Chronic diarrhea differential diagnosis: Difference between revisions

Latest revision as of 23:00, 8 February 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2], Seyedmahdi Pahlavani, M.D. [3]

Overview

The differential diagnosis for chronic diarrhea is enormous, with a large number of diagnostic tests available that can be used to evaluate these patients. Classifying a patient's chronic diarrhea into a subcategory such as watery, fatty and inflammatory helps to direct the diagnostic work-up. Some watery causes of chronic diarrhea which should be differentiated from one another include crohn's disease, hyperthyroidism, VIPoma, lactose intolerance, celiac disease and irritable bowel syndrome (IBS). The causes of fatty diarrhea that should be differentiated from one another include celiac sprue, pancreatic insufficiency, bacterial overgrowth and maldigestion problems which results from pancreatic exocrine insufficiency. Finally, the inflammatory causes of chronic diarrhea such as ulcerative colitis and entamoeba histolytica must also be differentiated.

Differential Diagnosis of Chronic Diarrhea from other diseases

The following table outlines the major differential diagnoses of chronic diarrhea.^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]^[16]^[17]^[18]^[19]^[20]^[21]^[22]^[23]^[24]^[25]^[26]^[27]^[28]^[29]^[30]

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, Nl: Normal, ASCA: Anti saccharomyces cerevisiae antibodies, ANCA: Anti–neutrophil cytoplasmic antibody, DNA: Deoxyribonucleic acid, CFTR: Cystic fibrosis transmembrane conductance regulator, SLC10A2: Solute carrier family 10 member 2, SeHCAT: Selenium homocholic acid taurine or tauroselcholic acid, IEL: Intraepithelial lymphocytes, MRCP: Magnetic resonance cholangiopancreatography, ANA: Antinuclear antibodies, AMA: Anti-mitochondrial antibody, LDH: Lactate dehydrogenase, CPK: Creatine phosphokinase, PCR: Polymerase chain reaction, ELISA: Enzyme–linked immunosorbent assay, LT: Heat–labile enterotoxin, ST: Heat–stable enterotoxin, RT-PCR: Reverse–transcriptase polymerase chain reaction, CD4: Cluster of differentiation 4, HIV: Human immunodeficiency virus, RUQ: Right-upper quadrant, VIP: Vasoactive intestinal peptide, GI: Gastrointestinal, FAP: Familial adenomatous polyposis, HNPCC: Hereditary nonpolyposis colorectal cancer, MTP: Microsomal triglyceride transfer protein, Scl‑70: Anti–topoisomerase I, TSH: Thyroid-stimulating hormone, T4: Thyroxine, T3: Triiodothyronine, DTR: Deep tendon reflex, RNA: Ribonucleic acid

		Symptoms								GI signs
Cause		Clinical manifestation									Lab findings									Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Duration		Diarrhea			Fever	Abdominal pain	Weight loss
		Duration		Diarrhea							Stool exam					CBC			Other lab findings
		Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings
Crohn's disease		–	+	+	+	+	±	+	+	Abdominal tenderness Oral mucosal lesions	+	+	–	Nl	–	↑	↓	↑	Anti saccharomyces cerevisiae antibodies (ASCA) Vitamin B12 deficiency Elevated ESR Elevated CRP	Uveitis Arthritis Erythema nodosum Pyoderma gangrenosum Amyloidosis Venous and arterial thromboembolism Renal stones Bronchiectasis	Abnormal immune response to self antigens	Colonoscopy with biopsy
Ulcerative colitis		–	+	+	+	+	±	+	+	Abdominal tenderness Blood on rectal examination	+	+	–	Nl	–	↑	↓	↑	Anti–neutrophil cytoplasmic antibody (P–ANCA) Hypoalbuminemia Hypokalemia Hypomagnesemia Elevated ESR Elevated CRP	Skin rash Iritis Uveitis Seronegative arthritis Clubbing Erythema nodosum	Abnormal immune response to self antigens	Colonoscopy with biopsy
Celiac disease		–	+	±	–	±	–	+	+	Abdominal distention Increased bowel sounds Oral mucosal lesions Hepatosplenomegaly Ascites	–	–	–	Nl	Fat droplets on sudan stain	Nl	↓	Nl	IgA endomysial antibody Anti–tissue transglutaminase antibody Anti–gliadin antibody Fat soluble vitamins deficiency	Malabsorption Dementia Dermatitis herpetiformis	HLA–DQ2 HLA–DQ8 Innate responses to wheat proteins	IgA endomysial antibody Anti–tissue transglutaminase antibody
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cystic fibrosis		–	+	–	–	+	±	+	+	Abdominal distention Hepatosplenomegaly Rectal prolapse	–	–	–	Nl	Fat droplets on sudan stain	Nl	↓	Nl	Positive DNA analysis for cystic fibrosis transmembrane conductance regulator (CFTR) Nasal transepithelial potential difference Fat soluble vitamins deficiency	Malabsorption Recurrent respiratory tract infection Bronchiectasis Diabetes mellitus Scoliosis Infertility	Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein	Positive genetic testing Elevated sweat chloride ≥60 mmol/L
Chronic pancreatitis		–	+	+	–	+	–	+	+	Abdominal tenderness	–	–	–	Nl	Fat droplets on sudan stain Positive fecal elastase measurement	Nl	Nl	Nl	Slightly elevated amylase and lipase Abnormal pancreatic function test Secretin stimulation test	Malabsorption Diabetes mellitus Pancreatic pseudocyst	Toxins Recurrent acute pancreatitis Genetic predesposition Autoimmune	Magnetic resonance cholangiopancreatography (MRCP)
Bile acid malabsorption		–	+	+	–	+	–	–	+		–	–	–	Nl	Fat droplets on sudan stain	Nl	Nl	Nl	Reduced cholesterol level	Malabsorption Hypotension Tachycardia	Genetic defects in SLC10A2	SeHCAT test
Microscopic colitis		–	+	+	–	–	–	+	+	Abdominal tenderness Fecal incontinence	–	–	–	Nl	–	Nl	↓	Nl	Hypokalemia Elevated CRP Positive autoantibodies include: RF ANA AMA ANCA	Arthritis Uveitis Idiopathic thrombocytopenic purpura Pleuro pericarditis Hypothyroidism Psoriasis	Mucosal immune responses to luminal factors in a genetically predisposed individual Drug–induced	Colonoscopy with mucosal biopsy with mononuclear infiltrates: Collagenous colitis is characterized by a colonic subepithelial collagen band >10 micrometers in diameter Lymphocytic colitis is characterized by ≥20 intraepithelial lymphocytes (IEL) per 100 surface epithelial cells
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Infective colitis		–	+	+	+	–	+	+	+	Rebound abdominal tenderness	+	+	+	Nl	Positive stool culture Positive fecal calprotectin Positive fecal lactoferrin	↑	↓	↑	Elevated CRP Elevated ESR	Arthritis Uveitis	Salmonella Shigella Campylobacter E. coli 0157:H7 Clostridium difficile Entamoeba histolytica Adenovirus Cytomegalovirus Herpes simplex virus	Stool culture Blood culture
Ischemic colitis		+	+	+	+	–	+	+	+	Hyperactive then absent bowel sounds Abdominal tenderness	+	+	–	Nl	–	↑	↓	↑	Elevated CRP Elevated ESR Elevated serum lactate Elevated lactate dehydrogenase (LDH) Elevated creatine phosphokinase (CPK) Elevated amylase Hypoalbuminemia	IgA vasculitis	Hypercoagulability Nonocclusive colonic ischemia Embolic and thrombotic arterial occlusion Mesenteric vein thrombosis	Abdominal CT scan
Lactose intolerance		+	+	+	–	–	–	+	–	Abdominal tenderness Abdominal distention	–	–	–	↑	–	Nl	Nl	Nl	Lactose tolerance test Genetic testing	Headache Vertigo Memory impairment Lethargy	Reduction of lactase enzyme activity or inability to produce persistent lactase Congenital lactase deficiency Secondary lactose malabsorption	Small bowel biopsy Lactose breath hydrogen test
Irritable bowel syndrome		–	+	±	–	±	–	±	–	Abdominal tenderness Abdominal distention Normal bowel sounds	–	–	–	Nl	–	Nl	Nl	Nl	Nl	Anxiety Palpitation	Unknown	Diagnosis of exclusion
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Whipple's disease		–	+	+	–	+	±	+	+	Hepatosplenomegaly Ascites	–	–	–	Nl	Positive fecal fat	↓	↓	↓/↑	Hypoalbuminemia Fat soluble vitamins deficiency	Malabsorption Abnormal extraocular movement Lymphadenopathy Hyperpigmentation Uveitis Endocarditis Encephalitis Dementia Pleural effusion	Tropheryma whipplei	Small intestine biopsy for Tropheryma whipplei testing PCR testing
Tropical sprue		+	+	+	–	+	+	+	+	Angular stomatitis Oral mucosal lesion	+	–	–	Nl	Positive stool culture	Nl	↓	Nl	Fat soluble vitamins deficiency Vitamin B12 deficiency Folate deficiency Hypokalemia	Myalgia Neuropathy Edema	Escherichia coli Klebsiella pneumoniae Enterobacter cloacae	Diagnosis of exclusion
Small bowel bacterial overgrowth		–	+	+	–	+	–	+	+	Abdominal distention	+	–	–	Nl	Positive stool culture Positive fecal fat	Nl	↓	Nl	Hypoalbuminemia Abnormal hydrogen breath test Lactic acidosis	Malabsorption Rosacea	Excess bacteria in the small intestine Alterations in intestinal anatomy or GI motility	Diagnosis of exclusion
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Salmonellosis		+	+	+	+	–	+	+	–	Abdominal distention Diffuse abdominal tenderness Hepatosplenomegaly	+	+	–	Nl	Positive stool culture Positive serologic testing	↑	Nl	↑	Hypokalemia Hypernatremia Hyponatremia Hypercalciuria Hypocitraturia	Post–infectious arthritis Obtundation Bacteremia Pericarditis Pyelonephritis Brain abscess	Salmonella	Stool culture
Escherichia coli enteritis	EPEC	+	+	+	+	–	+	+	+	Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	–	–	Enteropathogenic E. coli	DNA probe or polymerase chain reaction (PCR) of the EPEC adherence factor Stool culture
Escherichia coli enteritis	EAEC	+	+	+	+	–	–	+	–	Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	↓	↓	–	Chronic infection in immunocompromised patients	Enteroaggregative E. coli	Stool culture
Aeromonas		+	+	+	+	–	+	+	–	Abdominal distention Hyperactive bowel sounds Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	–	Wound infection Bacteremia Hemolytic uremic syndrome Meningitis Ocular infection Pneumonia Urinary tract infection Osteomyelitis Peritonitis Acute cholecystitis Opportunistic infections in immunocompromised patients	Aeromonas virulence factors including endotoxins, hemolysins, enterotoxins, and adherence factors	Blood culture Wound culture
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Mycobacterium avium complex		+	+	+	+	–	+	+	–	Abdominal distention Hepatosplenomegaly	+	+	–	Nl	–	↓	↓	Nl	Elevated liver enzymes	Opportunistic infection in immunocompromised patients Pulmonary infection Adenopathy Night sweats	Mycobacterium avium complex	Blood culture
CMV colitis		+	+	–	+	–	±	+	–	Diffuse abdominal tenderness	+	+	–	Nl	Viral antigen assay	↓	Nl	Nl	Decreased CD4 level Abnormal liver function test	Encephalitis Guillain–Barré syndrome Pneumonia Retinitis Pericarditis and myocarditis Atherosclerosis Venous thrombosis	Cytomegalovirus	Quantitative PCR tests
HIV		–	+	+	–	–	+	+	+	Abdominal distention Diffuse abdominal tenderness	+	–	–	Nl	–	↓	↓	Nl	Decreased CD4 level Electrolyte imbalance	Lymphadenopathy Disseminated infection	HIV	HIV virologic (viral load) test Immunoassay
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Entamoeba histolytica		+	+	+	+	–	+	+	–	Abdominal distention Diffuse abdominal tenderness	+	+	+	Nl	–	↑	Nl	Nl	–	Liver abscess Pleuropulmonary infection Cardiac infection Brain abscess Cutaneous infection	Entamoeba histolytica	Antigen testing Serology
Giardia		–	+	+	–	+	–	+	+	Abdominal distention Diffuse abdominal tenderness	–	–	+	Nl	–	Nl	Nl	Nl	–	Malabsorption Urticaria Depression	Giardia lamblia	Antigen detection assays
Cryptosporidium		–	+	+	–	–	–	+	+	Abdominal distention Diffuse abdominal tenderness	–	–	+	Nl	Positive stool microscopy	Nl	Nl	Nl	Elevated alkaline phosphatase	Chronic, life–threatening illness in immunocompromised patients	Cryptosporidium	Polymerase chain reaction
Microsporidia		+	+	+	–	–	+	+	–	Abdominal distention Diffuse abdominal tenderness	–	–	+	Nl	Positive stool microscopy	Nl	Nl	Nl	Decreased CD4 count	Malabsorption Keratitis Seizure Myositis	Microsporidia	Antigen detection assays
Isospora		+	+	+	–	+	+	+	+	Abdominal distention Diffuse abdominal tenderness	+	+	+	Nl	Positive stool microscopy Positive fecal fat	↑	Nl	Nl	Elevated eosinophils Hypokalemia Increased creatinine	Chronic illness in immunocompromised patients	Isospora	Detecting oocysts in the feces
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Carcinoid tumor		–	+	+	+	–	–	+	+	Abdominal distention	–	+	–	↓	–	Nl	Nl	Nl	Elevated urinary 5–hydroxyindoleacetic acid (5–HIAA) level High chromogranin A	Facial flushing Jaundice Edema Valvular heart disease Right–sided heart failure	Well–differentiated neuroendocrine tumor	Blood chromogranin A level
VIPoma		+	+	+	–	+	–	+	+	Abdominal distention Abdominal RUQ tenderness Nausea Vomiting	–	–	–	↓	–	Nl	Nl	Nl	Elevated VIP level Hypokalemia Hypochlorhydria or achlorhydria Low osmotic gap (<50 mOsm/kg)	Rash Facial flushing Dehydration Lethargy Muscle weakness	Primary secretory tumor	Blood VIP levels Followed by imaging
Zollinger–Ellison syndrome		–	+	+	+	+	–	+	+	Epigastric tenderness	–	–	–	↓	–	Nl	↓	Nl	Positive secretin stimulation test Elevated serum chromogranin A	Jaundice	Gastrin producing tumor mainly in duodenum	Secretin stimulation test
Somatostatinoma		–	+	+	–	–	–	+	+	Epigastric tenderness	–	–	–	↓	–	Nl	Nl	Nl	Elevated fasting plasma somatostatin	Diabetes mellitus Cholelithiasis Jaundice	Neuroendocrine tumors of D–cell origin	Plasma somatostatin level Followed by imaging
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Lymphoma		–	+	+	+	–	+	+	+	Diffuse abdominal tenderness Hepatosplenomegaly	–	+	–	Nl	–	Nl	↓	Nl	Paraproteinemia	Malabsorption Lactose intolerance Ascites	Primary tumor of GI tract	Colonoscopy with biopsy
Colorectal cancer		–	+	+	+	+	–	+	+	Diffuse abdominal tenderness	–	+	–	Nl	–	Nl	↓	Nl	Positive carcinoembryonic antigen	Metastasis	FAP gene HNPCC gene	Colonoscopy and biopsy
Medications ACE inhibitors Digoxin Cephalosporins Statins Thiazide diuretics Triptans Lactulose Anti retroviral agents Chemotherapeutic agents Antifungals Magnesium		+	+	+	–	±	±	+	+	Abdominal distention Dehydration	–	–	–	↑/↓	–	↑	Nl	Nl	Elevated plasma level of drug	–	Inflammation Pseudomembranous colitis	Clinical evaluation after discontinuation of the drugs
Factitious diarrhea		+	+	+	–	–	–	+	+	Abdominal distention	–	–	–	↑/↓	–	Nl	Nl	Nl	Hypokalemia Metabolic alkalosis Hypermagnesemia	Malabsorption Lethargy Generalized weakness Acute renal failure	Medications	Clinical evaluation after discontinuation of the drugs
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Heavy metal ingestion		–	+	+	–	–	–	+	+	Abdominal distention	–	–	–	Nl	–	Nl	Nl	Nl	Elevated plasma heavy metal level	Headache Numbness Alopecia Vertigo	Heavy metal ingestion	Plasma level of heavy metal
Organophosphate poisoning		+	+	+	–	–	–	+	–	Salivation Vomiting	–	–	–	Nl	–	Nl	Nl	Nl	Reduced RBC acetylcholinesterase Plasma cholinesterase activity	Autonomic dysfunction Motor deficit Sensory deficit Bronchospasm Urination Miosis Bradycardia Lacrimation Sweating Cardiac arrhythmias Acute renal injury	Neurotoxins bind to acetylcholinesterase (AChE)	Clinical diagnosis
Opium withdrawal		+	+	+	–	–	–	+	–	Hyperactive bowel sounds	–	–	–	Nl	–	Nl	Nl	Nl	Azotemia Hypokalemia Metabolic alkalosis	Dysphoria Restlessness Sweating Rhinorrhea Lacrimation Myalgia Arthralgia	Opium withdrawal	Clinical diagnosis following opium withdrawal
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Short bowel syndrome		+	+	+	–	+	–	–	+	Abdominal distention Abdominal tenderness	–	–	–	Nl	Positive fecal fat	Nl	↓	↑	Hypoalbuminemia High level of acute phase reactant Abnormal liver function tests	Prior intestinal surgery Malabsorption Crohn's disease Malignancy Peripheral edema Muscle atrophy	Surgical bowel resection	Clinical diagnosis following bowel resection
Radiation enteritis		+	+	+	+	+	–	+	+	Abdominal tenderness	+	+	–	Nl	Positive fecal fat	Nl	↓	Nl	Vitamin B12 deficiency Hypoalbuminemia	Prior history of malignancy and radiation therapy Malabsorption Telangiectasias	Radiation	Segmental bowel inflammation on endoscopy or colonoscopy
Dumping syndrome		–	+	+	–	+	–	–	+	Hyperactive bowel sound	–	–	–	Nl	–	Nl	Nl	Nl	Hypoglycemia Hydrogen breath test	Malnutrition Fat soluble vitamin deficiency	Postgastrectomy	Clinical diagnosis following gastrectomy
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Abetalipoproteinemia		–	+	+	–	+	–	+	+	Abdominal distension	–	–	–	Nl	–	Nl	Nl	Nl	Low triglyceride Low total cholesterol levels Acanthocytes Low vitamin E levels	Ataxia Visual field defect Dysarthria	Autosomal recessive disorder caused by mutations encoding the microsomal triglyceride transfer protein (MTP)	Clinical findings and low triglyceride and cholesterol level
Hyperthyroidism		–	+	+	–	–	±	+	+	–	–	–	–	Nl	Positive fecal fat	Nl	Nl	Nl	Elevated T4 Elevated T3 Decreased TSH High serum alkaline phosphatase	Lump in the neck Lid lag Malabsorption Sweating Hyperpigmentation Proptosis Tremor Increased DTR	Graves' disease Hashimoto's thyroiditis Toxic adenoma	TSH
Diabetic neuropathy		–	+	+	–	+	–	+	+	Fecal incontinence	–	–	–	Nl	Positive fecal fat	Nl	↓	Nl	Hyperglycemia Azotemia Hypokalemia	Malabsorption	Unclear Disordered motility Increased intestinal secretion Small intestinal bacterial overgrowth	Clinical diagnosis in a patient with long lasting diabetes mellitus
Systemic sclerosis		–	+	+	±	+	–	+	+	Epigastric tenderness Fecal incontinence	–	+	–	Nl	Positive fecal fat	Nl	↓	Nl	Anti–topoisomerase I (Scl‑70) antibodies Antinuclear antibodies (ANA) Anti–centromere antibodies Anti–RNA polymerase III antibody	Malabsorption Skin changes Raynaud phenomenon Pulmonary hypertension Arthritis Telangiectasia Chronic renal failure	Autoimmune reaction	Clinical diagnosis Followed by serologic tests

References

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↑ Mena Bares LM, Carmona Asenjo E, García Sánchez MV, Moreno Ortega E, Maza Muret FR, Guiote Moreno MV, Santos Bueno AM, Iglesias Flores E, Benítez Cantero JM, Vallejo Casas JA (2017). "75SeHCAT scan in bile acid malabsorption in chronic diarrhoea". Rev Esp Med Nucl Imagen Mol. 36 (1): 37–47. doi:10.1016/j.remn.2016.08.005. PMID 27765536.
↑ Gibson RJ, Stringer AM (2009). "Chemotherapy-induced diarrhoea". Curr Opin Support Palliat Care. 3 (1): 31–5. doi:10.1097/SPC.0b013e32832531bb. PMID 19365159.
↑ Abraham BP, Sellin JH (2012). "Drug-induced, factitious, & idiopathic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 633–48. doi:10.1016/j.bpg.2012.11.007. PMID 23384808.
↑ Reintam Blaser A, Deane AM, Fruhwald S (2015). "Diarrhoea in the critically ill". Curr Opin Crit Care. 21 (2): 142–53. doi:10.1097/MCC.0000000000000188. PMID 25692805.
↑ McMahan ZH, DuPont HL (2007). "Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy". Aliment. Pharmacol. Ther. 25 (7): 759–69. doi:10.1111/j.1365-2036.2007.03261.x. PMID 17373914.
↑ Schiller LR (2012). "Definitions, pathophysiology, and evaluation of chronic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 551–62. doi:10.1016/j.bpg.2012.11.011. PMID 23384801.
↑ Giannella RA (1986). "Chronic diarrhea in travelers: diagnostic and therapeutic considerations". Rev. Infect. Dis. 8 Suppl 2: S223–6. PMID 3523719.
↑ Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.
↑ Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.
↑ Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.
↑ RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue". Gastroenterology. 38: 28–49. PMID 14439871.
↑ Konvolinka CW (1994). "Acute diverticulitis under age forty". Am J Surg. 167 (6): 562–5. PMID 8209928.
↑ Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006). "The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications". Gut. 55 (6): 749–53. doi:10.1136/gut.2005.082909. PMC 1856208. PMID 16698746.
↑ Haque R, Huston CD, Hughes M, Houpt E, Petri WA (2003). "Amebiasis". N Engl J Med. 348 (16): 1565–73. doi:10.1056/NEJMra022710. PMID 12700377.
↑ Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.
↑ Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.
↑ BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.

[Casburn-JonesFarthing2004-1] Casburn-Jones, Anna C; Farthing, Michael Jg (2004). "Traveler's diarrhea". Journal of Gastroenterology and Hepatology. 19 (6): 610–618. doi:10.1111/j.1440-1746.2003.03287.x. ISSN 0815-9319.

[KamatMathur2006-2] Kamat, Deepak; Mathur, Ambika (2006). "Prevention and Management of Travelers' Diarrhea". Disease-a-Month. 52 (7): 289–302. doi:10.1016/j.disamonth.2006.08.003. ISSN 0011-5029.

[PfeifferDuPont2012-3] Pfeiffer, Margaret L.; DuPont, Herbert L.; Ochoa, Theresa J. (2012). "The patient presenting with acute dysentery – A systematic review". Journal of Infection. 64 (4): 374–386. doi:10.1016/j.jinf.2012.01.006. ISSN 0163-4453.

[pmid24506120-4] Barr W, Smith A (2014). "Acute diarrhea". Am Fam Physician. 89 (3): 180–9. PMID 24506120.

[pmid29255768-5] Amil Dias J (2017). "Celiac Disease: What Do We Know in 2017?". GE Port J Gastroenterol. 24 (6): 275–278. doi:10.1159/000479881. PMID 29255768.

[pmid29254859-6] Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi A (2017). "Shigellosis". Lancet. doi:10.1016/S0140-6736(17)33296-8. PMID 29254859. Vancouver style error: initials (help)

[Yamamoto-FurushoBosques-Padilla2017-7] Yamamoto-Furusho, J.K.; Bosques-Padilla, F.; de-Paula, J.; Galiano, M.T.; Ibañez, P.; Juliao, F.; Kotze, P.G.; Rocha, J.L.; Steinwurz, F.; Veitia, G.; Zaltman, C. (2017). "Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation". Revista de Gastroenterología de México. 82 (1): 46–84. doi:10.1016/j.rgmx.2016.07.003. ISSN 0375-0906.

[BorbélyOsterwalder2017-8] Borbély, Yves M; Osterwalder, Alice; Kröll, Dino; Nett, Philipp C; Inglin, Roman A (2017). "Diarrhea after bariatric procedures: Diagnosis and therapy". World Journal of Gastroenterology. 23 (26): 4689. doi:10.3748/wjg.v23.i26.4689. ISSN 1007-9327.

[CrawfordRamani2017-9] Crawford, Sue E.; Ramani, Sasirekha; Tate, Jacqueline E.; Parashar, Umesh D.; Svensson, Lennart; Hagbom, Marie; Franco, Manuel A.; Greenberg, Harry B.; O'Ryan, Miguel; Kang, Gagandeep; Desselberger, Ulrich; Estes, Mary K. (2017). "Rotavirus infection". Nature Reviews Disease Primers. 3: 17083. doi:10.1038/nrdp.2017.83. ISSN 2056-676X.

[pmid11068510-10] Kist M (2000). "[Chronic diarrhea: value of microbiology in diagnosis]". Praxis (Bern 1994) (in German). 89 (39): 1559–65. PMID 11068510.

[pmid4014291-11] Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH (1985). "Evaluation and diagnosis of acute infectious diarrhea". Am. J. Med. 78 (6B): 91–8. PMID 4014291.

[pmid10575169-12] López-Vélez R, Turrientes MC, Garrón C, Montilla P, Navajas R, Fenoy S, del Aguila C (1999). "Microsporidiosis in travelers with diarrhea from the tropics". J Travel Med. 6 (4): 223–7. PMID 10575169.

[WahnschaffeIgnatius2009-13] Wahnschaffe, Ulrich; Ignatius, Ralf; Loddenkemper, Christoph; Liesenfeld, Oliver; Muehlen, Marion; Jelinek, Thomas; Burchard, Gerd Dieter; Weinke, Thomas; Harms, Gundel; Stein, Harald; Zeitz, Martin; Ullrich, Reiner; Schneider, Thomas (2009). "Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas". Scandinavian Journal of Gastroenterology. 42 (3): 391–396. doi:10.1080/00365520600881193. ISSN 0036-5521.

[pmid27765536-14] Mena Bares LM, Carmona Asenjo E, García Sánchez MV, Moreno Ortega E, Maza Muret FR, Guiote Moreno MV, Santos Bueno AM, Iglesias Flores E, Benítez Cantero JM, Vallejo Casas JA (2017). "75SeHCAT scan in bile acid malabsorption in chronic diarrhoea". Rev Esp Med Nucl Imagen Mol. 36 (1): 37–47. doi:10.1016/j.remn.2016.08.005. PMID 27765536.

[pmid19365159-15] Gibson RJ, Stringer AM (2009). "Chemotherapy-induced diarrhoea". Curr Opin Support Palliat Care. 3 (1): 31–5. doi:10.1097/SPC.0b013e32832531bb. PMID 19365159.

[pmid23384808-16] Abraham BP, Sellin JH (2012). "Drug-induced, factitious, & idiopathic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 633–48. doi:10.1016/j.bpg.2012.11.007. PMID 23384808.

[pmid25692805-17] Reintam Blaser A, Deane AM, Fruhwald S (2015). "Diarrhoea in the critically ill". Curr Opin Crit Care. 21 (2): 142–53. doi:10.1097/MCC.0000000000000188. PMID 25692805.

[pmid17373914-18] McMahan ZH, DuPont HL (2007). "Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy". Aliment. Pharmacol. Ther. 25 (7): 759–69. doi:10.1111/j.1365-2036.2007.03261.x. PMID 17373914.

[pmid23384801-19] Schiller LR (2012). "Definitions, pathophysiology, and evaluation of chronic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 551–62. doi:10.1016/j.bpg.2012.11.011. PMID 23384801.

[pmid3523719-20] Giannella RA (1986). "Chronic diarrhea in travelers: diagnostic and therapeutic considerations". Rev. Infect. Dis. 8 Suppl 2: S223–6. PMID 3523719.

[pmid16151544-21] Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.

[pmid12135027-22] Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.

[pmid1702075-23] Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.

[pmid14439871-24] RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue". Gastroenterology. 38: 28–49. PMID 14439871.

[pmid8209928-25] Konvolinka CW (1994). "Acute diverticulitis under age forty". Am J Surg. 167 (6): 562–5. PMID 8209928.

[pmid16698746-26] Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006). "The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications". Gut. 55 (6): 749–53. doi:10.1136/gut.2005.082909. PMC 1856208. PMID 16698746.

[pmid12700377-27] Haque R, Huston CD, Hughes M, Houpt E, Petri WA (2003). "Amebiasis". N Engl J Med. 348 (16): 1565–73. doi:10.1056/NEJMra022710. PMID 12700377.

[pmid8694025-28] Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.

[pmid9414969-29] Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.

[pmid15391722-30] BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Chronic diarrhea}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Chronic_diarrhea]]
-{{CMG}}; {{AE}} {{DAMI}}
+'''''To review the differential diagnosis of diarrhea, click [[Diarrhea#Differential Diagnosis of Diarrhea of other diseases|here]].'''''
+{{CMG}}; {{AE}} {{SSH}}, {{SMP}}
 ==Overview==
-The differential diagnosis for chronic diarrhea is enormous, with a large number of diagnostic tests available that can be used to evaluate these patients. Classifying the patient with chronic diarrhea into a subcategory helps to direct the diagnostic work-up.
+The [[differential diagnosis]] for [[chronic diarrhea]] is enormous, with a large number of diagnostic tests available that can be used to evaluate these patients. Classifying a patient's [[chronic diarrhea]] into a subcategory such as [[Watery diarrhea|watery]], fatty and [[inflammatory]] helps to direct the [[diagnostic]] work-up. Some [[Watery diarrhea|watery]] causes of chronic diarrhea which should be differentiated from one another include [[crohn's disease]], [[hyperthyroidism]], [[VIPoma]], [[lactose intolerance]], [[celiac disease]] and [[irritable bowel syndrome]] (IBS). The causes of fatty diarrhea that should be differentiated from one another include [[celiac sprue]], [[pancreatic insufficiency]], [[bacterial overgrowth]] and [[maldigestion]] problems which results from [[Pancreatic insufficiency|pancreatic exocrine insufficiency]]. Finally, the [[inflammatory]] causes of chronic diarrhea such as [[ulcerative colitis]] and [[entamoeba histolytica]] must also be differentiated.
-==Differential diagnosis==
+==Differential Diagnosis of Chronic Diarrhea from other diseases==
-The tree diagram below gives a clear understanding as to how to asses a patient presenting with diarrhea lasting more than 4 weeks.
+'''The following table outlines the major differential diagnoses of chronic diarrhea.'''<ref name="Casburn-JonesFarthing2004">{{cite journal|last1=Casburn-Jones|first1=Anna C|last2=Farthing|first2=Michael Jg|title=Traveler's diarrhea|journal=Journal of Gastroenterology and Hepatology|volume=19|issue=6|year=2004|pages=610–618|issn=0815-9319|doi=10.1111/j.1440-1746.2003.03287.x}}</ref><ref name="KamatMathur2006">{{cite journal|last1=Kamat|first1=Deepak|last2=Mathur|first2=Ambika|title=Prevention and Management of Travelers’ Diarrhea|journal=Disease-a-Month|volume=52|issue=7|year=2006|pages=289–302|issn=00115029|doi=10.1016/j.disamonth.2006.08.003}}</ref><ref name="PfeifferDuPont2012">{{cite journal|last1=Pfeiffer|first1=Margaret L.|last2=DuPont|first2=Herbert L.|last3=Ochoa|first3=Theresa J.|title=The patient presenting with acute dysentery – A systematic review|journal=Journal of Infection|volume=64|issue=4|year=2012|pages=374–386|issn=01634453|doi=10.1016/j.jinf.2012.01.006}}</ref><ref name="pmid24506120">{{cite journal |vauthors=Barr W, Smith A |title=Acute diarrhea |journal=Am Fam Physician |volume=89 |issue=3 |pages=180–9 |year=2014 |pmid=24506120 |doi= |url=}}</ref><ref name="pmid29255768">{{cite journal |vauthors=Amil Dias J |title=Celiac Disease: What Do We Know in 2017? |journal=GE Port J Gastroenterol |volume=24 |issue=6 |pages=275–278 |year=2017 |pmid=29255768 |doi=10.1159/000479881 |url=}}</ref><ref name="pmid29254859">{{cite journal |vauthors=Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi AKM |title=Shigellosis |journal=Lancet |volume= |issue= |pages= |year=2017 |pmid=29254859 |doi=10.1016/S0140-6736(17)33296-8 |url=}}</ref><ref name="Yamamoto-FurushoBosques-Padilla2017">{{cite journal|last1=Yamamoto-Furusho|first1=J.K.|last2=Bosques-Padilla|first2=F.|last3=de-Paula|first3=J.|last4=Galiano|first4=M.T.|last5=Ibañez|first5=P.|last6=Juliao|first6=F.|last7=Kotze|first7=P.G.|last8=Rocha|first8=J.L.|last9=Steinwurz|first9=F.|last10=Veitia|first10=G.|last11=Zaltman|first11=C.|title=Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation|journal=Revista de Gastroenterología de México|volume=82|issue=1|year=2017|pages=46–84|issn=03750906|doi=10.1016/j.rgmx.2016.07.003}}</ref><ref name="BorbélyOsterwalder2017">{{cite journal|last1=Borbély|first1=Yves M|last2=Osterwalder|first2=Alice|last3=Kröll|first3=Dino|last4=Nett|first4=Philipp C|last5=Inglin|first5=Roman A|title=Diarrhea after bariatric procedures: Diagnosis and therapy|journal=World Journal of Gastroenterology|volume=23|issue=26|year=2017|pages=4689|issn=1007-9327|doi=10.3748/wjg.v23.i26.4689}}</ref><ref name="CrawfordRamani2017">{{cite journal|last1=Crawford|first1=Sue E.|last2=Ramani|first2=Sasirekha|last3=Tate|first3=Jacqueline E.|last4=Parashar|first4=Umesh D.|last5=Svensson|first5=Lennart|last6=Hagbom|first6=Marie|last7=Franco|first7=Manuel A.|last8=Greenberg|first8=Harry B.|last9=O'Ryan|first9=Miguel|last10=Kang|first10=Gagandeep|last11=Desselberger|first11=Ulrich|last12=Estes|first12=Mary K.|title=Rotavirus infection|journal=Nature Reviews Disease Primers|volume=3|year=2017|pages=17083|issn=2056-676X|doi=10.1038/nrdp.2017.83}}</ref><ref name="pmid11068510">{{cite journal |vauthors=Kist M |title=[Chronic diarrhea: value of microbiology in diagnosis] |language=German |journal=Praxis (Bern 1994) |volume=89 |issue=39 |pages=1559–65 |year=2000 |pmid=11068510 |doi= |url=}}</ref><ref name="pmid4014291">{{cite journal |vauthors=Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH |title=Evaluation and diagnosis of acute infectious diarrhea |journal=Am. J. Med. |volume=78 |issue=6B |pages=91–8 |year=1985 |pmid=4014291 |doi= |url=}}</ref><ref name="pmid10575169">{{cite journal |vauthors=López-Vélez R, Turrientes MC, Garrón C, Montilla P, Navajas R, Fenoy S, del Aguila C |title=Microsporidiosis in travelers with diarrhea from the tropics |journal=J Travel Med |volume=6 |issue=4 |pages=223–7 |year=1999 |pmid=10575169 |doi= |url=}}</ref><ref name="WahnschaffeIgnatius2009">{{cite journal|last1=Wahnschaffe|first1=Ulrich|last2=Ignatius|first2=Ralf|last3=Loddenkemper|first3=Christoph|last4=Liesenfeld|first4=Oliver|last5=Muehlen|first5=Marion|last6=Jelinek|first6=Thomas|last7=Burchard|first7=Gerd Dieter|last8=Weinke|first8=Thomas|last9=Harms|first9=Gundel|last10=Stein|first10=Harald|last11=Zeitz|first11=Martin|last12=Ullrich|first12=Reiner|last13=Schneider|first13=Thomas|title=Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas|journal=Scandinavian Journal of Gastroenterology|volume=42|issue=3|year=2009|pages=391–396|issn=0036-5521|doi=10.1080/00365520600881193}}</ref><ref name="pmid27765536">{{cite journal |vauthors=Mena Bares LM, Carmona Asenjo E, García Sánchez MV, Moreno Ortega E, Maza Muret FR, Guiote Moreno MV, Santos Bueno AM, Iglesias Flores E, Benítez Cantero JM, Vallejo Casas JA |title=75SeHCAT scan in bile acid malabsorption in chronic diarrhoea |journal=Rev Esp Med Nucl Imagen Mol |volume=36 |issue=1 |pages=37–47 |year=2017 |pmid=27765536 |doi=10.1016/j.remn.2016.08.005 |url=}}</ref><ref name="pmid19365159">{{cite journal |vauthors=Gibson RJ, Stringer AM |title=Chemotherapy-induced diarrhoea |journal=Curr Opin Support Palliat Care |volume=3 |issue=1 |pages=31–5 |year=2009 |pmid=19365159 |doi=10.1097/SPC.0b013e32832531bb |url=}}</ref><ref name="pmid23384808">{{cite journal |vauthors=Abraham BP, Sellin JH |title=Drug-induced, factitious, & idiopathic diarrhoea |journal=Best Pract Res Clin Gastroenterol |volume=26 |issue=5 |pages=633–48 |year=2012 |pmid=23384808 |doi=10.1016/j.bpg.2012.11.007 |url=}}</ref><ref name="pmid25692805">{{cite journal |vauthors=Reintam Blaser A, Deane AM, Fruhwald S |title=Diarrhoea in the critically ill |journal=Curr Opin Crit Care |volume=21 |issue=2 |pages=142–53 |year=2015 |pmid=25692805 |doi=10.1097/MCC.0000000000000188 |url=}}</ref><ref name="pmid17373914">{{cite journal |vauthors=McMahan ZH, DuPont HL |title=Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy |journal=Aliment. Pharmacol. Ther. |volume=25 |issue=7 |pages=759–69 |year=2007 |pmid=17373914 |doi=10.1111/j.1365-2036.2007.03261.x |url=}}</ref><ref name="pmid23384801">{{cite journal |vauthors=Schiller LR |title=Definitions, pathophysiology, and evaluation of chronic diarrhoea |journal=Best Pract Res Clin Gastroenterol |volume=26 |issue=5 |pages=551–62 |year=2012 |pmid=23384801 |doi=10.1016/j.bpg.2012.11.011 |url=}}</ref><ref name="pmid3523719">{{cite journal |vauthors=Giannella RA |title=Chronic diarrhea in travelers: diagnostic and therapeutic considerations |journal=Rev. Infect. Dis. |volume=8 Suppl 2 |issue= |pages=S223–6 |year=1986 |pmid=3523719 |doi= |url=}}</ref><ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue=  | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544  }}</ref><ref name="pmid12135027">{{cite journal| author=Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D| title=Bowel habits and bile acid malabsorption in the months after cholecystectomy. | journal=Am J Gastroenterol | year= 2002 | volume= 97 | issue= 7 | pages= 1732-5 | pmid=12135027 | doi=10.1111/j.1572-0241.2002.05779.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12135027  }}</ref><ref name="pmid1702075">{{cite journal| author=Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R et al.| title=Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia. | journal=Gastroenterology | year= 1991 | volume= 100 | issue= 2 | pages= 359-69 | pmid=1702075 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1702075  }}</ref><ref name="pmid14439871">{{cite journal| author=RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC| title=Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue. | journal=Gastroenterology | year= 1960 | volume= 38 | issue=  | pages= 28-49 | pmid=14439871 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14439871  }}</ref><ref name="pmid8209928">{{cite journal| author=Konvolinka CW| title=Acute diverticulitis under age forty. | journal=Am J Surg | year= 1994 | volume= 167 | issue= 6 | pages= 562-5 | pmid=8209928 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8209928  }} </ref><ref name="pmid16698746">{{cite journal| author=Satsangi J, Silverberg MS, Vermeire S, Colombel JF| title=The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. | journal=Gut | year= 2006 | volume= 55 | issue= 6 | pages= 749-53 | pmid=16698746 | doi=10.1136/gut.2005.082909 | pmc=1856208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16698746  }} </ref><ref name="pmid12700377">{{cite journal| author=Haque R, Huston CD, Hughes M, Houpt E, Petri WA| title=Amebiasis. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 16 | pages= 1565-73 | pmid=12700377 | doi=10.1056/NEJMra022710 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700377  }} </ref><ref name="pmid8694025">{{cite journal| author=Hertzler SR, Savaiano DA| title=Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. | journal=Am J Clin Nutr | year= 1996 | volume= 64 | issue= 2 | pages= 232-6 | pmid=8694025 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8694025  }} </ref><ref name="pmid9414969">{{cite journal| author=Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC| title=Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect? | journal=Gut | year= 1997 | volume= 41 | issue= 5 | pages= 632-5 | pmid=9414969 | doi= | pmc=1891556 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9414969  }} </ref><ref name="pmid15391722">{{cite journal| author=BLACK-SCHAFFER B| title=The tinctoral demonstration of a glycoprotein in Whipple's disease. | journal=Proc Soc Exp Biol Med | year= 1949 | volume= 72 | issue= 1 | pages= 225-7 | pmid=15391722 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15391722  }} </ref>
+<span style="font-size:85%">'''Abbreviations:''' '''GI:''' [[Gastrointestinal tract|Gastrointestinal]], '''CBC''': [[Complete blood count]], '''WBC:''' [[White blood cells|White blood cell]], '''RBC''': [[Red blood cell]], '''Plt:''' [[Platelet]], '''Hgb:''' [[Hemoglobin]], '''ESR''': [[Erythrocyte sedimentation rate]], '''CRP''': [[C-reactive protein|C–reactive protein]], '''IgE:''' [[Immunoglobulin E]], '''IgA:''' [[Immunoglobulin A]], '''ETEC:''' [[Escherichia coli enteritis]], '''EPEC''': [[Escherichia coli|Enteropathogenic Escherichia coli]], '''EIEC''': [[Escherichia coli enteritis|Enteroinvasive Escherichia coli]], '''EHEC''': [[Escherichia coli|Enterohemorrhagic Escherichia coli]], '''EAEC''': [[Escherichia coli enteritis|Enteroaggregative Escherichia coli]], '''Nl''': Normal, '''ASCA''': [[Anti saccharomyces cerevisiae antibodies]], '''ANCA''': [[Anti-neutrophil cytoplasmic antibody|Anti–neutrophil cytoplasmic antibody]], '''DNA''': [[DNA|Deoxyribonucleic acid]], '''CFTR''': [[Cystic fibrosis transmembrane conductance regulator]], '''SLC10A2''': [[SLC10A2|Solute carrier family 10 member 2]], '''SeHCAT''': [[SeHCAT|Selenium homocholic acid taurine or tauroselcholic acid]], '''IEL''': Intraepithelial [[Lymphocyte|lymphocytes]], '''MRCP''': [[Magnetic resonance cholangiopancreatography]], '''ANA''': [[Antinuclear antibodies]], '''AMA''': [[Anti-mitochondrial antibody]], '''LDH''': [[Lactate dehydrogenase]], '''CPK''': [[Creatine phosphokinase]], '''PCR''': [[Polymerase chain reaction]], '''ELISA''': [[Enzyme linked immunosorbent assay (ELISA)|Enzyme–linked immunosorbent assay]], '''LT''': Heat–labile [[enterotoxin]], ST: Heat–stable [[enterotoxin]], '''RT-PCR''': Reverse–transcriptase [[polymerase chain reaction]], '''CD4:''' [[CD4|Cluster of differentiation 4]], '''HIV''': [[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]], '''RUQ''': [[RUQ|Right-upper quadrant]], '''VIP''': [[Vasoactive intestinal peptide]], '''GI:''' [[Gastrointestinal tract|Gastrointestinal]], '''FAP''': [[Familial adenomatous polyposis]], '''HNPCC''': [[Hereditary nonpolyposis colorectal cancer]], '''MTP''': [[Microsomal triglyceride transfer protein]], '''Scl‑70''': Anti–[[Type I topoisomerase|topoisomerase I]], '''TSH''': [[Thyroid-stimulating hormone]], '''T4''': [[Thyroxine]], '''T3''': [[Triiodothyronine]], '''DTR''': [[Deep tendon reflex]], '''RNA''': [[RNA|Ribonucleic acid]]</span>
-{{familytree/start}}
+{| class="wikitable" style="border: 0px; font-size: 100%; margin: 3px;" align="center"
-{{familytree | | | A01 | | | A01= Adults with chronic diarrhea (> 4 weeks)}}
+! colspan="2" rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
-{{familytree | | | |!| | | | }}
+| colspan="9" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestation'''
-{{familytree | | | B01 | | | B01=<div style="float: left; text-align: left; height: 36em; width: 30em; padding:1em;"> '''Characterize the symptoms:'''<br>
+! colspan="9" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Lab findings'''
-❑ Onset (congenital, abrupt or gradual) <br> ❑ Pattern (continuous or intermittent) <br> ❑ Duration <br> ❑ Stool characteristics (watery, bloody or fatty) <br> ❑ [[Fever]] <br> ❑ [[Abdominal pain]] <br> ❑ [[Weight loss]] <br> ❑ Fecal incontinence
+! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
-----
+! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
-'''Obtain a detailed history:'''<br>
+! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
-❑ Aggravating factors ([[diet]] or [[stress]]) <br> ❑ Over-the-counter drugs or use of prescription <br> ❑ Previous evaluations (objective records, radiograms or [[biopsy]] specimens) <br> ❑ Radiation therapy or surgery <br> ❑ Factitious diarrhea (eating disorders, laxative ingestion, [[secondary gain]] or [[malingering]]) <br> ❑ Systemic disease ([[cancer]], [[diabetes]], [[HIV]], [[hyperthyroidism]]) <br>
+|-
-----
+! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" |Symptoms
-'''Elicit the epidemiological factors:'''<br>
+! rowspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
-❑ Travel before the onset of illness <br>
+|-
-❑ Exposure to contaminated food or water <br>
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
-❑ Illness in other family members </div>}}
+! colspan="3" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
-{{familytree | | | |!| | | }}
+! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
-{{familytree | | | C01 | | | C01=<div style="float: left; text-align: left; height: 29em; width: 30em; padding:1em;"> '''Examine the patient:'''<br>
+! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
-'''Assess the volume status:''' <br>
+! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
-❑ General condition <br>
+|-
-❑ Thirst <br>
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
-❑ [[Pulse]] <br>
+| colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |'''CBC'''
-❑ [[Blood pressure]] <br>
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
-❑ Eyes <br>
-❑ Mucosa
-----
-'''Perform a general physical exam:'''<br>
-❑ Skin ([[flushing]], [[rash]]es or dermatographism) <br> ❑ Oral cavity (ulcers) <br> ❑ Cardiovascular system (murmur)<br> ❑ Respiratory system (wheezing) <br> ❑ [[Thyroid]] (mass) <br> ❑ [[Abdomen]] ([[ascites]], [[hepatomegaly]], mass or tenderness) <br> ❑ Anorectal ([[Abscess]], blood, [[fistula]] or sphincter competence) <br> ❑ Extremities ([[edema]]) </div>}}
-{{familytree | | | |!| | | | }}
-{{familytree | | | D01 | | | | D01=<div style="float: left; text-align: left; height: 12em; width: 30em; padding:1em;"> '''Order routine laboratory tests:'''
-❑ [[CBC|CBC and differential]] <br> ❑ [[ESR]] <br> ❑ [[Serum electrolytes]]<br> ❑ Total serum [[protein]] and [[albumin]] <br> ❑ [[Thyroid function tests]] <br> ❑ [[Urinalysis]] <br>
-</div>}}
-{{familytree | | | |!| | | | }}
-{{familytree | | | D10 | | | | D10= <div style="float: left; text-align: left"> '''Start altered diet:'''<br> ❑ Stop lactose products <br> ❑  Avoid alcohol and high osmolar supplements <br> ❑ Drink 8-10 large glasses of clear fluids (fruit juices, soft drinks etc) <br> ❑ Eat frequent small meals (rice, potato, banana, pastas etc) <br>
-----
-❑ '''Start [[oral rehydration therapy]] or [[intravenous fluids]] depending on the hydration status'''</div>}}
-{{familytree | | | |!| | | | | }}
-{{familytree | | | D02 | | | | | D02 = '''Any specific obvious diagnosis through history and examination?'''}}
-{{familytree | |,|-|^|-|.| | }}
-{{familytree | D03 | | D04 | | D03= <div style="float: left; text-align: left; width: 30em; padding:1em;">Yes </div>| D04=<div style="float: left; text-align: left; width: 30em; padding:1em;">No </div>}}
-{{familytree | |!| | | |!| | }}
-{{familytree | D05 | | |!| | D05= <div style="float: left; text-align: left; height: 22em; width: 30em; padding:1em;"> '''Chronic infection (outbreaks or endemic areas)'''<br> ❑ Trial of oral [[metronidazole]] 500 mg TID for 5 days for protozoal diarrhea<br> ❑ Oral [[ciprofloxacin]] 500 mg BD X 3 days for enteric bacterial diarrhea
------
-'''Medication induced:''' <br>
-❑ Discontinuation of the drug
------
-'''Irritable bowel syndrome''' (chronic abdominal pain and altered bowel habits in the absence of any organic disorder)<br>
-❑ Trial of antispasmodic agents (oral [[dicyclomine]] 20 mg QID),OR <br>
-❑ [[Tricyclic antidepressant|TCA's]]([[amitriptyline]] 10-25 mg OD), OR <br>
-❑ [[SSRI]] ([[fluoxetine]] 20-40 mg OD), OR <br>
-❑ [[Rifaximin]]</div>}}
-{{familytree | |!| | | |!| | }}
-{{familytree | E01 | | |!| | E01= No resolution of the diarrhea}}
-{{familytree | |`|-|v|-|'| | }}
-{{familytree | | | F01 | | | F01=<div style="float: left; text-align: left; line-height: 150% "> '''Order stool analysis:'''<br>
-❑ [[Diarrhea laboratory findings#Fecal Weight|Stool weight]] <br> ❑ [[Diarrhea laboratory findings#Stool Osmotic Gap|Stool electrolytes and fecal osmotic gap]] <br> ❑ [[Diarrhea laboratory findings#Fecal pH|Stool pH]] <br> ❑ [[Diarrhea laboratory findings#Occult Blood|Fecal occult blood testing]] <br> ❑ [[Diarrhea laboratory findings#White Blood Cells|Stool WBC's]] <br> ❑ Stool fat: [[Diarrhea laboratory findings#Fecal Fat Concentration and Output|Quantitative]] / [[Diarrhea laboratory findings#Sudan Stain for Fat|Sudan stain]] <br> ❑ [[Diarrhea laboratory findings#Analysis for Laxatives|Laxative screen]] </div>}}
-{{familytree/end}}
-This management is as per the American Gastroenterological Association guidelines for the evaluation and management of chronic diarrhea.<ref name="pmid10348831">{{cite journal| author=| title=American Gastroenterological Association medical position statement: guidelines for the evaluation and management of chronic diarrhea. | journal=Gastroenterology | year= 1999 | volume= 116 | issue= 6 | pages= 1461-3 | pmid=10348831 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10348831  }} </ref>
-<br>
-===Additional Management===
-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 diarrhea|watery]], [[Steatorrhea|fatty]], [[inflammatory]]. Watery chronic diarrhea can then further be sub-divided into [[osmotic]] or [[Secretory component|secretory]] [[diarrhea]]. Below is a list of differential diagnosis of chronic diarrhea by [[Stool examination|stool]] characteristics.<ref name="pmid10348832">{{cite journal| author=Fine KD, Schiller LR| title=AGA technical review on the evaluation and management of chronic diarrhea. | journal=Gastroenterology | year= 1999 | volume= 116 | issue= 6 | pages= 1464-86 | pmid=10348832 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10348832  }} </ref><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>
-*The [[stool]] [[osmotic]] gap is a calculation performed to distinguish among different causes of diarrhea.
-*290 − 2 * (stool Na + stool K)<ref name="pmid8159195">{{cite journal| author=Topazian M, Binder HJ| title=Brief report: factitious diarrhea detected by measurement of stool osmolality. | journal=N Engl J Med | year= 1994 | volume= 330 | issue= 20 | pages= 1418-9 | pmid=8159195 | doi=10.1056/NEJM199405193302004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8159195  }} </ref>
-*A low stool osmolic gap can imply secretory diarrhea, while a high gap can imply osmotic diarrhea.<ref name="pmid3994188">{{cite journal| author=Shiau YF, Feldman GM, Resnick MA, Coff PM| title=Stool electrolyte and osmolality measurements in the evaluation of diarrheal disorders. | journal=Ann Intern Med | year= 1985 | volume= 102 | issue= 6 | pages= 773-5 | pmid=3994188 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3994188  }} </ref>{{familytree/start}}
-{{familytree | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | |A01=❑ '''Classify diarrhea by the results of the stool analysis:'''}}
-{{familytree | | | |,|-|-|-|-|-|v|-|-|-|v|-|-|-|.| | | | | | | | | | }}
-{{familytree | | | E01 | | | | E02 | | E03 | | E04 | | | | | | | | | | | E01 = Stool osmotic gap >50 mOsm/kg | E02 = Stool osmotic gap <50 mOsm/kg | E03 = Fecal occult blood (+), WBC (+), [[lactoferrin]] (+), calprotectin(+) | E04 = Fecal fat (+)}}
-{{familytree | | | |!| | | | | |!| | | |!| | | |!| | | | | | | |}}
-{{familytree | | | E01 | | | | E02 | | E03 | | E04 | | | | | | | | | | |E01= '''Osmotic diarrhea''' | E02= '''Secretory diarrhea'''|E03= '''Inflammatory diarrhea''' |E04= '''Fatty diarrhea''' }}
-{{familytree | | | |!| | | | | |!| | | |!| | | |!| | | | | | | |}}
-{{familytree | | | E05 | | | | |!| | | |!| | | |!| | | | | | | |E05= ❑ Check the pH of the stool}}
-{{familytree | |,|-|^|-|.| | | |!| | | |!| | | |!| | | | | | | | | | | | }}
-{{familytree | F01 | | F02 | | F03 | | F04 | | F05 | | | | | | | | | | | |F01= '''Low pH'''<br> <div style="float: left; text-align: left">❑ Evaluate for [[malabsorption|carbohydrate malabsorption]]</div> | F02= '''High pH''' <br> <div style="float: left; text-align: left">❑ Evaluate for ingestion of magnesium or antacids <br> ❑ Evaluate for laxative abuse </div>|F03= <div style="float: left; text-align: left">'''1. Exclude infection by any/combination of the following tests:'''
-----
-❑ [[Diarrhea laboratory findings#Fecal Cultures|Stool culture]] <br> ❑ Microscopic evaluation for ova and [[parasite]]s <br> ❑ Stool antigen test for [[Giardia]] <br> ❑ [[Diarrhea laboratory findings#Upper Tract Endoscopy|Small bowel aspirate]] or [[Diarrhea laboratory findings#Tests for Bacterial Overgrowth|breath H2 test]] to rule out bacterial overgrowth </div>
-|F04=<div style="float: left; text-align: left"> '''1. Exclude structural disease by any/combination of the following tests:'''
-----
-❑ [[Diarrhea laboratory findings#Radiography|Small bowel radiographs]] <br> ❑ [[Diarrhea laboratory findings#Sigmoidoscopy and Colonoscopy|Sigmoidoscopy or colonoscopy with biopsy]] <br> ❑ [[Diarrhea laboratory findings#Radiography|CT abdomen]] <br> ❑ [[Diarrhea laboratory findings#Upper Tract Endoscopy|UGI scopy and small bowel biopsy]] <br>
-</div>  |F05=<div style="float: left; text-align: left; line-height: 150% "> '''1. Exclude structural disease by any/combination of the following tests'''
-----
-❑ [[Diarrhea laboratory findings#Radiography|Small bowel radiographs]] <br> ❑ [[Diarrhea laboratory findings#Radiography|CT abdomen]] <br> ❑ [[Diarrhea laboratory findings#Upper Tract Endoscopy|Small bowel biopsy and aspirate for quantitative culture]] <br>
-</div>   }}
-{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | | | | | | | | | | }}
-{{familytree | G01 | | G06 | | G02 | | G03 | | G04 | | | | | | | | | | |G01= ❑ Take a careful dietary history <br> ❑ Order [[lactose intolerance laboratory findings|breath H2 test (lactose), OR ❑ Order lactase measurement in a mucosal biopsy]] | G06 = ❑ Order stool alkanization test <br> ❑ Order chromatographic and chemical tests | G02=<div style="float: left; text-align: left; line-height: 150% "> '''2. Exclude structural disease by any/combination of the following tests:'''
-----
-❑ [[Diarrhea laboratory findings#Radiography|Small bowel radiographs]] <br> ❑ [[Diarrhea laboratory findings#Sigmoidoscopy and Colonoscopy|Sigmoidoscopy or colonoscopy with biopsy]] <br> ❑ [[Diarrhea laboratory findings#Radiography|CT abdomen]] <br> ❑ [[Diarrhea laboratory findings#Upper Tract Endoscopy|Biopsy of the proximal small bowel mucosa]] <br>
-</div> |G03=<div style="float: left; text-align: left; line-height: 150% "> '''2. Exclude infection by any/combination of the following tests:'''
-----
-❑ [[Diarrhea laboratory findings#Fecal Cultures|Stool culture]]: Standard [[Aeromonas]], [[Plesiomonas]], [[Tuberculosis]] etc <br> ❑ Stool for ova and [[parasite]]s <br> ❑ [[Clostridium difficile laboratory findings|Clostridium toxin assay]] <br> ❑ Other specific test (Serology, [[ELISA]], [[immunofluorescence]] to rule out virus and parasites) <br>
-</div> |G04=<div style="float: left; text-align: left; line-height: 150% ">'''2. Exclude exocrine pancreatic insufficieny by any/combination of the following tests:'''
-----
-❑ [[Zollinger-Ellison syndrome laboratory tests|Secretin test]] <br> ❑ Stool chymotrypsin activity <br> ❑ [[Bentiromide|Bentiromide test]] <br> ❑ Others ([[Diarrhea laboratory findings#Tests for Bacterial Overgrowth|D-xylose absorption tests / Schilling test]]) <br>
-</div> }}
-{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | | | | | | | | | | }}
-{{familytree | |!| | | |!| | | H01 | | |!| | | |!| | | | | | | | | |H01=<div style="float: left; text-align: left; line-height: 150% "> '''3. Order selective testing:'''
-----
-❑ Cholestyramine test for bile acid diarrhea <br> ❑ Plasma peptides ([[Gastrin]], [[calcitonin]], [[vasoactive intestinal polypeptide]] or [[somatostatin]]) <br> ❑ Urine (5-hydroxyindole acetic acid, [[metanephrine]] or [[histamine]]) <br> ❑ Others ([[TSH]], [[ACTH stimulation test]], serum protein electrophoresis or serum [[immunoglobulins]]) <br> </div> }}
-{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | | | | | | | | }}
-{{familytree | |`|-|-|-|^|-|-|-|+|-|-|-|^|-|-|-|'| | | | | | | | | | }}
-{{familytree | | | | | | | | | G05 | | | | | | | | | | | | | | | | | | | | | | G05 = Confirmatory diagnosis}}
-{{familytree | | | | | | | |,|-|^|-|.| | | | | | | | | | | | | | | | | | | }}
-{{familytree | | | | | | | D01 | | D02 | | | | | | | | | | | | | | | | | | | D01= Yes | D02= No }}
-{{familytree | | | | | | | |!| | | |!| | | | | | | | | | | | | | | | | | | }}
-{{familytree | | | | | | | D05 | | |!| | | | | | | | | | | | | | | | | | | | D06 = Significant response and recovery | D05 = Specific treatment per results and symptomatic treatment}}
-{{familytree | | | | | | | |!| | | |!| | | | | | | | | | | | | }}
-{{familytree | | | | | | | D02 | | |!| | | | | | | | | | | | | | D02 = No response}}
-{{familytree | | | | | | | |`|-|v|-|'| | | | | | | | | | | | | | | | | | | }}
-{{familytree | | | | | | | | | G03 | | | | | | | | | | | | | | | | | | | | | |G03=<div style="float: left; text-align: left; line-height: 150% "> '''Administer empirical therapy'''<br>
-❑ Adequate hydration <br> ❑ Opiates or [[octreotide]] <br>
-</div>  }}
-{{familytree/end}}
-'''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's disease|Crohn disease]] (early [[ileocolitis]])
-**[[Endocrine]] disorders e.g., [[hyperthyroidism]]
-**[[Medications]] (see causes section)
-**[[Microscopic colitis]] ([[Lymphocytic colitis|lymphocytic]] and [[Collagenous colitis|collagenous]] subtypes)
-**[[Neuroendocrine tumors]] (e.g., [[gastrinoma]], [[VIPoma|vipoma]], [[carcinoid tumors]], [[mastocytosis]])
-**Nonosmotic laxatives (e.g., [[senna]], [[docusate sodium]])
-**Postsurgical (e.g., [[cholecystectomy]], [[gastrectomy]], [[vagotomy]], intestinal resection)
-**[[Vasculitis]]
-*'''Osmotic''' (fecal osmotic gap > 50 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]]
-Table showing watery causes of chronic diarrhea (Table 1)
-{| class="wikitable"
-! colspan="3" rowspan="2" |Cause
-! colspan="2" |Osmotic gap
-! rowspan="2" |History
-! rowspan="2" |Physical exam
-! rowspan="2" |Gold standard
-! rowspan="2" |Treatment
 |-
-!< 50 mOsm per kg
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
-!> 50 mOsm per kg*
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
 |-
-| rowspan="5" |Watery
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Crohns disease|Crohn's disease]]
-| rowspan="3" |Secretory
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-|[[Crohns disease|Crohns]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-|<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-|<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* [[Abdominal pain]] followed by diarrhea
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* [[Abdominal]] [[tenderness ]]when palpated in severe disease
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Blood seen on [[rectal exam]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Fever]]
+* [[Abdominal tenderness]]
-*[[Tachycardia]]
+* Oral [[mucosal]] lesions
-*[[Hypotension]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Anti saccharomyces cerevisiae antibodies]] (ASCA)
+* [[Vitamin B12]] deficiency
+* Elevated [[erythrocyte sedimentation rate|ESR]]
+* Elevated [[C-reactive protein|CRP]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Uveitis]]
+* [[Arthritis]]
+* [[Erythema nodosum]]
+* [[Pyoderma gangrenosum]]
+* [[Amyloidosis]]
+* Venous and arterial [[thromboembolism]]
+* [[Kidney stone|Renal stones]]
+* [[Bronchiectasis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Abnormal immune response to self [[antigens]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * [[Colonoscopy]] with [[biopsy]]
-|
-* Topical mucosamine and [[corticosteroids]] are prefferd
-* [[Mesalamine]] and [[sulfasalazine]] are used for remission
 |-
-|[[Hyperthyroidism]]
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Ulcerative colitis]]
-|<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-|<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Excessive [[sweating]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Heat intolerance
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* [[Hypermotility|Increased bowel movements]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Lump in the neck
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* [[Proptosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* [[Tremors]]
+* [[Abdominal tenderness]]
-* Increased DTR
+* [[Blood]] on [[rectal examination]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* TSH with T3 and T4
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* [[Carbimazole]]  and [[methimazole]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-* [[Beta blockers]] like [[propylthiouracil]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* [[Iodine-131]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Anti-neutrophil cytoplasmic antibody|Anti–neutrophil cytoplasmic antibody]] ([[P-ANCA|P–ANCA]])
+* [[Hypoalbuminemia]]
+* [[Hypokalemia]]
+* [[Hypomagnesemia]]
+* Elevated [[Erythrocyte sedimentation rate|ESR]]
+* Elevated [[C-reactive protein|CRP]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Skin rash]]
+* [[Iritis]]
+* [[Uveitis]]
+* Seronegative [[arthritis]]
+* [[Clubbing]]
+* [[Erythema nodosum]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Abnormal immune response to self [[antigens]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Colonoscopy]] with [[biopsy]]
 |-
-|VIPoma
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Celiac disease]]
-|<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-| -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
-* Watery [[diarrhea]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* [[Dehydration]]  ([[thirst]], [[dry skin]], [[dry mouth]], [[tiredness]], [[headaches]], and [[dizziness]])
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
-* [[Lethargy]], [[muscle weakness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* [[Nausea]], [[vomiting]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Crampy [[abdominal pain]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* [[Weight loss]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* [[Flushing]]
-|
-* [[Tachycardia]]
-* [[Rash]]
-* [[Facial flushing]]
 * [[Abdominal distention]]
-* [[Abdominal tenderness]] in the right upper abdominal quadrant
+* Increased [[bowel]] sounds
-|
+* Oral [[Mucous membrane|mucosal]] lesions
-* Elevated VIP levels
+* [[Hepatosplenomegaly]]
-* Followed by imaging
+* [[Ascites]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* [[Sandostatin]] or [[chemotherapy]]  for malignant tumors
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* Surgical removal of the [[tumor]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Fat droplets on [[sudan stain]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[IgA]] endomysial [[antibody]]
+* Anti–tissue [[transglutaminase]] [[antibody]]
+* [[Anti-gliadin antibodies|Anti–gliadin antibody]]
+* [[Fat soluble vitamins]] deficiency
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Malabsorption]]
+* [[Dementia]]
+* [[Dermatitis herpetiformis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[HLA-DQ2|HLA–DQ2]]
+* [[HLA-DQ8|HLA–DQ8]]
+* Innate responses to wheat [[Protein|proteins]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[IgA]] endomysial [[antibody]]
+* Anti–tissue [[transglutaminase]] [[antibody]]
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Cystic fibrosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Abdominal distension|Abdominal distention]]
+*[[Hepatosplenomegaly]]
+*[[Rectal prolapse]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Fat droplets on [[sudan stain]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Positive [[DNA]] analysis for [[CFTR|cystic fibrosis transmembrane conductance regulator]] [[CFTR|(CFTR)]]
+* Nasal transepithelial potential difference
+* [[Fat soluble vitamins]] deficiency
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Malabsorption]]
+* Recurrent [[respiratory tract infection]]
+* [[Bronchiectasis]]
+* [[Diabetes mellitus]]
+* [[Scoliosis]]
+* [[Infertility]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Mutations in the [[cystic fibrosis transmembrane conductance regulator]] ([[CFTR]]) protein
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Positive [[genetic testing]]
+* Elevated [[Sweat chloride test|sweat chloride]] ≥60 mmol/L
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Chronic pancreatitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Tenderness (medicine)|Abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Fat droplets on [[sudan stain]]
+* Positive [[fecal elastase]] measurement
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Slightly elevated [[amylase]] and [[lipase]]
+* Abnormal pancreatic function test
+* [[Secretin]] stimulation test
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Malabsorption]]
+* [[Diabetes mellitus]]
+* [[Pancreatic pseudocyst]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Toxin|Toxins]]
+* Recurrent [[acute pancreatitis]]
+* [[Genetics|Genetic]] predesposition
+* [[Autoimmunity|Autoimmune]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Magnetic resonance cholangiopancreatography]] ([[Magnetic resonance cholangiopancreatography|MRCP]])
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Bile acid malabsorption]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Fat droplets on [[sudan stain]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Reduced [[cholesterol]] level
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Malabsorption]]
+*[[Hypotension]]
+*[[Tachycardia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Genetic defects in ''[[SLC10A2]]''
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[SeHCAT]] test
 |-
-| rowspan="2" |Osmotic
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Microscopic colitis]]
-|Lactose intolerance
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-| -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-|<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-:* [[Abdominal pain]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-:* [[Bloating]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-:* [[Diarrhea]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-:* [[Flatulence]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * [[Abdominal tenderness]]
-|
+* Fecal [[incontinence]]
-* Intestinal [[biopsy]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
-* Avoidance of dietary [[lactose]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* Substitution to maintain nutrient intake
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-* Regulation of [[calcium]] intake
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
-* Use of enzyme [[lactase]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Hypokalemia]]
+* Elevated [[C-reactive protein|CRP]]
+* Positive [[autoantibodies]] include:
+**RF
+**[[ANA]]
+**[[Anti-mitochondrial antibody|AMA]]
+**[[ANCA]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Arthritis]]
+* [[Uveitis]]
+* [[Idiopathic thrombocytopenic purpura]]
+* Pleuro [[pericarditis]]
+* [[Hypothyroidism]]
+* [[Psoriasis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Mucosal]] [[immune responses]] to luminal factors in a genetically predisposed individual
+* Drug–induced
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Colonoscopy]] with [[mucosal]] [[biopsy]] with [[mononuclear]] infiltrates:
+** [[Collagenous colitis]] is characterized by a colonic subepithelial [[collagen]] band >10 micrometers in diameter
+** [[Lymphocytic]] [[colitis]] is characterized by ≥20 intraepithelial [[lymphocytes]] (IEL) per 100 surface epithelial cells
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Infective colitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*Rebound [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[stool culture]]
+*Positive fecal calprotectin
+*Positive fecal [[lactoferrin]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated [[C-reactive protein|CRP]]
+*Elevated [[Erythrocyte sedimentation rate|ESR]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Arthritis]]
+* [[Uveitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Salmonella|''Salmonella'']]
+*[[Shigella|''Shigella'']]
+*[[Campylobacter|''Campylobacter'']]
+*''[[Escherichia coli|E. coli 0157:H7]]''
+*[[Clostridium difficile|''Clostridium difficile'']]
+*[[Entamoeba histolytica|''Entamoeba histolytica'']]
+*[[Adenoviridae|''Adenovirus'']]
+*[[Cytomegalovirus|''Cytomegalovirus'']]
+*[[Herpes simplex virus|''Herpes simplex virus'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Stool culture]]
+*[[Blood culture]]
 |-
-|[[Celiac disease (patient information)|Celiac disease]]
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Ischemic colitis]]
-| -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* May be asymptomatic
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Vague [[abdominal pain]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* [[Diarrhea]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* [[Weight loss]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* [[Malabsorption]] / [[steatorrhea]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Bloatedness
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
-|
+*Hyperactive then absent [[Stomach rumble|bowel sounds]]
-* [[Abdominal pain]] and [[cramping]]
+*[[Tenderness (medicine)|Abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated [[C-reactive protein|CRP]]
+*Elevated [[Erythrocyte sedimentation rate|ESR]]
+*Elevated serum [[Lactic acid|lactate]]
+*Elevated [[lactate dehydrogenase]] ([[Lactate dehydrogenase|LDH]])
+*Elevated [[Creatine kinase|creatine phosphokinase]] ([[Creatine kinase|CPK]])
+*Elevated [[amylase]]
+*[[Hypoalbuminemia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Henoch-Schönlein purpura|IgA vasculitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Thrombophilia|Hypercoagulability]]
+*Nonocclusive [[Ischemic colitis|colonic ischemia]]
+*[[Embolism|Embolic]] and [[Thrombosis|thrombotic]] arterial occlusion
+*[[Mesenteric vein thrombosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Abdominal [[Computed tomography|CT scan]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Lactose intolerance]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Abdominal tenderness ]]
 * [[Abdominal distention]]
-* [[Tetany]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
-* [[Mouth ulcers]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
-* [[Dermatitis herpetiformis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* Signs of the fat-soluble vitamins A, D, E, and K deficiency
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
-* IgA tissue transglutaminase Ab
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-* [[Gluten-free diet]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Lactose tolerance test
+* Genetic testing
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Headache]]
+* [[Vertigo]]
+* [[Memory impairment]]
+* [[Lethargy]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Reduction of lactase enzyme activity or inability to produce persistent [[lactase]]
+* Congenital [[lactase deficiency]]
+* Secondary lactose malabsorption
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Small bowel]] [[biopsy]]
+* Lactose breath hydrogen test
 |-
-|
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Irritable bowel syndrome]]
-|Functional
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-|Irritable bowel syndrome
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-| -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-| -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-[[Abdominal pain]] or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following:
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* Improves with [[defecation]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* Onset associated with change in frequency of [[stool]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Onset associated with change in appearance of stool
-* 25% of bowel movements are loose stools
-History of straining is also common
-|
 * [[Abdominal tenderness]]
-* Hard stool in the rectal vault
+* [[Abdominal distention]]
-|
+* Normal [[Stomach rumble|bowel sounds]]
-* Clinical diagnosis
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
-** ROME III criteria
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
-** Pharmacologic studies based criteria
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-* High [[dietary fiber]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
-* Osmotic [[laxatives]] such as [[polyethylene glycol]], [[sorbitol]], and [[lactulose]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-* [[Antispasmodic]] drugs (e.g. [[Anticholinergic|anticholinergics]] such as [[hyoscyamine]] or [[dicyclomine]])
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-|}{{WikiDoc Help Menu}} {{WikiDoc Sources}}
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Nl
-'''Fatty (bloating and steatorrhea in many, but not all cases)'''
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Malabsorption syndrome (damage to or loss of absorptive ability)
+*[[Anxiety]]
-**[[Amyloidosis]]
+*[[Palpitation]]
-**Carbohydrate malabsorption (e.g., [[lactose intolerance]])
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-**[[Celiac sprue]] (gluten [[enteropathy]])–various clinical presentations
+*Unknown
-**[[Gastric bypass]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-**[[Lymphatic]] damage (e.g., [[congestive heart failure]], some [[lymphomas]])
+* Diagnosis of exclusion
-**Medications (e.g., [[orlistat]] [[Xenical]]; inhibits fat absorption, [[acarbose]] [[Precose]]; inhibits [[carbohydrate]] absorption])
+|-
-**[[Mesenteric ischemia]]
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
-**Noninvasive [[small bowel]] parasite (e.g., [[Giardia]])
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
-**Post-resection diarrhea
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
-**[[Short bowel syndrome]]
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
-**Small bowel [[bacterial]] overgrowth (> 105 bacteria per mL)
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
-**[[Tropical sprue]]
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
-**[[Whipple's disease|Whipple disease]] (Tropheryma whippelii infection)
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
-*[[Maldigestion]] (loss of digestive function)
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
-**[[Hepato-biliary diseases|Hepato-biliary disorders]]
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
-**Inadequate [[luminal]] [[bile acid]]
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
-**Loss of regulated [[gastric]] emptying
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
-**[[Pancreatic]] exocrine insufficiency
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
-Table showing fatty causes of chronic diarrhea ( Table 2)
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
-{| class="wikitable"
+|-
-! rowspan="2" |Cause
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
-! colspan="2" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
-! rowspan="2" |History
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
-! rowspan="2" |Physical exam
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
-! rowspan="2" |Gold standard
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
-! rowspan="2" |Treatment
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Whipple's disease]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Hepatosplenomegaly]]
+* [[Ascites]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓/↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Hypoalbuminemia]]
+*[[Fat soluble vitamins]] deficiency
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Malabsorption]]
+* [[Ocular motility disorders|Abnormal extraocular movement]]
+* [[Lymphadenopathy]]
+* [[Hyperpigmentation]]
+* [[Uveitis]]
+* [[Endocarditis]]
+* [[Encephalitis]]
+* [[Dementia]]
+* [[Pleural effusion]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Tropheryma whipplei|''Tropheryma whipplei'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Small intestine]] [[biopsy]] for [[Tropheryma whipplei]] testing
+* [[PCR]] testing
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Tropical sprue]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Angular [[stomatitis]]
+* Oral mucosal lesion
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[stool culture]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Fat soluble vitamins]] deficiency
+* [[Vitamin B12 deficiency]]
+* [[Folate deficiency]]
+* [[Hypokalemia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Myalgia]]
+*[[Neuropathy]]
+*[[Edema]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* ''[[Escherichia coli]]''
+* ''[[Klebsiella pneumoniae]]''
+* ''[[Enterobacter cloacae]]''
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Diagnosis of exclusion
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Small bowel bacterial overgrowth syndrome|Small bowel bacterial overgrowth]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Abdominal distension|Abdominal distention]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[stool culture]]
+*Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Hypoalbuminemia]]
+* Abnormal [[Hydrogen Breath Test|hydrogen breath test]]
+* [[Lactic acidosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Malabsorption]]
+* [[Rosacea]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Excess bacteria in the [[small intestine]]
+* Alterations in [[Intestine|intestinal]] [[anatomy]] or GI motility
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Diagnosis of exclusion
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Salmonellosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distention]]
+*Diffuse [[abdominal tenderness]]
+*[[Hepatosplenomegaly]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[stool culture]]
+*Positive serologic testing
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Hypokalemia]]
+*[[Hypernatremia]]
+*[[Hyponatremia]]
+* [[Hypercalciuria]]
+* [[Hypocitraturia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Post-infectious arthritis|Post–infectious arthritis]]
+* [[Obtundation]]
+* [[Bacteremia]]
+* [[Pericarditis]]
+* [[Pyelonephritis]]
+*[[Brain abscess]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Salmonella|''Salmonella'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Stool culture]]
+|-
+! rowspan="2" style="background:#DCDCDC;" align="center" |[[Escherichia coli enteritis]]
+| style="background:#DCDCDC;" align="center" |[[EPEC|'''EPEC''']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*Diffuse [[abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[stool culture]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*''[[Enteropathogenic E. coli]]''
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Hybridization probe|DNA probe]] or [[polymerase chain reaction]] ([[Polymerase chain reaction|PCR]]) of the ''EPEC'' adherence factor
+*[[Stool culture]]
+|-
+| style="background:#DCDCDC;" align="center" |[[EAEC|'''EAEC''']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*Diffuse [[abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[stool culture]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Chronic infection in [[Immunodeficiency|immunocompromised]] patients
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Escherichia coli enteritis|''Enteroaggregative E. coli'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Stool culture]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Aeromonas]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+* [[Abdominal distention]]
+* Hyperactive [[Stomach rumble|bowel sounds]]
+* Diffuse [[abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[stool culture]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Wound [[infection]]
+*[[Bacteremia]]
+*[[Hemolytic-uremic syndrome|Hemolytic uremic syndrome]]
+*[[Meningitis]]
+*[[Ocular]] infection
+*[[Pneumonia]]
+*[[Urinary tract infection]]
+*[[Osteomyelitis]]
+*[[Peritonitis]]
+*[[Acute cholecystitis]]
+*[[Opportunistic infection|Opportunistic infections]] in [[Immunodeficiency|immunocompromised]] patients
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*''[[Aeromonas]]'' virulence factors including [[Endotoxin|endotoxins]], [[Hemolysin|hemolysins]], [[Enterotoxin|enterotoxins]], and adherence factors
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Blood culture]]
+*Wound [[Culture collection|culture]]
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Mycobacterium avium complex]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Abdominal distension|Abdominal distention]]
+*[[Hepatosplenomegaly]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated [[Liver function tests|liver enzymes]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Opportunistic infection]] in [[Immunodeficiency|immunocompromised]] patients
+*[[Pulmonary]] [[infection]]
+*[[Lymphadenopathy|Adenopathy]]
+*[[Sleep hyperhidrosis|Night sweats]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Mycobacterium avium complex|''Mycobacterium avium complex'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Blood culture]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[CMV colitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Viral antigen assay
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Decreased [[CD4]] level
+*Abnormal [[Liver function tests|liver function test]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Encephalitis]]
+*[[Guillain-Barré syndrome|Guillain–Barré syndrome]]
+*[[Pneumonia]]
+*[[Retinitis]]
+*[[Pericarditis]] and [[myocarditis]]
+*[[Atherosclerosis]]
+*[[Venous thromboembolism|Venous thrombosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Cytomegalovirus|''Cytomegalovirus'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Quantitative polymerase chain reaction|Quantitative PCR]] tests
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Human Immunodeficiency Virus (HIV)|HIV]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distension|Abdominal distention]]
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Decreased [[CD4]] level
+*[[Electrolyte disturbance|Electrolyte imbalance]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Lymphadenopathy]]
+*Disseminated [[infection]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Human Immunodeficiency Virus (HIV)|''HIV'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*HIV virologic (viral load) test
+*Immunoassay
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Entamoeba histolytica]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distension|Abdominal distention]]
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Liver abscess]]
+*Pleuropulmonary infection
+*[[Cardiac]] [[infection]]
+*[[Brain abscess]]
+*[[Skin and soft-tissue infections|Cutaneous infection]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Entamoeba histolytica|''Entamoeba histolytica'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Antigen testing
+*Serology
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Giardia lamblia|Giardia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distension|Abdominal distention]]
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Malabsorption]]
+*[[Urticaria]]
+*[[Depression]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*''[[Giardia lamblia]]''
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Antigen detection assays
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Cryptosporidium]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distension|Abdominal distention]]
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive stool microscopy
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated [[alkaline phosphatase]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Chronic, life–threatening illness in [[Immunodeficiency|immunocompromised]] patients
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Cryptosporidium|''Cryptosporidium'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Polymerase chain reaction
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Microsporidia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distension|Abdominal distention]]
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive stool microscopy
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Decreased [[CD4]] count
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Malabsorption]]
+*[[Keratitis]]
+*[[Seizure]]
+*[[Myositis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Microsporidia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Antigen detection assays
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Isospora]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Abdominal distension|Abdominal distention]]
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive stool microscopy
+*Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated [[Eosinophil granulocyte|eosinophils]]
+*[[Hypokalemia]]
+*Increased [[creatinine]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Chronic illness in [[Immunodeficiency|immunocompromised]] patients
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Isospora|''Isospora'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Detecting oocysts in the feces
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Carcinoid syndrome|Carcinoid tumor]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+* [[Abdominal distention]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated urinary [[5-Hydroxyindoleacetic acid|5–hydroxyindoleacetic acid]] ([[5-Hydroxyindoleacetic acid|5–HIAA]]) level
+*High [[chromogranin A]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Flushing|Facial flushing]]
+*[[Jaundice]]
+*[[Edema]]
+*[[Valvular heart disease]]
+*[[Congestive heart failure|Right–sided heart failure]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Well–differentiated [[Neuroendocrine tumors|neuroendocrine tumor]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Blood [[chromogranin A]]  level
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[VIPoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+* [[Abdominal distention]]
+* Abdominal [[RUQ]] [[tenderness]]
+* [[Nausea]]
+* [[Vomiting]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated [[VIP]] level
+*[[Hypokalemia]]
+*[[Hypochlorhydria]] or [[achlorhydria]]
+*Low osmotic gap (<50 mOsm/kg)
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Rash]]
+* [[Facial flushing]]
+* [[Dehydration]]
+* [[Lethargy]]
+* [[Muscle weakness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Primary secretory tumor
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Blood [[VIP]] levels
+* Followed by imaging
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Zollinger-Ellison syndrome|Zollinger–Ellison syndrome]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+** [[Tenderness|Epigastric tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Positive [[secretin]] stimulation test
+* Elevated serum [[chromogranin A]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+** [[Jaundice]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Gastrin]] producing [[tumor]] mainly in [[duodenum]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Secretin]] stimulation test
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Neuroendocrine tumors|Somatostatinoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+** [[Tenderness|Epigastric tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated fasting plasma [[somatostatin]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+** [[Diabetes mellitus]]
+** [[Gallstone disease|Cholelithiasis]]
+** [[Jaundice]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Neuroendocrine tumors]] of D–cell origin
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Plasma [[somatostatin]] level
+*Followed by imaging
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Lymphoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+*[[Hepatosplenomegaly]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Paraproteinemia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Malabsorption]]
+* [[Lactose intolerance]]
+* [[Ascites]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Primary [[tumor]] of GI tract
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Colonoscopy]] with [[biopsy]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Colorectal cancer]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Positive [[carcinoembryonic antigen]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Metastasis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[FAP|FAP gene]]
+*[[Hereditary nonpolyposis colorectal cancer|HNPCC gene]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+** [[Colonoscopy]] and [[biopsy]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |Medications
+* [[ACE inhibitor|ACE inhibitors]]
+* [[Digoxin]]
+* [[Cephalosporin|Cephalosporins]]
+* [[Statins]]
+* [[Thiazide|Thiazide diuretics]]
+* [[Triptans]]
+* [[Lactulose]]
+* [[HIV AIDS medical therapy|Anti retroviral agents]]
+* [[Chemotherapy|Chemotherapeutic agents]]
+* [[Antifungal drug|Antifungals]]
+* [[Magnesium]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distention]]
+*[[Dehydration]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated plasma level of drug
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Inflammation]]
+*[[Pseudomembranous enterocolitis|Pseudomembranous colitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical evaluation after discontinuation of the drugs
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |Factitious diarrhea
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distention]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Hypokalemia]]
+*[[Metabolic alkalosis]]
+*[[Hypermagnesemia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Malabsorption]]
+*[[Lethargy]]
+*[[Generalized weakness]]
+*[[Acute kidney injury|Acute renal failure]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Medication|Medications]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical evaluation after discontinuation of the drugs
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Heavy metal ingestion]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distention]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated plasma heavy metal level
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Headache]]
+*[[Paresthesia|Numbness]]
+*[[Alopecia]]
+*[[Vertigo]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Heavy metal ingestion]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Plasma level of heavy metal
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Organophosphate poisoning]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Saliva|Salivation]]
+*[[Nausea and vomiting|Vomiting]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Reduced RBC acetylcholinesterase
+*Plasma [[cholinesterase]] activity
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Dysautonomia|Autonomic dysfunction]]
+*Motor deficit
+*Sensory deficit
+*[[Bronchospasm]]
+*[[Urination]]
+*[[Miosis]]
+*[[Bradycardia]]
+*[[Lacrimation]]
+*[[Sweating]]
+*[[Cardiac arrhythmia|Cardiac arrhythmias]]
+*[[Acute kidney injury|Acute renal injury]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Neurotoxin|Neurotoxins]] bind to [[ACHE|acetylcholinesterase]] (AChE)
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical diagnosis
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Opium withdrawal]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*Hyperactive [[Stomach rumble|bowel sounds]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Azotemia]]
+*[[Hypokalemia]]
+*[[Metabolic alkalosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Dysphoria]]
+*[[Agitation (emotion)|Restlessness]]
+*[[Perspiration|Sweating]]
+*[[Rhinorrhea]]
+*[[Tears|Lacrimation]]
+*[[Myalgia]]
+*[[Arthralgia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Opium|Opium withdrawal]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical diagnosis following [[opium withdrawal]]
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Short bowel syndrome]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Abdominal distension|Abdominal distention]]
+* [[Tenderness (medicine)|Abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Hypoalbuminemia]]
+* High level of [[Acute phase protein|acute phase reactant]]
+* Abnormal [[liver function tests]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Prior [[Intestine|intestinal]] surgery
+* [[Malabsorption]]
+* [[Crohn's disease]]
+* [[Cancer|Malignancy]]
+* Peripheral [[edema]]
+* [[Muscle atrophy]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Surgical [[bowel resection]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical diagnosis following [[bowel resection]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Radiation enteropathy|Radiation enteritis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+* [[Tenderness (medicine)|Abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Vitamin B12 deficiency
+*[[Hypoalbuminemia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Prior history of [[Cancer|malignancy]] and [[radiation therapy]]
+*[[Malabsorption]]
+*[[Telangiectasia|Telangiectasias]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Radiation therapy|Radiation]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Segmental bowel [[inflammation]] on [[endoscopy]] or [[colonoscopy]]
 |-
-!< 50
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Gastric dumping syndrome|Dumping syndrome]]
-mOsm
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-per kg
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-!> 50
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-mOsm
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-per kg*
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*Hyperactive [[bowel sound]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Hypoglycemia]]
+* [[Hydrogen Breath Test|Hydrogen breath test]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Malnutrition]]
+*[[Fat soluble vitamins|Fat soluble vitamin]] deficiency
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Post operative complications|Postgastrectomy]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical diagnosis following [[gastrectomy]]
 |-
-|[[lactose intolerance]]
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
-| -
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
-| +
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
-|
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
-* Bloating,
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
-* Flatulence
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
-* Abdominal pain, and/or chronic diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
-* after ingestion of lactose
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
-|
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
-* [[Abdominal]] [[tenderness ]]when palpated in severe disease
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
-* Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
-* Hypotension
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
-* Tachycardia
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
-* Nausea and vomitting
-|Lactose breath hydrogen test
-|Restriction of  lactose and  maintain calcium and vitamin D intake.
 |-
-|[[Celiac sprue]]
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
-| -
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
-| +
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
-|
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
-* Diarrhea with bulky, foul-smelling stools
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
-* Growth failure in children,
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
-* Weight loss,
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
-* Anemia,
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
-* Neurologic disorders
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
-* Osteopenia
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
-|
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
-* Neuropsychiatric disease
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
-* Dermatitis herpetiformis
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
-* Arthritis
-* Iron deficiency
-* Metabolic bone disease
-* Hyposplenism
-* Kidney disease
-* Idiopathic pulmonary hemosiderosis
-|Immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody followed by upper ebdoscopy with biopsy.
-|Dietary counseling, elimination of gluten in the diet.
 |-
-|[[Whipple's disease|Whipple disease]]
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Abetalipoproteinemia]]
-| -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-| +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Arthralgias
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* Weight loss
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Diarrhea
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* Abdominal pain
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Leukocytopenia
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Thrombocytopenia
+* [[Abdominal distension]]
-* Skin hyperpigmentation
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-*
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-|Upper endoscopy with biopsies of the small intestine for ''T. whipplei'' testing (histology with PAS staining, polymerase chain reaction [PCR] testing, and immunohistochemistry)
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-|Doxycycline and hydroxychloroquine was bactericidal
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-|}
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-'''Inflammatory or exudative (elevated white blood cell count, occult or frank blood or pus)'''
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-*[[Inflammatory bowel disease]] [[Crohn's disease|Crohn disease]] (ileal or early [[Crohn's disease|Crohn disease]] may be secretory)
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-**[[Diverticulitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-**[[Ulcerative colitis]]
+* Low [[triglyceride]]
-**Ulcerative jejunoileitis
+* Low total [[cholesterol]] levels
-*Invasive infectious diseases
+* [[Acanthocytes]]
-**[[Clostridium difficile CT|Clostridium difficile]] ([[Pseudomembranous enterocolitis|pseudomembranous]]) colitis–antibiotic history
+* Low [[vitamin E]] levels
-**Invasive bacterial infections (e.g., [[tuberculosis]], [[yersiniosis]])
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-**Invasive parasitic infections (e.g., [[Entamoeba]])–travel history
+* [[Ataxia]]
-**Ulcerating viral infections (e.g., [[cytomegalovirus]], [[herpes simplex virus]])
+* [[Visual field defect]]
-*[[Neoplasia]]
+* [[Dysarthria]]
-**[[Colon carcinoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-**[[Lymphoma]]
+* [[Autosomal recessive]] disorder caused by mutations encoding the [[microsomal triglyceride transfer protein]] (MTP)
-**Villous [[adenocarcinoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Radiation colitis]]
+* Clinical findings and low [[triglyceride]] and [[cholesterol]] level
-Table showing inflammatory causes of chronic diarrhea ( Table 3)
-{| class="wikitable"
-!Cause
-!History
-!Laboratory findings
-!Diagnosis
-!Treatment
 |-
-|Diverticulitis
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Hyperthyroidism]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* Bloody diarrhea
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Left lower quadrant abdominal pain
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Abdominal tenderness on physical examination
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* Low grade fever
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-* Leukocytosis
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Elevated serum amylase and lipase
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Sterile pyuria on urinalysis
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
-|Abdominal CT scan with oral and intravenous (IV) contrast
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-|bowel rest, IV fluid resuscitation, and broad-spectrum antimicrobial therapy which covers [[Anaerobic organism|anaerobic]] [[bacteria]] and [[gram-negative]] [[Bacteria|rods]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Elevated [[T4]]
+* Elevated [[T3]]
+* Decreased [[TSH]]
+* High serum [[alkaline phosphatase]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Lump in the neck
+* Lid lag
+* [[Malabsorption]]
+* [[Sweating]]
+* [[Hyperpigmentation]]
+* [[Proptosis]]
+* [[Tremor]]
+* Increased [[Deep tendon reflex|DTR]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Graves' disease]]
+* [[Hashimoto's thyroiditis]]
+* [[Toxic adenoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[TSH]]
 |-
-|Ulcerative colitis
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Diabetic neuropathy]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* [[Diarrhea]] mixed with blood and [[mucus]], of gradual onset.
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Signs of [[weight loss]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Rectal urgency
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* [[Tenesmus]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Blood is often noticed on underwear
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* Different degrees of [[abdominal pain]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* [[Anemia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
-* [[Thrombocytosis]]
+*[[Fecal incontinence]]
-* A high [[platelet]] count
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* Elvated ESR (>30mm/hr)
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* Low albumin
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-|[[Endoscopy]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|Induction of  [[Remission (medicine)|remission]] with mesalamine and corticosteroids followed by the administration of sulfasalazine and 6-Mercaptopurine depending on the severity of the disease. See ...
+*Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Hyperglycemia]]
+*[[Azotemia]]
+*[[Hypokalemia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Malabsorption]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Unclear
+*Disordered [[motility]]
+*Increased [[Intestine|intestinal]] secretion
+*[[Small intestinal bacterial overgrowth]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical diagnosis in a patient with long lasting [[diabetes mellitus]]
 |-
-|Entamoeba histolytica
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Scleroderma|Systemic sclerosis]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* [[Abdominal cramps]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* [[Diarrhea]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-** Passage of 3 - 8 semiformed [[stools]] per day
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
-** Passage of soft [[stools]] with [[mucus]] and occasional [[blood]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* [[Fatigue]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* [[Intestinal]] gas (excessive [[flatus]])
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* [[Rectal pain]] while having a [[bowel movement]] ([[tenesmus]])
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* Unintentional [[weight loss]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
-|cysts shed with the stool
+*[[Abdominal pain|Epigastric tenderness]]
-|detects ameba DNA in feces
+*[[Fecal incontinence]]
-|Amebic dysentery ;
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-* [[Metronidazole]] 500-750mg three times a day for 5-10 days
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-* [[Tinidazole]] 2g once a day for 3 days is an alternative to metronidazole
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
-Luminal amebicides for ''[[E. histolytica]]'' in the colon:
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-* [[Paromomycin]] 500mg three times a day for 10 days
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* [[Diloxanide furoate]] 500mg three times a day for 10 days
+*Positive [[fecal fat]]
-* [[Iodoquinol]] 650mg three times a day for 20 days
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-For amebic liver abscess:
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
-* [[Metronidazole]] 400mg three times a day for 10 days
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
-* [[Tinidazole]] 2g once a day for 6 days is an alternative to metronidazole
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* [[Diloxanide furoate]] 500mg three times a day for 10 days must always be given afterwards.
+* Anti–[[Type I topoisomerase|topoisomerase I]] (Scl‑70) antibodies
+* [[Antinuclear antibodies]] ([[Antinuclear antibodies|ANA]])
+* [[Anti-centromere antibodies|Anti–centromere antibodies]]
+* Anti–[[RNA polymerase III]] antibody
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Malabsorption]]
+*[[Skin changes]]
+*[[Raynaud's phenomenon|Raynaud phenomenon]]
+*[[Pulmonary hypertension]]
+*[[Arthritis]]
+*[[Telangiectasia]]
+*[[Chronic renal failure]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Autoimmunity|Autoimmune reaction]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical diagnosis
+*Followed by serologic tests
+|- }
 |}
 ==References==
 {{Reflist|2}}
-{{WH}}
-{{WS}}

Chronic diarrhea differential diagnosis: Difference between revisions

Latest revision as of 23:00, 8 February 2019

Overview

Differential Diagnosis of Chronic Diarrhea from other diseases

References

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