Differenzialdiagnose der Diarrhö

 

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Zusammenfassung

Durchfallerkrankungen sind häufig, ihre Differenzialdiagnosen ungewöhnlich vielfältig. Der Beitrag vermittelt Ansätze für ein rationales und rationelles Vorgehen, ausgehend von den praktischen Möglichkeiten bei der akuten und bei 4 Schlüsselfragen der chronischen Diarrhö. Der Einsatz moderner Bildgebung (Endoskopie, Sonografie) wird ebenso diskutiert wie infektiologische Aspekte und funktionsdiagnostische Verfahren. Ziel des Beitrags ist es, betroffenen Patienten möglichst sinnvoll zu einer präzisen Diagnose zu verhelfen. Dies beinhaltet eine transparente und gezielte ärztliche Strategie, die punktuelle Eingebungen zur Differenzialdiagnose („trial and error“) ebenso vermeidet wie umfängliche Überdiagnostik bei vermeintlicher Diarrhö. Die Kenntnis der Einsatzmöglichkeiten indizierter diagnostischer Verfahren, die evtl. in der Praxis nicht selbst durchgeführt werden (können) und ihrer Voraussetzungen/Limitationen ist hierfür ein wesentlicher Baustein. Das Fundament für den Einsatz derartiger Methoden und den Schlüssel zu kosteneffektiver Diagnostik bilden für die Differenzialdiagnose von Durchfallerkrankungen in besonderem Maße die Anamnese und einfache Tests.

Abstract

Diarrhoea is a common symptom and numerous differential diagnoses must be considered. This article illustrates approaches for a rational and efficient work-up based on practical facilities in acute diarrhoea and fostered by 4 key questions scrutinising chronic diarrhoea. The applications of imaging methods (endoscopy, ultrasonography) are discussed along with infectious topics and function testing. The aim of this contribution is to help patients to get a precise diagnosis in a most rational way. This implies a transparent and targeted medical strategy, avoiding selective intuitions (“trial and error”) as well as extensive diagnostic overdoing in the case of only putative diarrhoea. Knowing the potential of diagnostic methods which are (or can) possibly not performed regularly in the physician's office, and their requirements/limitations is an important component in this situation. The basic fundament for application of such methods, however, and the clue to economic diagnosis as well as the differential diagnosis of diarrhoeal diseases are the history and simple tests.

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