Differential Diagnosis

Disease/Condition Differentiating Signs/Symptoms Differentiating Tests

Bacterial High fever, bloody diarrhea, or severe
gastroenteritis diarrhea suggests bacterial infection.
Protozoal infections May be suspected if a patient has
recently traveled to countries where
protozoal infections are endemic (e.g.,
Mexico, India, South America, many
parts of the US). Signs and symptoms
vary based on the parasite.
Amebic dysentery presents with bloody
diarrhea with excessive mucus and
abdominal pain.
Giardiasis can present with bloating
and prolonged diarrhea.
Parasitic infections should always be
ruled out in immunocompromised
patients.
Stool microscopy and culture are
differentiating tests. Evidence of
inflammation (fecal leukocytes or a positive
lactoferrin immunoassay) may be present.
Culture may grow enteropathogenic bacteria,
such as Campylobacter
jejuni, Salmonella species,
enteropathogenic Escherichia
coli, Shigella, Yersinia enterocolitica, Shiga
toxin-producing E coli, or Vibrio cholerae.
Traditionally, stool microscopy is used to
identify Giardia lamblia, Entamoeba
histolytica, cryptosporidium, or other
parasites. Stool antigen testing or serology
can also be used.

Helminthic infections These infections are common in Stool microscopy can identify the worm.
immunocompromised patients and in
immigrants from endemic areas.

Clostridium difficile Recent antibiotic use is a risk factor. Stool test for C difficile toxin would be
colitis positive.
Some cases can progress very rapidly
to serious toxic megacolon, so early
detection and presumptive treatment
with oral metronidazole or vancomycin
may be warranted.

Food poisoning Usually suspected if multiple people Stool cultures are low-yield as most of these
develop symptoms after eating the diseases are caused by toxins. Toxin testing
same contaminated food or drink.
Symptoms can vary from nausea,
Disease/Condition Differentiating Signs/Symptoms
vomiting, abdominal pain, and/or
diarrhea which start suddenly a few
hours to 2 days after eating the
contaminated food.
Differentiating Tests
may be available for epidemiologic
purposes.

PATHOPHYSIOLOGY OF ACUTEGASTROENTERITIS (AGE)

Acute gastroenteritis is usually caused by bacteria and protozoan. In the
Philippines,one of the most common causes of acute gastroenteritis is E.
histolytica. The pathologicprocess starts with ingestion of fecally
contaminated food and water. The organism affects thebody through direct
invasion and by endotoxin being released by the organism. Through
thesetwo processes the bowel mucosal lining is stimulated and destroyed
the eventually lead toattempted defecation or tenesmus as the body tries to
get rid of the foreign organism in thestomach.The client with acute
gastroenteritis may also report excessive gas formation that mayleads
toabdominal distention and passing of flatus due to digestive and
absorptive malfunction in thesystem. Feeling of fullness and the increase
motility of the gastrointestinal tract may progress tonausea and vomiting
and increasing frequency of defecation. Abdominal pain and feeling
offullness maybe relieved only when thepatient is able to pass a flatus.As
the destruction of the bowel continues the mucosal lining erodes due to
toxin, directinvasion of the organism and the action of the hydrochloric acid
of the stomach. As theprotective coating of the stomach erodes the
digestive capabilities of the acid helps indestroying the stomach lining. Pain
or tenderness of the abdomen is then felt by the patient.When the burrows
or ulceration reaches the blood vessels in the stomach bleeding will
beinduced. Dysentery may be characterized by melena or hematochezia
depending on the siteand quantity of bleeding that may ensue. Signs of
bleeding may be observed also throughhematemesis.As the bowel is
stimulated by the organism and its toxin, the intestinal tract secreteswater
andelectrolytes in the intestinal lumen. The body secretes and therefore
lost Chloride andbicarbonate ions in the bowel as the body try to get rid of
the organism by increasing peristalsisand number of defecation. Sodium
and water reabsorption in the bowel is inhibited with the lostof the two
electrolytes.Mild diarrhea is characterized by 2-3 stool, borborygmi
(hyperactive bowel sound),fluidand electrolyte imbalance and
hypernatremia. When the condition continue to progress, proteini n t h e
b o d y i s e xc r e t e d t o t h e l u me n t h a t f u r t h e r d e c r e a s e s t h e
r e a b s o r p t i o n a n d t h e b o d y become overwhelmed that leads to
intense diarrhea with more than 10 watery stool. Seriousfluid volume
deficit may lead to hypovolemic shock and eventually death