Approach to Acute Diarrhea

Question 1

what is gastroenteritis?

Answer 1

inflammation of the stomach and small intestine

Question 2

what is diarrhea?

Answer 2

≥ 3 watery or loose BM in 24h OR at least 200g of stool per day

Question 3

ddx for acute diarrhea

Answer 3

infectious causes
- viral: rotavirus (children, decrease bc of vaccination), norovirus (most common; adults), adenovirus, and astrovirus
- bacterial: Shiga toxin-producing E. coli, salmonella, Listeria, campylobacter, Shigella
- parasitic: giardia, Entamoeba histolytica, roundworm
- drugs: antacids, abx, laxatives
- toxins
inflammatory causes
- IBD

Question 4

explain osmotic/malabsorption diarrhea

Answer 4

1. impaired absorption of substances bc loss of brush border enzymes
2. osmotically active substances remain in the lumen of the intestines
3. water is drawn into the intestines
4. increased watery stool

Question 5

explain secretory diarrhea

Answer 5

1. destroy enterocytes in the GI epithelium
2. disrupted luminal ion channels
3. disordered electrolyte transport – can be increased secretion or decreased absorption of ions
4. secretory diarrhea

Question 6

what are general s/s of gastroenteritis?

Answer 6

N/V, diarrhea, vomitting, abdo pain and fever

Question 7

what s/s are more intense in a bacterial cause vs a viral cause of gastroenteritis?

Answer 7

bacterial causes have more of a fever and abdo pain presentation

Question 8

what are some red flag s/s of gastroenteritis?

Answer 8

• dehydration s/s: dry mucous membranes, decrease skin turgor, hypotension, and orthostasis
• altered mental status
• tachycardia
• bloody stools
• decrease urine output

Question 9

what ix would we order to determine the cause of gastroenteritis?

Answer 9

1. good hx ➔ travel hx, food/diet hx, sick contacts, housing situation, vaccinations, PMHx, recent abx use, occupational, recent hospitalizations
2. physical ➔ fluid status
3. infectious w/u
   - stool culture, c. diff toxin, ova and parasite, helminths (for special travel parasites)

Question 10

how to manage acute diarrhea

Answer 10

1. if hypotensive/dehydrated ➔ rehydration; attempt oral, if not sufficient, IV and admit
2. fix electrolytes if deranged
3. could consider antiemetic (ondansteron)
4. pt education on food safety and hand hygiene
5. BRAT diet (bananas, rice, applesauce, and toast)

viral cause – usually self limiting

bacterial cause – empiric abx w/ azithromycin or cipro for severe disease or host factors (>70Y, immunocomp, etc.)