Table 40-2 Association between Pathobiology of Causative Agents and Clinical Features

in Acute Infectious Diarrhea

Pathobiology/Agents Incubation
Period
Vomiting Abdominal
Pain
Fever Diarrhea
Toin !roducers
Prefor"ed toin
Bacillus cereus#
Staphylococcus aureus#
$%& h
'%4( $%2( 0%$( '%4(# watery
Clostridium perfringens &%24 h
)nterotoin
Vibrio cholerae#
enterotoigenic
Escherichia coli# Klebsiella
pneumoniae# Aeromonas
s!ecies
&%*2 h 2%4( $%2( 0%$( '%4(# watery
)nteroadherent
)ntero!athogenic and
enteroadherent E. coli#
Giardia organis"s#
cry!tos!oridiosis#
hel"inths
$%& d 0%$( $%'( 0%2( $%2(# watery#
"ushy
Cytotoin-!roducers
Clostridium difficile $%' d 0%$( '%4( $%2( $%'(# usually
watery#
occasionally
bloody
+e"orrhagic E. coli $2%*2 h 0%$( '%4( $%2( $%'(# initially
watery#
,uic-ly bloody
Invasive organis"s
.ini"al infla""ation
/otavirus and 0orwal-
agent
$%' d $%'( 2%'( '%4( $%'(# watery
1ariable infla""ation
Salmonella#
Campylobacter# and
Aeromonas s!ecies# Vibrio
parahaemolyticus# Yersinia
$2 h%$$ d 0%'( 2%4( '%4( $%4(# watery
or bloody
Pathobiology/Agents Incubation
Period
Vomiting Abdominal
Pain
Fever Diarrhea
2evere infla""ation
Shigella s!ecies#
enteroinvasive E. coli#
Entamoeba histolytica
$2 h%& d 0%$( '%4( '%4( $%2(# bloody
Table 40-' .a3or Causes of Chronic Diarrhea According to Predo"inant
Patho!hysiologic.echanis"
Secretory causes
)ogenous sti"ulant laatives
Chronic ethanol ingestion
4ther drugs and toins
)ndogenous laatives 5dihydroy
bile acids6
Idio!athic secretory diarrhea
Certain bacterial infections
7owel resection# disease# or fistula
5 absor!tion6
Partial bowel obstruction or fecal
i"!action
+or"one-!roducing tu"ors
5carcinoid# 1IPo"a# "edullary
cancer of thyroid# "astocytosis#
gastrino"a# colorectal villous
adeno"a6
Addison8s disease
Congenital electrolyte absor!tion
defects
Osmotic causes
4s"otic laatives 5.g
2(
# P44
%'
#
244
%2
6
9actase and other disaccharide
deficiencies
0onabsorbable carbohydrates
5sorbitol# lactulose# !olyethylene
glycol6
Steatorrheal causes
Intralu"inal "aldigestion
5!ancreatic eocrine insufficiency#
bacterial overgrowth# bariatric
surgery# liver disease6
.ucosal "alabsor!tion 5celiac
s!rue# :hi!!le8s disease# infections#
abetali!o!roteine"ia# ische"ia6
Post-"ucosal obstruction 5$; or 2;
ly"!hatic obstruction6
Inflammatory causes
Idio!athic infla""atory bowel
disease 5Crohn8s# chronic ulcerative
colitis6
9y"!hocytic and collagenous colitis
I""une-related "ucosal disease 5$;
or 2; i""unodeficiencies# food
allergy# eosino!hilic gastroenteritis#
graft-vs-host disease6
Infections 5invasive bacteria#
viruses# and !arasites# 7rainerd
diarrhea6
/adiation in3ury
<astrointestinal "alignancies
Dysmotile causes
Irritable bowel syndro"e 5including
!ost-infectious I726
1isceral neuro"yo!athies
+y!erthyroidis"
Drugs 5!ro-inetic agents6
Postvagoto"y
Factitial causes
.unchausen
)ating disorders
Iatrogenic causes
Cholecystecto"y
Ileal resection
7ariatric surgery
1agoto"y# fundo!lication
Table 40-4 Physical )a"ination in Patients with Chronic Diarrhea
$= Are there general features to suggest "alabsor!tion or infla""atory bowel disease
5I7D6 such as ane"ia# der"atitis her!etifor"is# ede"a# or clubbing>
2= Are there features to suggest underlying autono"ic neuro!athy or collagen-vascular
disease in the !u!ils# orthostasis# s-in# hands# or 3oints>
'= Is there an abdo"inal "ass or tenderness>
4= Are there any abnor"alities of rectal "ucosa# rectal defects# or altered anal s!hincter
functions>
?= Are there any "ucocutaneous "anifestations of syste"ic disease such as der"atitis
her!etifor"is 5celiac disease6# erythe"a nodosu" 5ulcerative colitis6# flushing
5carcinoid6# or oral ulcers for I7D or celiac disease>