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Below is a list of differential Diagnosis of Chronic Diarrhea by Stool Characteristics.<ref name="LacyMearin2016">{{cite journal|last1=Lacy|first1=Brian E.|last2=Mearin|first2=Fermín|last3=Chang|first3=Lin|last4=Chey|first4=William D.|last5=Lembo|first5=Anthony J.|last6=Simren|first6=Magnus|last7=Spiller|first7=Robin|title=Bowel Disorders|journal=Gastroenterology|volume=150|issue=6|year=2016|pages=1393–1407.e5|issn=00165085|doi=10.1053/j.gastro.2016.02.031}}</ref>
Below is a list of differential Diagnosis of Chronic Diarrhea by Stool Characteristics.<ref name="LacyMearin2016">{{cite journal|last1=Lacy|first1=Brian E.|last2=Mearin|first2=Fermín|last3=Chang|first3=Lin|last4=Chey|first4=William D.|last5=Lembo|first5=Anthony J.|last6=Simren|first6=Magnus|last7=Spiller|first7=Robin|title=Bowel Disorders|journal=Gastroenterology|volume=150|issue=6|year=2016|pages=1393–1407.e5|issn=00165085|doi=10.1053/j.gastro.2016.02.031}}</ref>


Watery
'''Watery'''


Secretory (often nocturnal; unrelated to food intake; fecal osmotic gap < 50 mOsm per kg*)
*Secretory (often nocturnal; unrelated to food intake; fecal osmotic gap < 50 mOsm per kg*)
**Alcoholism
**Bacterial enterotoxins (e.g., cholera)
**Bile acid malabsorption
**Brainerd diarrhea (epidemic secretory diarrhea)
**Congenital syndromes
**Crohn disease (early ileocolitis)
**Endocrine disorders (e.g., hyperthyroidism [increases motility])
**Medications (see causes section)
**Microscopic colitis (lymphocytic and collagenous subtypes)
**Neuroendocrine tumors (e.g., gastrinoma, vipoma, carcinoid tumors, mastocytosis)
**Nonosmotic laxatives (e.g., senna, docusate sodium [Colace])
**Postsurgical (e.g., cholecystectomy, gastrectomy, vagotomy, intestinal resection)
**Vasculitis
*Osmotic (fecal osmotic gap > 125 mOsm per kg*)
**Carbohydrate malabsorption syndromes (e.g., lactose, fructose)
**Celiac disease
**Osmotic laxatives and antacids (e.g., magnesium, phosphate, sulfate)
**Sugar alcohols (e.g., mannitol, sorbitol, xylitol)
*Functional (distinguished from secretory types by hypermotility, smaller volumes, and improvement at night and with fasting)
**Irritable bowel syndrome


'''Fatty (bloating and steatorrhea in many, but not all cases)'''
*Malabsorption syndrome (damage to or loss of absorptive ability)
**Amyloidosis
**Carbohydrate malabsorption (e.g., lactose intolerance)
**Celiac sprue (gluten enteropathy)–various clinical presentations
**Gastric bypass
**Lymphatic damage (e.g., congestive heart failure, some lymphomas)
**Medications (e.g., orlistat [Xenical; inhibits fat absorption], acarbose [Precose; inhibits carbohydrate absorption])
**Mesenteric ischemia
**Noninvasive small bowel parasite (e.g., Giardia)
**Postresection diarrhea
**Short bowel syndrome
**Small bowel bacterial overgrowth (> 105 bacteria per mL)
**Tropical sprue
**Whipple disease (Tropheryma whippelii infection)
*Maldigestion (loss of digestive function)
**Hepatobiliary disorders
**Inadequate luminal bile acid
**Loss of regulated gastric emptying
**Pancreatic exocrine insufficiency


Alcoholism
'''Inflammatory or exudative (elevated white blood cell count, occult or frank blood or pus)'''
 
*Inflammatory bowel disease Crohn disease (ileal or early Crohn disease may be secretory)
**Diverticulitis
 
**Ulcerative colitis
Bacterial enterotoxins (e.g., cholera)
**Ulcerative jejunoileitis
 
*Invasive infectious diseases
**Clostridium difficile (pseudomembranous) colitis–antibiotic history
 
**Invasive bacterial infections (e.g., tuberculosis, yersiniosis)
Bile acid malabsorption
**Invasive parasitic infections (e.g., Entamoeba)–travel history
 
**Ulcerating viral infections (e.g., cytomegalovirus, herpes simplex virus)
*Neoplasia
 
**Colon carcinoma
Brainerd diarrhea (epidemic secretory diarrhea)
**Lymphoma
 
**Villous adenocarcinoma
*Radiation colitis
 
Congenital syndromes
 
 
Crohn disease (early ileocolitis)
 
 
Endocrine disorders (e.g., hyperthyroidism [increases motility])
 
 
Medications (see Table 3)
 
 
Microscopic colitis (lymphocytic and collagenous subtypes)
 
 
Neuroendocrine tumors (e.g., gastrinoma, vipoma, carcinoid tumors, mastocytosis)
 
 
Nonosmotic laxatives (e.g., senna, docusate sodium [Colace])
 
 
Postsurgical (e.g., cholecystectomy, gastrectomy, vagotomy, intestinal resection)
 
 
Vasculitis
 
Osmotic (fecal osmotic gap > 125 mOsm per kg*)
 
 
Carbohydrate malabsorption syndromes (e.g., lactose, fructose)
 
 
Celiac disease
 
 
Osmotic laxatives and antacids (e.g., magnesium, phosphate, sulfate)
 
 
Sugar alcohols (e.g., mannitol, sorbitol, xylitol)
 
Functional (distinguished from secretory types by hypermotility, smaller volumes, and improvement at night and with fasting)
 
 
Irritable bowel syndrome
 
Fatty (bloating and steatorrhea in many, but not all cases)
 
Malabsorption syndrome (damage to or loss of absorptive ability)
 
 
Amyloidosis
 
 
Carbohydrate malabsorption (e.g., lactose intolerance)
 
 
Celiac sprue (gluten enteropathy)–various clinical presentations
 
 
Gastric bypass
 
 
Lymphatic damage (e.g., congestive heart failure, some lymphomas)
 
 
Medications (e.g., orlistat [Xenical; inhibits fat absorption], acarbose [Precose; inhibits carbohydrate absorption])
 
 
Mesenteric ischemia
 
 
Noninvasive small bowel parasite (e.g., Giardia)
 
 
Postresection diarrhea
 
 
Short bowel syndrome
 
 
Small bowel bacterial overgrowth (> 105 bacteria per mL)
 
 
Tropical sprue
 
 
Whipple disease (Tropheryma whippelii infection)
 
Maldigestion (loss of digestive function)
 
 
Hepatobiliary disorders
 
 
Inadequate luminal bile acid
 
 
Loss of regulated gastric emptying
 
 
Pancreatic exocrine insufficiency
 
Inflammatory or exudative (elevated white blood cell count, occult or frank blood or pus)
 
Inflammatory bowel disease Crohn disease (ileal or early Crohn disease may be secretory)
 
 
Diverticulitis
 
 
Ulcerative colitis
 
 
Ulcerative jejunoileitis
 
Invasive infectious diseases
 
 
Clostridium difficile (pseudomembranous) colitis–antibiotic history
 
 
Invasive bacterial infections (e.g., tuberculosis, yersiniosis)
 
 
Invasive parasitic infections (e.g., Entamoeba)–travel history
 
 
Ulcerating viral infections (e.g., cytomegalovirus, herpes simplex virus)
 
Neoplasia
 
 
Colon carcinoma
 
 
Lymphoma
 
 
Villous adenocarcinoma
 
Radiation colitis


==References==
==References==

Revision as of 15:51, 7 June 2017

Chronic diarrhea Microchapters

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Overview

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Differentiating Chronic diarrhea from other Diseases

Epidemiology and Demographics

Risk Factors

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History and Symptoms

Physical Examination

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Future or Investigational Therapies

Case Studies

Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]

Overview

Differential diagnosis

It is important to differentiate chronic diarrhea based on the kind of diarrhea that is produced. Chronic diarrhea can be subdivided into three major types; watery, fatty, inflammatory. Watery chronic diarrhea can then further be sub-divided into osmotic or secretory diarrhea. Below is a list of differential Diagnosis of Chronic Diarrhea by Stool Characteristics.[1]

Watery

  • Secretory (often nocturnal; unrelated to food intake; fecal osmotic gap < 50 mOsm per kg*)
    • Alcoholism
    • Bacterial enterotoxins (e.g., cholera)
    • Bile acid malabsorption
    • Brainerd diarrhea (epidemic secretory diarrhea)
    • Congenital syndromes
    • Crohn disease (early ileocolitis)
    • Endocrine disorders (e.g., hyperthyroidism [increases motility])
    • Medications (see causes section)
    • Microscopic colitis (lymphocytic and collagenous subtypes)
    • Neuroendocrine tumors (e.g., gastrinoma, vipoma, carcinoid tumors, mastocytosis)
    • Nonosmotic laxatives (e.g., senna, docusate sodium [Colace])
    • Postsurgical (e.g., cholecystectomy, gastrectomy, vagotomy, intestinal resection)
    • Vasculitis
  • Osmotic (fecal osmotic gap > 125 mOsm per kg*)
    • Carbohydrate malabsorption syndromes (e.g., lactose, fructose)
    • Celiac disease
    • Osmotic laxatives and antacids (e.g., magnesium, phosphate, sulfate)
    • Sugar alcohols (e.g., mannitol, sorbitol, xylitol)
  • Functional (distinguished from secretory types by hypermotility, smaller volumes, and improvement at night and with fasting)
    • Irritable bowel syndrome

Fatty (bloating and steatorrhea in many, but not all cases)

  • Malabsorption syndrome (damage to or loss of absorptive ability)
    • Amyloidosis
    • Carbohydrate malabsorption (e.g., lactose intolerance)
    • Celiac sprue (gluten enteropathy)–various clinical presentations
    • Gastric bypass
    • Lymphatic damage (e.g., congestive heart failure, some lymphomas)
    • Medications (e.g., orlistat [Xenical; inhibits fat absorption], acarbose [Precose; inhibits carbohydrate absorption])
    • Mesenteric ischemia
    • Noninvasive small bowel parasite (e.g., Giardia)
    • Postresection diarrhea
    • Short bowel syndrome
    • Small bowel bacterial overgrowth (> 105 bacteria per mL)
    • Tropical sprue
    • Whipple disease (Tropheryma whippelii infection)
  • Maldigestion (loss of digestive function)
    • Hepatobiliary disorders
    • Inadequate luminal bile acid
    • Loss of regulated gastric emptying
    • Pancreatic exocrine insufficiency

Inflammatory or exudative (elevated white blood cell count, occult or frank blood or pus)

  • Inflammatory bowel disease Crohn disease (ileal or early Crohn disease may be secretory)
    • Diverticulitis
    • Ulcerative colitis
    • Ulcerative jejunoileitis
  • Invasive infectious diseases
    • Clostridium difficile (pseudomembranous) colitis–antibiotic history
    • Invasive bacterial infections (e.g., tuberculosis, yersiniosis)
    • Invasive parasitic infections (e.g., Entamoeba)–travel history
    • Ulcerating viral infections (e.g., cytomegalovirus, herpes simplex virus)
  • Neoplasia
    • Colon carcinoma
    • Lymphoma
    • Villous adenocarcinoma
  • Radiation colitis

References

  1. ↑ Lacy, Brian E.; Mearin, Fermín; Chang, Lin; Chey, William D.; Lembo, Anthony J.; Simren, Magnus; Spiller, Robin (2016). "Bowel Disorders". Gastroenterology. 150 (6): 1393–1407.e5. doi:10.1053/j.gastro.2016.02.031. ISSN 0016-5085.


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