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
Stool exam CBC Other lab findings
Acute Chronic Watery Bloody Fatty WBC RBC Ova/Parasite Osmotic gap Other WBC Hgb Plt
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