Sandbox: malabsorption

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Diarrhea

Abbreviations: GI: Gastrointestinal, CBC: Complete blood count, WBC: White blood cell, RBC: Red blood cell, Plt: Platelet, Hgb: Hemoglobin, ESR: Erythrocyte sedimentation rate, CRP: C–reactive protein, IgE: Immunoglobulin E, IgA: Immunoglobulin A, ETEC: Escherichia coli enteritis, EPEC: Enteropathogenic Escherichia coli, EIEC: Enteroinvasive Escherichia coli, EHEC: Enterohemorrhagic Escherichia coli, EAEC: Enteroaggregative Escherichia coli,

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 + + + + + + + + +
  • Abnormal immune response to self antigens
Celiac disease + ± ± + +
Cystic fibrosis + + ± + +
Chronic pancreatitis + + + + +
Bile acid malabsorption + + + +
Microscopic colitis + + + +
Infective colitis + + + - + + + + + +
Ischemic colitis + + + + - + + + + +
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
  • Stool exam
  • CT
Shigella
Salmonella
Campylobacter jejuni
E–coli ETEC

(Traveler's diarrhea)

+ + +
  • Enterotoxins:
    • Heat–labile enterotoxin (LT) 
    • Heat–stable enterotoxin (ST)
  • Enterotoxins:
    • Heat–labile enterotoxin (LT)
    • Heat–stable enterotoxin (ST)
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 + + + + +
  • Surgical intestinal resection
Radiation enteritis
Dumping syndrome
Others Abetalipoproteinemia + + + + +
Hyperthyroidism + + ± + +
  • Elevated T4
  • Elevated T3
  • Decreased TSH
Diabetic neuropathy
Systemic sclerosis