Sandbox: malabsorption: Difference between revisions

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Revision as of 17:53, 12 December 2017

Diarrhea

Abbreviations: GI: Gastrointestinal, WBC: White blood cells, Plt: Platelets, Hgb: Hemoglobin, IgE: Immunoglobulin E, IgA: Immunoglobulin A, ETEC: Escherichia coli enteritis, EPEC: Enteropathogenic Escherichia coli, EIEC: Enteroinvasive Escherichia coli, EHEC: Enterohemorrhagic Escherichia coli, EAEC: Enteroaggregative Escherichia coli

Categories Cause Clinical manifestation Lab findings Extra intestinal findings Cause/Pathogenesis Gold standard diagnosis
Symptoms GI signs
Duration Diarrhea Fever Abdominal pain Weight loss
Stool exam CBC Other lab findings
Acute Chronic Watery Bloody Fatty WBC RBC Ova/Parasite Osmotic gap Other WBC Hgb Plt
Gastrointestinal Crohns disease - + + + + ± + + + + - -
  • Abnormal immune response to self antigens
Ulcerative colitis - + + + + + + + -
  • Hypoalbuminemia
  • Hypokalemia
  • Hypomagnesemia
  • Iron deficiency
  • Elevated ESR
  • Elevated CRP
  • Abnormal immune response to self antigens
Celiac disease - + ± - ± - + +
- -
  • IgA endomysial antibody
  • Anti-tissue transglutaminase antibody
  • Anti-gliadin antibody
  • IgA endomysial antibody
  • IgA tissue transglutaminase antibody
Cystic fibrosis - + - - + ± + +
- -
  • Positive DNA analysis for CFTR
  • Evaluated nasal transepithelial potential difference (NPD)
Chronic pancreatitis - + + - + - + +
- - -
  • Slightly elevated amylase and lipase
  • Abnormal pancreatic function test
  • Repeated acute pancreatitis
  • Alcohol abuse
  • Genetic
  • Autoimmune
Microscopic colitis - + + + - - + + -
- -
Infective colitis -
Ischemic colitis -
Mesenteric ischemia -
Lactose intolerance + + + - - - + -
- - -
Irritable bowel syndrome - + ± - ± - ± - -
- - -
  • Diagnosis of exclusion
Infection Bacterial Whipple's disease - + + - + ± + + - - - ↓/↑
Tropical sprue + + + - + + + +
- -
  • Diagnosis of exclusion
Small bowel bacterial overgrowth - + + - + - + +
- -
  • Excess bacteria in the small intestine
  • Alterations in intestinal anatomy or GI motility, 
  • Lack of gastric acid secretion
  • Diagnosis of exclusion
Food poisoning -
Pseudomembranous colitis + - + +/- - + + +/-
  • Abdominal tenderness
  • Presence of pseudomembranes of endoscopy
  • Enzyme immunoassay (EIA) for C difficile toxin A and B
  • Polymerase chain reaction (PCR) assay or C difficile antigen (glutamate dehydrogenase [GDH]) EIA
  • Leukocytosis
  • Elevated serum creatinine
  • Hypoalbuminemia
  • Anasarca
  • Elevated serum lactate
  • Recent antibiotics use
  • Recent surgery
  • Colon cancer
  • Diverticulitis
  • Appendicitis
  • Stool exam
  • CT
Shigella -
Salmonella -
Campylobacter jejuni -
E-coli ETEC -
EPEC -
EIEC -
EHEC -
EAEC -
Yersinia enterocolitica -
Vibrio cholera -
Aeromonas -
Plesiomonas -
Mycobacterium avium complex + + +/- + -
+/- + - -
- -
  • Immune system analysis may show defects
Other infections
  • aaaa
  • bbbb
+ + - + +/-
+ + - -
  • Stool culture may be positive for responsible organism
- -
Virus Rotavirus -
Echovirus -
Adenovirus -
Norovirus -
CMV colitis + + +/- + -
+/- + - -
- -
  • CD 4 level decreased as it is maily associated with HIV
HIV -
Hepatitis Hepatitis A -
Hepatitis E -
Parasite Entamoeba histolytica -
Giardia -
Cryptosporidium -
Microsporidia -
Isospora + + + -
+ + - -
-
Other Parasitic diarrhea
  • aaaa
  • bbbb
+ + + - + +/-
+ + + -
- -
Tumors Carcinoid tumor -
VIPoma + + + - + - + +
- - -
  • Primary secretory tumor
  • Elevated VIP levels
  • Followed by imaging
Zollinger-Ellison syndrome - + + - + - + +
- -
  • Elevated basal or stimulated serum gastrin> 120 pg/mL
Somatostatinoma -
Lymphoma -
Colorectal cancer + + + +
- + - -
- ↑/↓ -
  • May be associated with FAP gene or HNPCC gene
Medication/Toxicity Drug induced enteritis -
Laxative abuse -
Heavy metal ingestion -
Organophosphate poisoning -
Opium withdrawal -
Iatrogenic Short bowel syndrome + + + - + - - +
-
  • Prior intestinal surgery
  • Surgical intestinal resection
Radiation enteritis -
Dumping syndrome -
Others Abetalipoproteinemia - + + - + - + +
- - -
Hyperthyroidism - + + - - ± + +
- - -
  • Elevated T4
  • Elevated T3
  • Decreased TSH
Diabetic neuropathy -
Systemic sclerosis -