Diarrhea: Or something else? Differential Diagnosis

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

  • Abetalipoproteinemia (synonym: homozygous familial hypobetalipoproteinemia, ABL/HoFHBL) – genetic disorder with autosomal recessive inheritance; severe form of familial hypobetalipoproteinemia characterized by deficiency of apolipoprotein B48 and B100; defect in the formation of chylomicrons leading to fat digestion disorders in children, resulting in malabsorption (disorder of food absorption).
  • Congenital ion channel defects such as the Na-/H-channel defect.
  • Cronkhite-Canada syndrome (CCS) – gastrointestinal polyposis syndrome (polyps in the gastrointestinal tract), which, in addition to the clustered occurrence of intestinal polyps, leads, among other things, to changes in the skin and skin appendages such as alopecia (hair loss), hyperpigmentation and nail formation disorders; Symptoms do not appear until after the age of fifty; initial symptoms include watery diarrhea (diarrhea), loss of taste and appetite, abnormal weight loss, and hypoproteinemia (decreased levels of proteins in the blood); sporadic occurrence
  • Cystic Fibrosis (ZF) – genetic disease with autosomal recessive inheritance characterized by the production of secretions in various organs to be tamed.

Blood, blood-forming organs – immune system (D50-D90).

  • Hypogammaglobulinemia – deficiency of immunoglobulins characterized by immunodeficiencies.

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Amyloidosis – extracellular (“outside the cell”) deposits of amyloids (degradation-resistant proteins) that can lead to cardiomyopathy (heart muscle disease), neuropathy (peripheral nervous system disease), and hepatomegaly (liver enlargement), among other conditions
  • Diabetes mellitus
  • Disaccharidase deficiency – deficiency of the enzyme that cleaves the two-saccharides.
  • Fructose intolerance (fructose intolerance).
  • Hyperthyroidism (hyperthyroidism)
  • Lactose intolerance (lactose intolerance) – congenital or acquired metabolic disorder that makes lactose cleavage impossible.
  • Addison’s disease (adrenal insufficiency).
  • Sorbitol tolerance (sorbitol intolerance) – disturbance of the utilization of sorbitol in the small intestine.
  • Thyrotoxicosis – crisis exacerbation of hyperthyroidism, which is acutely life-threatening due to its symptoms.
  • Zollinger-Ellison syndrome – usually located in the pancreas (pancreas) neoplasm, which produces increased gastrin and is manifested mainly by frequently recurring peptic ulcers (ulcers) in the upper gastrointestinal tract.

Skin and subcutaneous (L00-L99).

  • Waldmann’s disease (genuine intestinal lymphangiectasia) – congenital or acquired dilatation of lymphatic vessels with impaired lymphatic drainage.

Circulatory system (I00-I99)

  • Mesenteric artery stenosis (narrowing of the mesenteric or visceral arteries; chronic diarrhea).

Infectious and parasitic diseases (A00-B99).

  • Acute infectious gastroenteritis (gastrointestinal influenza), e.g., rotavirus infection
  • Amoebic dysentery (tropical intestinal infection).
  • Campylobacter infection – Campylobacter are the most common bacterial agents of vomiting diarrhea.
  • Cryptosporidium
  • Cytomegalovirus (CMV)
  • Escheria coli infection – bacterial gastroenteritis (vomiting diarrhea).
  • Giardiasis – disease caused by the flagellate Giardia intestinalis (genotype A and B).
  • Hookworm disease
  • Lamblia-induced diarrhea – diarrheal disease caused by the protozoan Giardia lamblia.
  • Legionellosis – infectious disease caused by the bacterium Legionella pneumophila, usually occurring in late summer and autumn; symptoms are mainly pneumonias (lung infections).
  • Listeriosis – infectious disease caused by the bacterium Listeria monocytogenes and manifests itself mainly in weakened immune systems.
  • Mycobacteria
  • Opportunistic infection in HIV or other immunosuppressive diseases.
  • Pseudomembranous enterocolitis/pseudomembranous colitis – inflammation of the intestinal mucosa that usually occurs after taking antibiotics; the cause is an overgrowth of the intestine with the bacterium Clostridium difficile.
  • Salmonella infection (salmonella gastroenteritis).
  • Toxic-shock syndrome (TSS) – serious infectious disease caused by the enterotoxin of the bacterium Staphylococcus aureus; it has been observed mainly during the use of tampons, but also after surgical wound infections
  • Viral hepatitis (inflammation of the liver).
  • Viral infection – especially with rotavirus.
  • Yersinia

Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).

  • Chologenic diarrhea – if bile acids enter the colon (large intestine), bile acid-induced diarrhea results from the osmotic effect of bile acids.
  • Chronic pancreatitis (inflammation of the pancreas).
  • Exocrine pancreatic insufficiency – inability of the pancreas to produce sufficient digestive enzymes.
  • Bile acid loss syndrome (disease in which there is a functionally relevant deficiency of bile acids; leading symptoms: chologenic diarrhea (bile acid-induced diarrhea), steatorrhea (fatty stools); secondary diseases; maldigestion (insufficient breakdown of food components), possibly also cholesterol gallstones and oxalate kidney stones).
  • Liver cirrhosis – irreversible damage to the liver, leading to a gradual connective tissue remodeling of the liver with restriction of liver function.
  • Pancreatic duct obstruction

Mouth, esophagus (food pipe), stomach and intestines (K00-K67; K90-K93).

  • Anal incontinence (fecal incontinence) – inability to retain stool.
  • Appendicitis (appendicitis).
  • Autoimmune enteropathy – disorders in the intestinal tract due to autoantibody formation against intestinal tissue.
  • Bacterial infections – mainly caused by the bacteria Staphylococcus aureus, Campylobacter and Salmonella.
  • Bacterial overgrowth or mispopulation of the intestine (dysbiosis).
  • Ulcerative colitischronic inflammatory bowel disease.
  • Cronkhite-Canada syndrome – rare gastrointestinal polyposis syndrome (polyp formation in the gastrointestinal tract), which lead to malabsorption (absorption disorder), alopecia (hair loss), nail dystrophies and other symptoms.
  • Intestinal infections, unspecified
  • Intestinal motility disorders – disorders in the involuntary movements of the intestine to transport food.
  • Intestinal stenosis (narrowing)
  • Colon polyps – mucosal protrusions in the area of the colon.
  • Diverticulitis – inflammation of diverticula (mucosal protrusion through a muscle gap in a hollow organ, usually in the colon).
  • Small intestinal diverticula – mucosal protrusions through muscle gaps in a hollow organ, here the small intestine.
  • Small bowel subileus – motility disorder of the small intestine, which is considered an early stage of ileus (intestinal obstruction).
  • Dysbacteria – bacterial overgrowth of the intestine.
  • Enterocolic fistulas – abnormal connections between the small and large intestine.
  • Ischemic colitis – inflammation of the mucosa of the colon due to vascular occlusion of the supplying arteries.
  • Colitis (inflammation of the intestine), infectious.
  • Short bowel syndrome
  • Gastrocolonic fistula – abnormal duct between the stomach and large intestine through which undigested food components can be passed.
  • Microscopic colitis or microscopic colitis (synonyms: collagenous colitis; collagen colitis, collagen colitis) – chronic, somewhat atypical inflammation of the mucosa of the colon (large intestine), the cause of which is unclear and which is clinically accompanied by violent watery diarrhea (diarrhea)/4-5 times a day, even at night; some patients suffer from abdominal pain (abdominal pain) in addition; 75-80% are women/females > 50 years of age; correct diagnosis is only possible with colonoscopy (colonoscopy) and step biopsies (taking tissue samples in the individual sections of the colon), i.e. i.e. by a histological (fine tissue) examination to put.
  • Crohn’s disease – chronic inflammatory bowel disease; it usually progresses in relapses and can affect the entire digestive tract; characteristic is the segmental affection of the intestinal mucosa, that is, several intestinal sections may be affected, which are separated from each other by healthy sections
  • Whipple’s disease – rare systemic infectious disease; caused by the gram-positive rod bacterium Tropheryma whippelii (from the group of actinomycetes), which can affect various other organ systems in addition to the obligately affected intestinal system and is a chronic recurrent disease; symptoms: Fever, arthralgia (joint pain), brain dysfunction, weight loss, diarrhea (diarrhea), abdominal pain (abdominal pain), and more.
  • Food allergy
  • Proctitis (rectal inflammation)
  • Constipation (constipation) – this is a paradoxical diarrhea.
  • Irritable bowel syndrome (IBS; Colon irritable).
  • Fecal incontinence (in older patients: fecal overflow incontinence) – inability to retain the intestinal contents as well as intestinal gases arbitrarily in the rectum.
  • Tropical sprue – diarrheal disease occurring in the tropics due to folic acid and vitamin B12 deficiency.
  • Villous adenomas – benign tumor, but degenerates in more than 30% of cases and should therefore always be ablated.
  • Celiac disease (gluten-induced enteropathy) – chronic disease of the mucosa of the small intestine (small intestinal mucosa), which is based on hypersensitivity to the cereal protein gluten.

Musculoskeletal system and connective tissue (M00-M99).

  • Immobile persons – here is a so-called paradoxical diarrhea due to fermentation of the stool by bacteria.
  • Behçet’s disease (synonym: Adamantiades-Behçet’s disease; Behçet’s disease; Behçet’s aphthae) – multisystem disease from the rheumatic form circle, which is associated with a recurrent, chronic vasculitis (vascular inflammation) of the small and large arteries and mucosal inflammation; The triad (the occurrence of three symptoms) of aphthae (painful, erosive mucosal lesions) in the mouth and aphthous genital ulcers (ulcers in the genital region), as well as uveitis (inflammation of the middle eye skin, which consists of the choroid (choroid), the corpus ciliary (corpus ciliare) and the iris) is stated as typical for the disease; a defect in cellular immunity is suspected
  • Vasculitides – inflammatory rheumatic diseases characterized by a tendency to inflammation of the (usually) arterial blood vessels (bloody diarrhea).

Neoplasms – tumor diseases (C00-D48).

  • Bronchial carcinoid – tumor of the neuroendocrine system located in the lungs.
  • Hormone-active neuroendocrine tumors
  • Colon carcinoma (colorectal cancer) (paradoxical diarrhea; alternating with constipation/constipation).
  • Mastocytosis – two main forms: cutaneous mastocytosis (skin mastocytosis) and systemic mastocytosis (whole body mastocytosis); clinical picture of cutaneous mastocytosis: Yellowish-brown spots of varying size (urticaria pigmentosa); in systemic mastocytosis, there are also episodic gastrointestinal complaints (gastrointestinal complaints), (nausea (nausea), burning abdominal pain and diarrhea (diarrhea)), ulcer disease, and gastrointestinal bleeding (gastrointestinal bleeding) and malabsorption (disorder of food absorption); In systemic mastocytosis, there is an accumulation of mast cells (cell type that is involved in, among other things, allergic reactions). Among other things, involved in allergic reactions) in the bone marrow, where they are formed, as well as accumulation in the skin, bones, liver, spleen and gastrointestinal tract (GIT; gastrointestinal tract); mastocytosis is not curable; course usually benign (benign) and life expectancy normal; extremely rare degeneration mast cells (= mast cell leukemia (blood cancer)).
  • Medullary thyroid carcinoma – thyroid cancer originating from the calcitonin-producing cells.
  • Metastatic gastrointestinal carcinoid – tumor of the neuroendocrine system located in the gastrointestinal tract; its metastases may cause symptoms such as diarrhea and flushing
  • Multiple endocrine neoplasia (MEN) – genetic disease leading to various benign and malignant tumors; is divided into MEN 1 and MEN 2; in MEN 1, mainly pituitary and pancreatic tumors occur; in MEN 2, thyroid carcinoma and pheochromocytoma (catecholamine-producing tumor of the chromaffin cells of the adrenal medulla (85% of cases) or of the sympathetic ganglia (nerve cord, running along the spine in the thoracic (chest) and abdominal (stomach) regions) (15% of cases).
  • Somatostatinoma – neuroendocrine tumor that produces somatostatin.
  • Verner-Morrison syndrome (synonym: Water Diarrhea Hypokalemia Achlorhydria (WDHA) (also known as VIPoma in reference to the vasoactive intestinal peptide) – adenoma or (more commonly) adenocarcinoma arising from the D1 cells of the pancreas (pancreas) and belonging to the neuroendocrine tumors; associated with severe diarrhea (diarrhea; > 1. 000 g stool weight/day) and releases increased pancreatic enzymes and other polypeptides; sporadic occurrence.

Psyche – Nervous System (F00-F99; G00-G99).

  • Autonomic neuropathy (diabetes mellitus).
  • Alcohol dependence
  • Bulimia (binge eating disorder)
  • Munchausen syndrome – psychiatric clinical picture in which illnesses are faked in order to achieve a secondary gain of illness.
  • Paraneoplastic syndrome – symptoms that occur in cancer, but do not originate directly from the tumor, but are signs of the hormonal remote effect

Injuries, poisonings and other consequences of external causes (S00-T98).

  • Acute radiation enterocolitis – inflammation of the mucosa of the intestine after radiation therapy.
  • Graft-versus-host disease – rejection reaction of the immunocompetent graft against the host (recipient) occurring after organ transplantation.
  • Histamine intolerance – histamine is one of the inflammatory mediators and is also contained in many foods and alcohol; in the case of disturbances in histamine degradation, it can come to a wide variety of symptoms such as diarrhea, headache or tachycardia (too fast heartbeat: > 100 beats per minute)
  • Food allergy
  • Pseudoallergies

Further

  • Lymphatic drainage disorders from the gastrointestinal tract, especially after trauma or infection.
  • Food-induced, especially due to an overdose of sorbitol or xylitol (sugar substitutes).
  • Condition after gastric (partial) resection – after removal of parts of the stomach or stomach.

Medication

  • See also under “Causes” under medications

Environmental pollution – intoxications (poisoning).

  • Arsenic
  • Chromium
  • Bulbous mushroom poisoning or poisoning with other mushrooms.
  • Organophosphate insecticides
  • Mercury
  • Radiation damage
  • Environmental toxins such as ciguatera in seafood:
    • Ciguatera intoxication; tropical fish poisoning with ciguatoxin (CTX); clinical picture: diarrhea (after hours), neurological symptoms (paresthesias, numbness of mouth and tongue; cold pain on bathing) (after one day; persist for long to years).