3 lesions undergoing combined modality treatment; median survival was only 6.4 months if the patient had T4 disease. [20]
+Overall survival data were summarized by Detterbeck, who noted that 5-year survival rates ranged from 15% to 56%. [21] Of the 104 patients treated by Attar and coworkers, 7 (~7%) were 5-year survivors and 3 (~3%) were 10-year survivors. [20] Another study demonstrated surgical morbidity rates of 7-38%, with mortality ranging from 5% to 10%. [22]
+For neoplastic causes, predictors of 5-year survival are weight loss, supraclavicular fossa or vertebral body involvement, disease stage, and surgical treatment. A study by an MD Anderson group reported the following findings [23] :
+For patients with stage IIB disease, the 5-year survival rate was 47%, whereas for those with stage IIIA and IIIB disease, it was 14% and 16%, respectively
+In patients with stage IIB disease, surgical treatment and weight loss were significant independent predictors of 5-year survival
+Among patients with stage IIIA disease, the only predictor of survival was the Karnofsky performance score
+In patients with stage IIIB disease, the only independent predictor of survival was a right superior sulcus location, which was associated with a worse 5-year survival rate than a left superior sulcus location
+Compared with patients who had squamous cell tumors, more patients with adenocarcinoma had cerebral metastases within 5 years
+Relapse
+Locoregional relapse is common despite preoperative or postoperative radiation therapy. Muscolino et al found locoregional recurrence in 60% of patients treated with a combined radiosurgical approach. Ginsberg et al found that 94 of their 124 patients had recurrence of disease, with 72% of these cases being locoregional at initial recurrence. In two thirds of patients who underwent complete resection, local recurrences were the first site of relapse. [18]
+This distribution of relapses was noted in several studies reviewed by Detterbeck. In many of these studies, patients received preoperative radiation therapy. [21] In the Memorial Sloan-Kettering experience, additional postoperative brachytherapy was administered to achieve maximal possible local control; despite these measures, local relapses and, ultimately, distant relapses were frequent. [18]
+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:
+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
+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.
+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:
+Extension of the tumor into the neck or vertebrae
+Presence of substantial mediastinal lymph nodes
+Peripheral tumor dissemination
+Protocols that use combinations of radiation therapy, chemotherapy, and surgery are currently being studied to determine the best therapy.
+Pathophysiology
+Pancoast tumors are a subset of lung cancers that invade the apical chest wall. Because of their location in the pleural apex, they invade adjoining tissue. Although other tumors may have a similar clinical presentation because of their location at the thoracic inlet, the most common cause is believed to be a bronchogenic carcinoma arising in or near the superior sulcus and invading adjacent extrathoracic structures by direct extension. Location, rather than pathology or histology of origin, is significant in producing the tumor’s characteristic clinical pattern. [5]
+The bulk of a true Pancoast tumor is extrathoracic, originating in an extreme peripheral location with a plaquelike extension over the lung apex and principally involving the chest wall structures rather than the underlying lung parenchyma. Bronchogenic carcinomas occurring in the narrow confines of the thoracic inlet invade the lymphatic vessels in the endothoracic fascia and include, by direct extension, the following structures:
+Intercostal nerves
+Lower roots of the brachial plexus
+Stellate ganglion
+Sympathetic chain
+Adjacent ribs and vertebrae.
+Carcinomas in the superior pulmonary sulcus produce Pancoast syndrome, thus causing pain in the shoulder and along the ulnar nerve distribution of the arm and hand. [6] (These carcinomas also cause Horner syndrome.) These apical lung tumors tend to be locally invasive early. In the absence of metastases and regional nodal involvement, these apical cancers can be successfully treated.
+The tumor may invade the bony structures of the chest, including the first or second thoracic vertebra or the first, second, or third rib. In a review of 60 patients with Pancoast tumors, Maggi et al found radiographic evidence of rib erosion in 50%; an almost equal percentage demonstrated involvement of the first or second rib, and 20% had involvement of the third rib. One patient had involvement of all 3 ribs. [7]
+The tumor can also invade the first or second thoracic vertebral bodies or intervertebral foramina. From this point, it can extend to the spinal cord and result in cord compression. The subclavian vein or artery may also be invaded.

Sandbox:Mazia: Difference between revisions

Latest revision as of 19:11, 16 February 2018

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating [disease name] from other Diseases

Epidemiology and Demographics

Age

Gender

Race

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

Symptoms

Physical Examination

Laboratory Findings

Imaging Findings

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Medical Therapy

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