Sandbox: malabsorption

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Diarrhea

Abbreviations: GI: Gastrointestinal; WBC: White blood cells; Plt: Platelets, Hgb: Hemoglobin, IgE: Immunoglobulin E, IgA: Immunoglobulin A

Cause Clinical manifestation Lab findings Extra intestinal findings Cause/Pathogenesis Gold standard diagnosis
Symptoms GI signs
Duration Diarrhea Fever Abdominal pain Weight loss
CBC Stool exam Other lab findings
Acute Chronic Watery Bloody Fatty WBC Hgb Plt WBC RBC Ova/Parasite Osmotic gap Other
Whipple's disease + - + ± + + ↓/↑
Celiac disease ± - ± - + + - -
  • IgA endomysial antibody
  • Anti-tissue transglutaminase antibody
  • Anti-gliadin antibody
  • IgA endomysial antibody
  • IgA tissue transglutaminase antibody
Tropical sprue + - + + + + - -
  • Diagnosis of exclusion
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
Cystic fibrosis - - + ± + + - -
  • Positive DNA analysis for CFTR
  • Evaluated nasal transepithelial potential difference (NPD)
VIPoma + - + - + + - - -
  • Primary secretory tumor
  • Elevated VIP levels
  • Followed by imaging
Zollinger-Ellison syndrome + - + - + + - -
  • Elevated basal or stimulated serum gastrin> 120 pg/mL
Eosinophilic gastroenteritis  + - + - + + - -
Primary bile acid malabsorption + - + - + + - -
Abetalipoproteinemia + - + - + + - - -
Microscopic colitis + + - - + + - -
Hyperthyroidism + - - ± + + - - -
  • Elevated T4
  • Elevated T3
  • Decreased TSH
Lactose intolerance + - - - + - - - -
Irritable bowel syndrome ± - ± - ± - - - -
  • Diagnosis of exclusion
Chronic pancreatitis + - + - + + - - -
  • Slightly elevated amylase and lipase
  • Abnormal pancreatic function test
  • Repeated acute pancreatitis
  • Alcohol abuse
  • Genetic
  • Autoimmune
Cirrhosis + - + + + +
  • Jaundice
  • Hepatosplenomegaly
  • Abdominal distention
  • Shifting dullness
  • Asterixis
  • Skin telangiectasias 
  • Abnormal liver function tests
  • Prolonged PT/PTT
  • Coagulopathy
  • Portal hypertension
  • Hepatic encephalopathy
  • Liver biopsy
Short bowel syndrome + - + - - + -
  • Prior intestinal surgery
  • Surgical intestinal resection
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
 X-linked agammaglobulinemia + - + + + +
  • Signs of dehydration
  • Signs of infections
-
  • Hypogammaglobulinemia
  • Recurrent respiratory tract infections
  • Gastroenteritis
  • Bacterial infections
  • Malabsorption
  • Inherited Gene defect 
  • Low circulating immunoglobulin levels (IgG, IgA, IgM, IgE) on blood tests
Intestinal lymphangiectasia - - + - - +
  • Peripheral edema
  • Macular edema 
- -
  • Hypoproteinemia
  • Hypogammaglobulinemia
  • Protein-losing enteropathy
  • Malabsorption
  • Anergy
  • Homograft rejection
  • Pachydermoperiostosis 
  • Dilatation of intestinal lymphatics
Intestinal biopsy
Amyloidosis +
Mastocytosis
Drug induced enteritis
Giardiasis +
Strongyloidiasis
Tuberculosis
Chronic laxative abuse
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