eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Gastroenteritis: Differential Diagnoses & Workup

Author: Randy P Prescilla, MD, Instructor in Anesthesia, Harvard Medical School; Assistant in Perioperative Anesthesia, Children's Hospital Boston
Contributor Information and Disclosures

Updated: Jan 5, 2009

Differential Diagnoses

Crohn Disease
Cystic Fibrosis
Hemolytic-Uremic Syndrome
Lactose Intolerance

Other Problems to Be Considered

Chronic nonspecific diarrhea of childhood (toddler diarrhea)

Workup

Laboratory Studies

  • Most cases of children with mild-to-moderate dehydration require no laboratory tests. Electrolyte, BUN, serum creatinine, and glucose levels may be obtained for severely dehydrated children or those with atypical or inconsistent histories and physical examination results. Other laboratory tests may be performed to assess hydration status, including hematocrit and urine specific gravity tests.
  • Fecal leukocytes are usually observed in infections caused by invasive E coli and Shigella and Campylobacter species. This test's predictive value varies, as does that of occult blood testing.
  • Gram stain of the stools may help differentiate infectious from noninfectious diarrhea. Gram-negative seagull-shaped bacteria visible with Gram stain strongly suggest campylobacteriosis. An ova and parasite examination and specialized staining procedures are necessary to diagnose a parasitic etiology.
  • Stool cultures are usually reserved for cases of children with bloody diarrhea and those who are severely dehydrated, chronically ill or immunocompromised, or who have the appearance of toxemia.
  • Metabolic acidosis with a normal anion gap occurs with loss of bicarbonate, including the following conditions:
    • Ureterostomy
    • Small bowel fistula
    • Extra chloride
    • Diarrhea
    • Carbonic anhydrase inhibitors
    • Early chronic renal failure
    • Addison disease
    • Renal tubular acidosis
    • Pancreatic fistula
    • Parenteral nutrition

Imaging Studies

  • Although imaging studies are not routine for gastroenteritis, anatomical abnormalities (eg, obstruction) should be excluded in cases involving vomiting without diarrhea. Consider the possibility of intussusception in very young patients. Exclude appendicitis in patients who have abdominal pain greater than diarrhea.

Histologic Findings

  • Stool examination for patients whose gastroenteritis is caused by invasive enteropathogens usually reveals small amounts of mucoid stools containing leukocytes, RBCs, and/or gross blood. Both tests, however, have low specificity and are better used for their negative predictive value (ie, up to 95%).
  • The probability of an invasive bacterial pathogen is very low when both test results are negative.

More on Gastroenteritis

Overview: Gastroenteritis
Differential Diagnoses & Workup: Gastroenteritis
Treatment & Medication: Gastroenteritis
Follow-up: Gastroenteritis
References
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References

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Further Reading

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Keywords

gastroenteritis, enterogastritis, viral diarrhea, prematurity, dehydration, Shigella, enterohemorrhagic Escherichia coli, electrolyte imbalance, hyponatremia, hypernatremia, hypernatremic dehydration, rotavirus, dehydrating diarrhea, Norwalk virus, enteric adenovirus, calicivirus, sickle cell disease, Giardia lamblia, Cryptosporidium parvum, Cyclospora cayetanesis, Entamoeba coli, Endolimax nana, Iodamoeba butschlii, Blastocystis hominis, HIV, AIDS, cytomegalovirus

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Contributor Information and Disclosures

Author

Randy P Prescilla, MD, Instructor in Anesthesia, Harvard Medical School; Assistant in Perioperative Anesthesia, Children's Hospital Boston
Disclosure: Nothing to disclose.

Medical Editor

Ashir Kumar, MBBS, MD, FAAP, Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University; Consulting Staff, Department of Pediatrics, EW Sparrow Hospital
Ashir Kumar, MBBS, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University
Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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