Chronic diarrhea differential diagnosis: Difference between revisions
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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 | |||
'''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 | |||
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 |
Diagnosis |
---|
Treatment |
Case Studies |
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
- ↑ 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.