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A 65-year-old man goes to his general practitioner (GP) complaining of diarrhoea

65 years old | Male

Vignette:

History A 65-year-old man goes to his general practitioner (GP) complaining of diarrhoea. This had developed suddenly 2 days previously. His motions are watery and foul-smelling. There is no blood or mucus in the stool. There is colicky abdominal pain not relieved by defaeca- tion. The man has a poor appetite and feels nauseated. He feels tired. The man has recently retired, and returned 2 weeks ago from a coach trip to Eastern Europe and Russia. No one else on the coach was ill during the holiday. He is otherwise well, with no significant med- ical history. He smokes 10 cigarettes a day, and drinks two pints of beer a day. Examination is unremarkable, and the GP diagnoses ‘traveller’s diarrhoea’, and prescribes loperamide. Two weeks later the patient returns to the surgery. The diarrhoea has persisted and the patient has lost 6 kg in weight. Examination On examination the patient looks well. His blood pressure is 158/88 mmHg. Cardiovascular, respiratory and abdominal examinations are unremarkable.

Summary:

diarrhea | 2 days | watery diarrhea | foul-smelling | colicky pain | poor appetite | nauseated | tired | travel | smoking | weight loss | alcohol | hypertension

Dx:

giardiasis

Ref:

100 caces in clinical medicine case 23

Rank

Disease

Weight

1 pancreatic cancer 497.0
2 Giardiasis 402.0
3 Graves Disease 400.0
4 Mesenteric ischemia 398.0
5 Salmonella infection 397.0
6 Chronic Pancreatitis 381.0
7 Crohn Disease 378.0
8 Bacterial gastroenteritis 371.0
9 Listerial gastroenteritis 369.0
10 Primary sclerosing cholangitis 364.0
11 Alcoholic Liver Disease 358.0
12 Hepatocellular carcinoma 350.0
13 Systemic lupus erythematosus 344.0
14 Liver Cirrhosis 333.0
15 Biliary cirrhosis 332.0
16 Primary biliary cirrhosis 332.0
17 Hemolytic uremic syndrome 332.0
18 mucosal Eosinophilic gastroenteritis 329.0
19 Ulcerative Colitis 322.0
20 Brucellosis 320.0
21 Prinzmetal angina 319.0
22 Intestinal Entamoeba histolytica amebiasis 317.0
23 Viral Gastroenteritis 315.0
24 Amebic Liver Abscess 314.0
25 Henoch-Schonlein purpura 312.0
26 Duodenal Ulcer 311.0
27 Gastric Ulcer 311.0
28 Autoimmune hepatitis 309.0
29 Hyperthyroidism 308.0
30 Type 1 Diabetes mellitus 305.0
31 Acute viral meningitis 305.0
32 Acute Pancreatitis 305.0
33 Chronic atrial fibrillation 304.0
34 Gastroparesis 302.0
35 Sarcoidosis 301.0
36 Alcoholic Liver Cirrhosis 296.0
37 Non-cholera Vibrio infections 286.0
38 Gallbladder cancer 283.0
39 Non-ST-elevation myocardial infarction 283.0
40 Alcoholic hepatitis 281.0
41 Addison Disease 278.0
42 Liver disease 275.0
43 Lung Cancer 273.0
44 Polyarteritis nodosa 272.0
45 Klebsiella pneumoniae liver abscess 270.0
46 Alcoholic Fatty Liver 268.0
47 Acute peptic ulcer 267.0
48 Pyogenic Liver Abscess 262.0
49 Diverticulitis 259.0
50 Peptic Ulcer 258.0
51 Alzheimer disease 253.0
52 Non-small cell lung cancer 253.0
53 Hereditary Angioedema 251.0
54 Thrombotic thrombocytopenic purpura 249.0
55 Hepatic Encephalopathy 248.0
56 Gastric cancer 247.0
57 Diabetes Mellitus 245.0
58 Anaphylaxis 245.0
59 Pneumonia 244.0
60 Intussusception 244.0
61 Celiac Disease 243.0
62 Travelers diarrhea 242.0
63 Intestinal Pseudo Obstruction 241.0
64 Acute intermittent porphyria 240.0
65 Type 2 Diabetes mellitus 240.0
66 Intestinal Obstruction 239.0
67 Muscle Layer Eosinophilic gastroenteritis 238.0
68 Food poisoning 237.0
69 Foodborne E coli infection 237.0
70 Gallstone pancreatitis 237.0
71 Rocky Mountain spotted fever 236.0
72 Acute Cholecystitis 236.0
73 Acute perforated appendicitis 234.0
74 Malaria 233.0
75 Diabetic Amyotrophy 231.0
76 Stable ischemic heart disease 229.0
77 Intra-abdominal abscess 228.0
78 Chronic heart failure 228.0
79 Hereditary hemochromatosis 225.0
80 Acute Appendicitis 223.0
81 Laryngeal Cancer 221.0
82 Acute bacterial meningitis in children 220.0
83 Chronic Hepatitis 219.0
84 Colorectal cancer 219.0
85 Emphysematous cholecystitis 218.0
86 Graves ophthalmopathy 217.0
87 Acute fatty liver of pregnancy 217.0
88 Acute Liver Failure 216.0
89 Bladder Cancer 211.0
90 Acute Clonorchiasis 209.0
91 Cholera 209.0
92 Gastritis 206.0
93 Churg-Strauss Syndrome 206.0
94 Campylobacter infection 203.0
95 Adrenal crisis 203.0
96 Bruxism 203.0
97 subserosal eosinophilic gastroenteritis 202.0
98 Eosinophilic gastroenteritis 202.0
99 Ischemic stroke 201.0
100 Gingivitis 198.0
101 Clostridium difficile infection 197.0
102 Shigellosis 191.0
103 ST-elevation myocardial infarction 191.0
104 Autosomal Dominant Polycystic Kidney Disease 190.0
105 Acute Myeloid Leukemia in adults 190.0
106 Diabetic Kidney Disease 190.0
107 Osteoporosis 190.0
108 Acute bacterial meningitis in adults 189.0
109 Pheochromocytoma 188.0
110 Adrenocortical carcinoma 187.0
111 Acute respiratory failure 186.0
112 Renal and perinephric abscess 185.0
113 Chronic Kidney Diseases 183.0
114 anterior ischemic optic neuropathy 183.0
115 Psychogenic polydipsia 182.0
116 Glomerulonephritis 181.0
117 Stroke 181.0
118 Oropharyngeal cancer 181.0
119 Ovarian and fallopian tube torsion 179.0
120 Malt lymphoma 178.0
121 Analgesic nephropathy 178.0
122 Ovarian Cancer 178.0
123 Granulomatosis with polyangiitis 176.0
124 Acetaminophen overdose 176.0
125 Amphetamine use disorder 176.0
126 Zollinger-Ellison Syndrome 175.0
127 Peritoneal dialysis associated peritonitis 175.0
128 Typhoid infection 174.0
129 Lactose intolerance 172.0
130 Extraintestinal Entamoeba histolytica amebiasis 170.0
131 Migraine headache in adults 170.0
132 Spontaneous bacterial peritonitis 169.0
133 Foreign body ingestion 168.0
134 End Stage Renal Disease 168.0
135 Anthrax 166.0
136 Cryptococcosis 166.0
137 Ectopic Pregnancy 165.0
138 Ruptured ectopic pregnancy 165.0
139 Kawasaki disease 164.0
140 Diabetic Ketoacidosis 164.0
141 Tuberculous Peritonitis 164.0
142 Gastric Outlet Obstruction 164.0
143 Abetalipoproteinemia 162.0
144 Short bowel syndrome 162.0
145 Infectious mononucleosis 162.0
146 Aortic Dissection 162.0
147 Choledochal Cyst 161.0
148 Psoas Abscess 161.0
149 Systemic sclerosis 160.0
150 Hypertriglyceridemia 160.0
151 Dyspepsia 160.0
152 Obstructive Sleep Apnea 160.0
153 Labyrinthitis 159.0
154 Hyperparathyroidism 158.0
155 Choledocholithiasis 157.0
156 Adrenal Suppression 157.0
157 Chronic bacterial prostatitis 157.0
158 Cystic Fibrosis 156.0
159 Rheumatoid Arthritis 156.0
160 Insect bites and stings 155.0
161 Cushing syndrome 155.0
162 Irritable Bowel Syndrome 154.0
163 COPD Exacerbation 153.0
164 Acute pyelonephritis in adults 153.0
165 Influenza 152.0
166 Chronic pyelonephritis 150.0
167 Transient ischemic attack 150.0
168 Cataract 150.0
169 Autoimmune Pancreatitis 149.0
170 Endometrial cancer 149.0
171 Esophagitis 149.0
172 Amebiasis 148.0
173 Ischemic optic neuropathy 148.0
174 posteriorischemic optic neuropathy 148.0
175 Gallstones 146.0
176 Gastroenteritis 145.0
177 Familial Mediterranean fever 145.0
178 Guillain-Barre syndrome 142.0
179 Aseptic meningitis 142.0
180 Secondary Peritonitis 141.0
181 Ovarian Torsion 141.0
182 Acute otitis media 140.0
183 Sigmoid volvulus 140.0
184 Anal Fissure 139.0
185 Diabetic Neuropathy 139.0
186 Primary Myelofibrosis 139.0
187 Deep venous thrombosis 139.0
188 Psoriasis 137.0
189 Rumination Syndrome 136.0
190 Hepatorenal Syndrome 136.0
191 Anemia of chronic disease 136.0
192 Stable angina 136.0
193 Erectile dysfunction 136.0
194 Acute Lymphoblastic leukemia in children 135.0
195 Hyperaldosteronism 133.0
196 Breast Cancer 132.0
197 Gout 132.0
198 Liver Abscess 131.0
199 Kidney stones 129.0
200 Non-alcoholic Fatty Liver Disease 128.0
201 Hypercalcemia 128.0
202 Discogenic low back pain 127.0
203 Gastrointestinal Hemorrhage 126.0
204 Lower gastrointestinal hemorrhage 126.0
205 Upper gastrointestinal hemorrhage 126.0
206 Familial adenomatous polyposis syndrome 126.0
207 Multiple endocrine neoplasia 2A 126.0
208 Hyperosmolar Hyperglycemic state 125.0
209 Acromegaly 124.0
210 Hemorrhagic stroke 123.0
211 Achalasia 122.0
212 Acute bacterial meningitis in neonates 121.0
213 Peutz-Jeghers Syndrome 120.0
214 Autosomal Recessive Polycystic Kidney Disease 120.0
215 Cholangiocarcinoma 118.0
216 Motion Sickness 118.0
217 Acute Hepatitis 117.0
218 Acne fulminans 117.0
219 Acne conglobata 117.0
220 Gram-negative folliculitis 117.0
221 Excoriated acne 117.0
222 Renal Cell Carcinoma 116.0
223 Aortic coarctation 116.0
224 Central hypothyroidism 115.0
225 Ruptured Tuboovarian abscess 114.0
226 Panic disorder in adults 113.0
227 Pancreatic Pseudocyst 112.0
228 Chronic Myeloid Leukemia 111.0
229 Acute disseminated encephalomyelitis 111.0
230 Ileus 108.0
231 Clonorchiasis 108.0
232 Heparin-induced thrombocytopenia 106.0
233 Amyloidosis 106.0
234 Acute heart failure 106.0
235 Inguinal hernia 105.0
236 Unstable angina 104.0
237 Ovarian Hyperstimulation Syndrome 103.0
238 Leiomyomas 103.0
239 Ankylosing spondylitis 102.0
240 Renal Artery Stenosis 100.0
241 Peyronie Disease 100.0
242 Infertility in women 100.0
243 Insomnia in adults 100.0
244 Multiple endocrine neoplasia 2B 99.0
245 Annular pancreas 98.0
246 Eclampsia 98.0
247 Acne vulgaris 97.0
248 Chronic Clonorchiasis 95.0
249 STI HIV Pharyngitis 94.0
250 Hypogammaglobulinemia 94.0
251 Common cold(adults) 93.0
252 Toxic thyroid adenoma 92.0
253 Inflammatory Bowel Diseases 90.0
254 Urinary Tract Obstruction 90.0
255 COVID19 89.0
256 Atypical pneumonia 89.0
257 Common cutaneous drug reactions 89.0
258 Hyperprolactinemia 89.0
259 Gastroesophageal reflux disease 89.0
260 Meckel diverticulum 88.0
261 Intrahepatic cholestasis of pregnancy 88.0
262 Wilson disease 86.0
263 Intestinal malrotation 86.0
264 Painless thyroiditis 86.0
265 Acute Lymphocytic Leukemia in Adults 86.0
266 Secondary hypogonadism 85.0
267 Non-diabetic hypoglycemia 85.0
268 Hiatus hernia 83.0
269 Secondary hyperparathyroidism 83.0
270 Varicose veins 83.0
271 Subdural hematoma 82.0
272 Central retinal artery occlusion 82.0
273 Oral candidiasis 81.0
274 Hypothyroidism 80.0
275 Osteomyelitis 80.0
276 Tinnitus 79.0
277 Cellulitis 79.0
278 Fungal meningitis 78.0
279 Toxic Megacolon 77.0
280 Anaplastic thyroid cancer 77.0
281 Acute pericarditis 77.0
282 Endometriosis 74.0
283 Milk-alkali syndrome 73.0
284 Acute Milk-alkali syndrome 73.0
285 Chronic Milk-alkali syndrome 73.0
286 Multiple Myeloma 73.0
287 Dry eye 73.0
288 Acute bacterial rhinosinusitis 72.0
289 Systemic vasculitis 72.0
290 Preeclampsia 71.0
291 Chronic pelvic pain in women 70.0
292 Recurrent aphthous stomatitis 70.0
293 Drowning 68.0
294 Rosacea 68.0
295 Primary hypogonadism 68.0
296 Hypoparathyroidism 67.0
297 Medullary thyroid cancer 66.0
298 Gallbladder Dyskinesia 65.0
299 biliary SOD 65.0
300 Sphincter of Oddi Dysfunction 65.0
301 pancreatic SOD 65.0
302 Migraine 64.0
303 Mitral Stenosis 63.0
304 Asthma 61.0
305 Pyelonephritis 61.0
306 Chronic liver disease 61.0
307 Endometritis 60.0
308 Multiple Sclerosis 60.0
309 Mallory-Weiss syndrome 60.0
310 Testicular cancer 59.0
311 Premenstrual syndrome 58.0
312 Animal bites 57.0
313 Budd Chiari Syndrome 56.0
314 Menopause 56.0
315 Simple kidney cyst 55.0
316 Angle Closure Glaucoma 55.0
317 Prolactinoma 55.0
318 Common cold(children) 54.0
319 Stevens-Johnson syndrome 54.0
320 Acute Rhinosinusitis 54.0
321 Acute viral rhinosinusitis 54.0
322 Chronic meningitis 54.0
323 Abnormal uterine bleeding 54.0
324 Papilledema 51.0
325 Enterovaginal fistula 50.0
326 Musculoskeletal lower back pain 50.0
327 Androgenetic alopecia 50.0
328 Open Angle Glaucoma 50.0
329 Benign Prostatic Hyperplasia 50.0
330 Balanitis 50.0
331 Priapism 50.0
332 Achilles tendinopathy 50.0
333 Achilles tendon rupture 50.0
334 Carpal Tunnel Syndrome 50.0
335 Bell palsy 50.0
336 Chronic Lymphocytic Leukemia 49.0
337 Goiter 48.0
338 Diffuse nontoxic goiter 48.0
339 Toxic multinodular goiter 48.0
340 Cervical goiter 48.0
341 Sialadenitis 47.0
342 Meniere disease 46.0
343 Obstructive cervical goiters 46.0
344 Sunburn 46.0
345 Gestational diabetes mellitus 46.0
346 Male factor infertility 45.0
347 biliary colic 44.0
348 Pulmonary Embolism 42.0
349 Extrahepatic Cholestasis 42.0
350 Intrahepatic Cholestasis 42.0
351 Allergic rhinitis 41.0
352 Acalculous Cholecystitis 41.0
353 Acute Myeloid Leukemia in children 41.0
354 Dermatophyte infections 41.0
355 chronic acalculous cholecystitis 40.0
356 Ascites 39.0
357 Acute Cholangitis 38.0
358 Herpes zoster 36.0
359 Gastric Volvulus 36.0
360 Premature labor 36.0
361 Rotator Cuff Tears 34.0
362 Candidiasis 34.0
363 Candidal intertrigo 34.0
364 Candida Balanitis 34.0
365 Oropharyngeal and esophageal candidiasis 34.0
366 Vulvovaginal candidiasis 34.0
367 Bed bugs 33.0
368 Splenic Infarction 32.0
369 Pseudohypoparathyroidism 32.0
370 Phenylketonuria 32.0
371 Osteomalacia 30.0
372 Tinea versicolor 30.0
373 Epiploic appendagitis 29.0
374 Limited cutaneous systemic sclerosis 29.0
375 Paraneoplastic Syndromes 28.0
376 Umbilical hernia 28.0
377 Ichthyosis 27.0
378 Fibromyalgia 26.0
379 Penis Carcinoma 25.0
380 Acute Bronchitis 23.0
381 Nasal polyps 23.0
382 Zenker diverticulum 23.0
383 Parkinson disease 22.0
384 Aortic stenosis 22.0
385 Thyroid lymphoma 21.0
386 Biliary cyst 21.0
387 Tuboovarian abscess 20.0
388 Epidemic keratoconjunctivitis 20.0
389 Exocrine pancreatic insufficiency 20.0
390 Epilepsy 20.0
391 Central diabetes insipidus 20.0
392 Tetanus 20.0
393 Intraperitoneal bleeding 18.0
394 Acute Bacterial Prostatitis 18.0
395 Chronic Cholecystitis 18.0
396 Periorbital and orbital cellulitis 18.0
397 Hyperglycemia 18.0
398 Uveitis 18.0
399 Anterior uveitis 18.0
400 Intermediate uveitis 18.0
401 Posterior uveitis 18.0
402 Pan uveitis 18.0
403 Acute cervical spine trauma 18.0
404 Disseminated intravascular coagulation 17.0
405 Middle East respiratory syndrome 17.0
406 Bacterial pharyngitis 17.0
407 Gilbert syndrome 16.0
408 Pelvic inflammatory disease 16.0
409 Acute pelvic inflammatory disease 16.0
410 Psoriatic arthritis 15.0
411 Barrett esophagus 15.0
412 Sexual abuse and assault 15.0
413 Pressure ulcer 15.0
414 Peroneal Neuropathy 14.0
415 Musculoskeletal sprains and strains 14.0
416 Chronic Renal vein thrombosis 13.0
417 Von willebrand disease 12.0
418 Primary ciliary dyskinesia 11.0
419 Kartagener syndrome 11.0
420 Abdominal compartment syndrome 11.0
421 Acute epididymitis 11.0
422 Acute atrial fibrillation 10.0
423 Dubin-Johnson syndrome 8.0
424 Splenic abscess 8.0
425 Substernal goiter 8.0
426 Ramsay Hunt syndrome 6.0
427 Alopecia areata 5.0
428 Dacryocystitis 5.0
429 Chlamydia pneumoniae infection 2.0
430 Optic neuritis 1.0
431 Neuropapillitis 1.0
432 Bullous pemphigoid 1.0
433 Hemorrhoids 0.0
434 Immune thrombocytopenia 0.0
435 Myasthenia Gravis 0.0
436 Congenital Myasthenic Syndromes 0.0
437 Neonatal Myasthenia Gravis 0.0
438 Acute Cystitis(Men) 0.0
439 Conjunctivitis 0.0
440 Bacterial conjunctivitis 0.0
441 Viral conjunctivitis 0.0
442 Allergic conjunctivitis 0.0
443 Ligneous conjunctivitis 0.0
444 Vernal keratoconjunctivitis 0.0
445 Atopic keratoconjunctivitis 0.0
446 Noninfectious nonallergic conjunctivitis 0.0
447 Globus Sensation 0.0
448 Visceral leishmaniasis 0.0