Clinical or laboratory features | Potential etiology |
History | |
Symptom characteristics | |
Leakage of stool | Fecal incontinence |
Onset: | |
Congenital | Chloridorrhea, Na+ malabsorption |
Abrupt | Infections, idiopathic secretory diarrhea |
Gradual | Everything else |
Nocturnal diarrhea | Secretory or inflammatory diarrhea |
Stool characteristics: | |
Blood | Malignancy, inflammatory bowel disease |
Oil droplets | Malabsorption, maldigestion |
White/tan color | Celiac disease, absence of bile |
Stool volume: | |
Small volume, frequent | Colonic etiology |
Large volume | Small bowel etiology |
Associated symptoms | |
Weight loss | Malabsorption, pancreatic exocrine insufficiency, neoplasm |
Abdominal pain | Mesenteric vascular insufficiency, obstruction, irritable bowel syndrome |
Bloating and flatus | Carbohydrate malabsorption |
Systemic symptoms | Hyperthyroidism, diabetes, neoplasia, tuberculosis, adrenal insufficiency, mastocytosis, vasculitis, Whipple's disease |
Joint pain/arthritis | Inflammatory bowel disease, yersiniosis |
Risk factors | |
Medications | Medication-associated diarrhea (eg, metformin), infection (eg, Clostridioides difficile), enteropathy (eg, olmesartan) |
Radiation | Radiation enteritis, small intestinal bacterial overgrowth, enteroenteric fistula |
Abdominal surgery | Altered motility, post-cholecystectomy diarrhea, small intestinal bacterial overgrowth, bile acid malabsorption, short bowel syndrome |
Hematopoietic cell transplant | Graft versus host disease, cord-colitis syndrome (recipient of umbilical cord blood transplantation only) |
Diabetes mellitus | Altered motility, small intestinal bacterial overgrowth, medications associated with diarrhea, pancreatic exocrine insufficiency, or associated celiac disease |
Immunocompromised host | Infectious diarrhea (eg, Microsporidium, Cryptosporidium, Cytomegalovirus infection), lymphoma |
Recurrent bacterial infections | HIV/AIDS, immunoglobulin deficiencies |
Diet: | |
Sugar-free foods | Sorbitol, mannitol ingestion |
Raw milk | Brainerd diarrhea |
Food additives (eg, fructose) | Fructose intolerance |
FODMAPs | Irritable bowel syndrome |
Dairy | Lactase deficiency |
Exposure to contaminated food or water source | Chronic infections (eg, Aeromonas, Giardia, Cryptosporidium, E. histolytica), Brainerd diarrhea |
Antibiotic or healthcare exposure | Clostridioides difficile infection, fecal impaction with overflow diarrhea, ischemic colitis |
Travel | Infectious diarrhea, chronic idiopathic secretory diarrhea, post-infectious irritable bowel syndrome |
Secondary gain from illness | Laxative abuse |
Family history | Congenital absorptive defects, inflammatory bowel disease, celiac disease, multiple endocrine neoplasia |
Physical examination | |
Muscle wasting, peripheral edema | Malnutrition |
Urticaria pigmentosa, dermatographism | Mast cell disease (mastocytosis) |
Pinch purpura, macroglossia | Amyloidosis |
Hyperpigmentation, postural hypotension | Primary adrenal insufficiency (Addison's disease) |
Migratory necrotizing erythema | Glucagonoma |
Dermatitis herpetiformis | Celiac disease |
Erythema nodosum, pyoderma gangrenosum | Inflammatory bowel disease |
Flushing, heart murmur, wheezing | Carcinoid syndrome |
Thyroid nodule, tremor, lid lag | Hyperthyroidism |
Lymphadenopathy | HIV, lymphoma, cancer |
Hepatomegaly | Endocrine tumor, amyloidosis |
Splenomegaly | Mastocytosis, Whipple's disease, extranodal marginal zone lymphoma of mucosa associated lymphoid tissue (MALT lymphoma) |
Abdominal bruit | Chronic mesenteric ischemia |
Anal sphincter weakness | Fecal incontinence |
Laboratory tests | |
Anemia | Celiac disease, inflammatory bowel disease, malabsorption |
Elevated anti-tissue transglutaminase antibody | Celiac disease |
Elevated ESR/CRP | Active inflammatory process (nonspecific) |
Elevated fecal calprotectin | Inflammatory diarrhea |
Positive stool test for occult blood | Organic disease (eg, chronic infection or inflammatory bowel disease) |
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