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A 21-year-old woman presents with profuse watery diarrhea occurring up to 20 times per day

21 years old | Female

Vignette:

A 21-year-old woman presents with profuse watery diarrhea occurring up to 20 times per day. There is associated nausea, anorexia, and lethargy. She returned 4 days ago from Kenya, where she had tried many local delicacies, often from street vendors. On physical exam she has dry mucous membranes and reduced skin turgor. She is hypotensive (blood pressure 95/50 mmHg) and tachycardic (pulse 110 bpm). Abdominal exam reveals mild diffuse tenderness. She responds well to intravenous fluid replacement, with resolution of her symptoms within 48 hours. Stool cultures and serotyping are subsequently positive for enterotoxigenic E coli (ETEC).

Summary:

watery diarrhea | frequent diarrhea | nausea | anorexia | lethargy | travel | dry mucous membranes | reduced skin turgor | hypotensive | tachycardic | diffuse tenderness | E coli

Dx:

Bacterial Gastroenteritis Viral Gastroenteritis Gastroenteritis Eosinophilic Gastroenteritis Listerial Gastroenteritis Mucosal Eosinophilic Gastroenteritis Subserosal Eosinophilic Gastroenteritis Muscle Layer Eosinophilic Gastroenteritis

Ref:

https://online.epocrates.com/diseases/110522/Foodborne-E-coli-infection/Common-Vignette

Rank

Disease

Weight

1 Bacterial gastroenteritis 515.0
2 Listerial gastroenteritis 452.0
3 Foodborne E coli infection 441.0
4 Salmonella infection 417.0
5 Travelers diarrhea 411.0
6 Viral Gastroenteritis 378.0
7 Diabetic Ketoacidosis 370.0
8 Acute Pancreatitis 361.0
9 Type 1 Diabetes mellitus 354.0
10 mucosal Eosinophilic gastroenteritis 338.0
11 Gallstone pancreatitis 317.0
12 Primary sclerosing cholangitis 316.0
13 Toxic Megacolon 309.0
14 Brucellosis 307.0
15 Ulcerative Colitis 302.0
16 Short bowel syndrome 301.0
17 pancreatic cancer 298.0
18 Adrenal crisis 298.0
19 Secondary Peritonitis 294.0
20 Malaria 291.0
21 Non-cholera Vibrio infections 291.0
22 Cholera 284.0
23 Biliary cirrhosis 279.0
24 Primary biliary cirrhosis 279.0
25 Systemic lupus erythematosus 279.0
26 Acute peritonitis 277.0
27 Muscle Layer Eosinophilic gastroenteritis 276.0
28 Spontaneous bacterial peritonitis 274.0
29 Graves Disease 274.0
30 Giardiasis 273.0
31 Acute perforated appendicitis 272.0
32 Intestinal Obstruction 272.0
33 Addison Disease 271.0
34 Hemolytic uremic syndrome 270.0
35 Acute bacterial meningitis in children 268.0
36 Crohn Disease 266.0
37 Klebsiella pneumoniae liver abscess 259.0
38 Anaphylaxis 257.0
39 Acute Appendicitis 249.0
40 Rocky Mountain spotted fever 243.0
41 subserosal eosinophilic gastroenteritis 241.0
42 Autoimmune hepatitis 239.0
43 Food poisoning 238.0
44 Liver disease 235.0
45 Eosinophilic gastroenteritis 235.0
46 Gastroparesis 235.0
47 Hyperosmolar Hyperglycemic state 235.0
48 Acute viral meningitis 231.0
49 Chronic bacterial prostatitis 228.0
50 Gastroenteritis 227.0
51 Liver Cirrhosis 226.0
52 Intestinal Entamoeba histolytica amebiasis 226.0
53 Type 2 Diabetes mellitus 224.0
54 Ileus 223.0
55 Alcoholic Liver Disease 221.0
56 Mesenteric ischemia 219.0
57 Clostridium difficile infection 216.0
58 Diverticulitis 215.0
59 Pheochromocytoma 215.0
60 Ovarian Hyperstimulation Syndrome 214.0
61 Tuberculous Peritonitis 208.0
62 Acute pyelonephritis in adults 208.0
63 Hypercalcemia 207.0
64 Alcoholic Liver Cirrhosis 206.0
65 Acute fatty liver of pregnancy 204.0
66 Irritable Bowel Syndrome 202.0
67 Pyogenic Liver Abscess 199.0
68 Peritoneal dialysis associated peritonitis 193.0
69 Acute bacterial meningitis in adults 193.0
70 Acute intermittent porphyria 190.0
71 Foreign body ingestion 190.0
72 Sarcoidosis 189.0
73 Intra-abdominal abscess 188.0
74 Gastric Outlet Obstruction 187.0
75 Sialadenitis 187.0
76 Cushing syndrome 186.0
77 Hereditary Angioedema 185.0
78 Acute heart failure 184.0
79 Acute bacterial meningitis in neonates 182.0
80 Infectious mononucleosis 181.0
81 Alcoholic hepatitis 179.0
82 Acute peptic ulcer 178.0
83 Intussusception 176.0
84 Hyperthyroidism 173.0
85 Ovarian Cancer 170.0
86 Hyperparathyroidism 169.0
87 Gallbladder cancer 168.0
88 Ovarian and fallopian tube torsion 163.0
89 Amphetamine use disorder 162.0
90 Meckel diverticulum 161.0
91 Alcoholic Fatty Liver 161.0
92 Hiatus hernia 161.0
93 Anthrax 160.0
94 Shigellosis 159.0
95 Systemic sclerosis 159.0
96 Acute Cholecystitis 159.0
97 Emphysematous cholecystitis 159.0
98 Gout 159.0
99 Non-small cell lung cancer 159.0
100 Sigmoid volvulus 158.0
101 Lactose intolerance 157.0
102 Thrombotic thrombocytopenic purpura 151.0
103 Eclampsia 150.0
104 Intestinal Pseudo Obstruction 149.0
105 Hereditary hemochromatosis 149.0
106 Acute Liver Failure 149.0
107 Sunburn 146.0
108 Acute Hepatitis 145.0
109 Chronic Renal vein thrombosis 145.0
110 Acute Clonorchiasis 144.0
111 Polyarteritis nodosa 144.0
112 Chronic heart failure 143.0
113 Kawasaki disease 141.0
114 End Stage Renal Disease 140.0
115 Diabetic Amyotrophy 137.0
116 Acetaminophen overdose 137.0
117 Aseptic meningitis 136.0
118 Panic disorder in adults 136.0
119 Adrenal Suppression 135.0
120 Celiac Disease 134.0
121 Diabetes Mellitus 134.0
122 Renal vein thrombosis 134.0
123 Acute Renal vein thrombosis 134.0
124 Ruptured ectopic pregnancy 133.0
125 Endometritis 133.0
126 Churg-Strauss Syndrome 132.0
127 Migraine headache in adults 132.0
128 chronic acalculous cholecystitis 131.0
129 Duodenal Ulcer 129.0
130 Gastric Ulcer 129.0
131 Chronic Myeloid Leukemia 129.0
132 Disseminated intravascular coagulation 129.0
133 Henoch-Schonlein purpura 128.0
134 Campylobacter infection 128.0
135 Extraintestinal Entamoeba histolytica amebiasis 128.0
136 Pneumonia 126.0
137 Bacterial pharyngitis 126.0
138 Amebic Liver Abscess 125.0
139 Tetanus 124.0
140 Ovarian Torsion 123.0
141 Unstable angina 123.0
142 Non-ST-elevation myocardial infarction 123.0
143 Hyperglycemia 120.0
144 Acute Myeloid Leukemia in adults 119.0
145 Granulomatosis with polyangiitis 116.0
146 Non-diabetic hypoglycemia 115.0
147 Multiple endocrine neoplasia 2A 114.0
148 Ankylosing spondylitis 114.0
149 Ruptured Tuboovarian abscess 113.0
150 Acute Mitral regurgitation 113.0
151 Familial Mediterranean fever 112.0
152 Chronic Pancreatitis 112.0
153 Gastric cancer 112.0
154 Autosomal Dominant Polycystic Kidney Disease 111.0
155 ST-elevation myocardial infarction 111.0
156 Typhoid infection 110.0
157 Peritonitis 109.0
158 Malt lymphoma 108.0
159 Inflammatory Bowel Diseases 106.0
160 Acromegaly 106.0
161 Chronic pyelonephritis 106.0
162 Dyspepsia 105.0
163 Abetalipoproteinemia 103.0
164 Abdominal compartment syndrome 103.0
165 Cystic Fibrosis 102.0
166 Insect bites and stings 102.0
167 Colorectal cancer 101.0
168 Papilledema 101.0
169 Acute Myeloid Leukemia in children 101.0
170 Multiple endocrine neoplasia 2B 98.0
171 Graves ophthalmopathy 98.0
172 Choledocholithiasis 98.0
173 Choledochal Cyst 98.0
174 Aortic Dissection 98.0
175 COPD Exacerbation 98.0
176 Autoimmune Pancreatitis 97.0
177 anterior ischemic optic neuropathy 97.0
178 Toxic thyroid adenoma 97.0
179 Acute otitis media 96.0
180 Chronic pelvic pain in women 96.0
181 Diabetic Kidney Disease 96.0
182 Influenza 95.0
183 Peptic Ulcer 95.0
184 Migraine 95.0
185 Glomerulonephritis 94.0
186 Hepatic Encephalopathy 94.0
187 Guillain-Barre syndrome 93.0
188 Renal and perinephric abscess 93.0
189 Gastritis 92.0
190 Hypoparathyroidism 92.0
191 Chronic atrial fibrillation 92.0
192 Zollinger-Ellison Syndrome 91.0
193 Peutz-Jeghers Syndrome 91.0
194 Heparin-induced thrombocytopenia 91.0
195 Toxic multinodular goiter 91.0
196 Prinzmetal angina 91.0
197 Pulmonary Embolism 91.0
198 Chronic Hepatitis 90.0
199 Ectopic Pregnancy 89.0
200 Adrenocortical carcinoma 89.0
201 Anal Fissure 88.0
202 Motion Sickness 88.0
203 Pancreatic Pseudocyst 88.0
204 Inguinal hernia 88.0
205 Stable angina 88.0
206 Amyloidosis 87.0
207 Hypertriglyceridemia 87.0
208 Acute Lymphoblastic leukemia in children 86.0
209 Lung Cancer 85.0
210 Acute Cholangitis 85.0
211 Primary Myelofibrosis 84.0
212 Drowning 84.0
213 Epididymo-orchitis 83.0
214 Wilson disease 82.0
215 Cholangiocarcinoma 82.0
216 COVID19 81.0
217 Hepatocellular carcinoma 80.0
218 Amebiasis 80.0
219 Painless thyroiditis 80.0
220 Acute bacterial rhinosinusitis 80.0
221 Acute respiratory failure 80.0
222 Annular pancreas 79.0
223 Common cutaneous drug reactions 79.0
224 Acute pericarditis 79.0
225 Gastrointestinal Hemorrhage 78.0
226 Lower gastrointestinal hemorrhage 78.0
227 Upper gastrointestinal hemorrhage 78.0
228 Obstructive Sleep Apnea 77.0
229 Diabetic Neuropathy 76.0
230 Parkinson disease 76.0
231 Milk-alkali syndrome 76.0
232 Stable ischemic heart disease 76.0
233 Acute Milk-alkali syndrome 76.0
234 Chronic Milk-alkali syndrome 76.0
235 Asthma 76.0
236 Central hypothyroidism 76.0
237 Familial adenomatous polyposis syndrome 75.0
238 Stevens-Johnson syndrome 75.0
239 Kidney stones 75.0
240 Gallstones 74.0
241 Mallory-Weiss syndrome 74.0
242 STI HIV Pharyngitis 73.0
243 Ischemic stroke 73.0
244 Aortic stenosis 73.0
245 Chronic Clonorchiasis 71.0
246 Ascites 70.0
247 Chronic Kidney Diseases 70.0
248 Cryptococcosis 69.0
249 Esophagitis 68.0
250 Intrahepatic cholestasis of pregnancy 68.0
251 Rumination Syndrome 67.0
252 Intestinal malrotation 67.0
253 Acute atrial fibrillation 67.0
254 Gallbladder Dyskinesia 65.0
255 biliary SOD 65.0
256 Sphincter of Oddi Dysfunction 65.0
257 pancreatic SOD 65.0
258 Hyperaldosteronism 65.0
259 Pelvic inflammatory disease 65.0
260 Acute pelvic inflammatory disease 65.0
261 Medullary thyroid cancer 64.0
262 Anemia of chronic disease 64.0
263 Hemorrhagic stroke 62.0
264 Ischemic optic neuropathy 62.0
265 posteriorischemic optic neuropathy 62.0
266 Allergic rhinitis 61.0
267 Analgesic nephropathy 61.0
268 Pyelonephritis 61.0
269 Acute disseminated encephalomyelitis 61.0
270 Psoas Abscess 61.0
271 Hypothyroidism 60.0
272 Mitral Stenosis 59.0
273 Anaplastic thyroid cancer 59.0
274 Acalculous Cholecystitis 59.0
275 Labyrinthitis 59.0
276 Candidal intertrigo 59.0
277 Candida Balanitis 59.0
278 Oropharyngeal and esophageal candidiasis 59.0
279 Vulvovaginal candidiasis 59.0
280 Oral candidiasis 59.0
281 Gastroesophageal reflux disease 58.0
282 Clonorchiasis 58.0
283 Goiter 57.0
284 Diffuse nontoxic goiter 57.0
285 Obstructive cervical goiters 57.0
286 Cervical goiter 57.0
287 Psychogenic polydipsia 57.0
288 Rheumatoid Arthritis 56.0
289 Periorbital and orbital cellulitis 56.0
290 Angle Closure Glaucoma 55.0
291 Multiple Myeloma 55.0
292 Multiple Sclerosis 54.0
293 Intraperitoneal bleeding 53.0
294 Premenstrual syndrome 52.0
295 Endometrial cancer 50.0
296 Hepatorenal Syndrome 50.0
297 Hyperprolactinemia 50.0
298 Breast Cancer 50.0
299 Subdural hematoma 50.0
300 Hypogammaglobulinemia 49.0
301 Autosomal Recessive Polycystic Kidney Disease 49.0
302 Chronic Mitral regurgitation 48.0
303 Acute Lymphocytic Leukemia in Adults 47.0
304 Gilbert syndrome 46.0
305 Gastric Volvulus 45.0
306 Animal bites 45.0
307 Osteoarthritis 45.0
308 biliary colic 44.0
309 Osteoporosis 44.0
310 Meniere disease 43.0
311 Central diabetes insipidus 43.0
312 Nephrogenic diabetes insipidus 43.0
313 Paraneoplastic Syndromes 42.0
314 Bladder Cancer 42.0
315 Leiomyomas 41.0
316 Fungal meningitis 41.0
317 Fibromyalgia 41.0
318 Pseudohypoparathyroidism 41.0
319 Systemic vasculitis 39.0
320 Deep venous thrombosis 39.0
321 Common cold(children) 38.0
322 Renal Cell Carcinoma 38.0
323 Aortic coarctation 38.0
324 Atypical pneumonia 37.0
325 Herpes zoster 37.0
326 Ruptured ovarian cyst 36.0
327 Testicular cancer 35.0
328 Endometriosis 34.0
329 Acute Rhinosinusitis 34.0
330 Alopecia areata 34.0
331 Acute viral rhinosinusitis 34.0
332 Non-alcoholic Fatty Liver Disease 32.0
333 Splenic Infarction 32.0
334 Primary ciliary dyskinesia 32.0
335 Kartagener syndrome 32.0
336 Umbilical hernia 32.0
337 Balanitis 31.0
338 Exocrine pancreatic insufficiency 30.0
339 Autoimmune hemolytic anemia 30.0
340 Pharyngitis 30.0
341 Herpes pharyngitis 30.0
342 Insomnia in adults 30.0
343 Preeclampsia 30.0
344 Stroke 30.0
345 Achilles tendinopathy 30.0
346 Achilles tendon rupture 30.0
347 Liver Abscess 30.0
348 Chronic Lymphocytic Leukemia 29.0
349 Secondary hyperparathyroidism 29.0
350 Cellulitis 29.0
351 Psoriasis 28.0
352 Urinary Tract Obstruction 28.0
353 cholestatic liver disease 27.0
354 Viral pharyngitis 27.0
355 Erectile dysfunction 27.0
356 Bed bugs 26.0
357 Common cold(adults) 25.0
358 Candidiasis 25.0
359 Achalasia 24.0
360 Tinnitus 22.0
361 Laryngeal Cancer 22.0
362 Chronic liver disease 21.0
363 Miliaria 21.0
364 chronic cholestatic liver disease 20.0
365 Abnormal uterine bleeding 20.0
366 Nasal polyps 20.0
367 Chronic meningitis 20.0
368 Angiodysplasia of the colon 20.0
369 Morton neuroma 20.0
370 Chronic Cholecystitis 18.0
371 Renal Artery Stenosis 18.0
372 Croup 18.0
373 Acute cervical spine trauma 18.0
374 Phenylketonuria 18.0
375 Limited cutaneous systemic sclerosis 17.0
376 Atopic dermatitis 16.0
377 Epiploic appendagitis 15.0
378 Mitral Valve Prolapse 14.0
379 Erythema nodosum 14.0
380 Simple kidney cyst 12.0
381 Tuboovarian abscess 11.0
382 Epidemic keratoconjunctivitis 11.0
383 Rotor syndrome 11.0
384 Thyroid lymphoma 10.0
385 Premature labor 10.0
386 Hemorrhoids 9.0
387 Psoriatic arthritis 9.0
388 Alzheimer disease 9.0
389 Middle East respiratory syndrome 9.0
390 Immune thrombocytopenia 9.0
391 Acute Bacterial Prostatitis 9.0
392 Bullous pemphigoid 9.0
393 Budd Chiari Syndrome 8.0
394 Splenic abscess 8.0
395 Musculoskeletal sprains and strains 8.0
396 Acute Bronchitis 7.0
397 Discogenic low back pain 6.0
398 Von willebrand disease 6.0
399 Dacryocystitis 5.0
400 Ramsay Hunt syndrome 3.0
401 Chlamydia pneumoniae infection 1.0
402 Recurrent aphthous stomatitis 0.0
403 Myasthenia Gravis 0.0
404 Congenital Myasthenic Syndromes 0.0
405 Neonatal Myasthenia Gravis 0.0
406 Conjunctivitis 0.0
407 Bacterial conjunctivitis 0.0
408 Viral conjunctivitis 0.0
409 Allergic conjunctivitis 0.0
410 Ligneous conjunctivitis 0.0
411 Vernal keratoconjunctivitis 0.0
412 Atopic keratoconjunctivitis 0.0
413 Noninfectious nonallergic conjunctivitis 0.0
414 Acute epididymitis 0.0
415 Acute Cystitis(Men) 0.0
416 Transient ischemic attack 0.0
417 Carpal Tunnel Syndrome 0.0
418 Bell palsy 0.0
419 Optic neuritis 0.0
420 Neuropapillitis 0.0