clinical approach to diarrhea Flashcards
what is diarrhea defined by ?
diarrhea is defined as reduced stool consistency, increased water content and number of evacuations per day
what is the definition of chronic diarrhea ?
production of loose stools for more than 4 weeks
what is the prognosis of acute diarrhea ?
acute diarrhea is usually self limiting ( less than 4 weeks)
what is the most likely cause of acute diarrhea ?
an infectious cause is the most common cause
what is the most important step in management of acute diarrhea ?
hydration/rehydration preferably oral
when do we consider antibiotics for acute diarrhea ?
only when the patient is above the age of 65
immunocompromised
has severe bloody diarrhea
septic
or diarrhea that has lasted for more than 10 days
what are the characteristics of each diarrhea type ?
- watery diarrhea : either caused by secretory process osmotic process or both
- fatty diarrhea : bulky smelly pale stool which is difficult to flush
- inflammatory: loose stools with lots of blood
what are things to look for during examination ?
signs of dehydration signs of malnourishment and vitamin deficiency signs of thyroid disease anorectal examination extra-intestinal manifestations
what are the lab tests that may be required for diarrhea ?
CBC and differential stool analysis, stool culture and sensitivity TSH and free T4 Serum electrolyte CRP
what additional lab tests might be required ?
fecal calprotectin
celiac serology
giardia stool antigen
HIV seromarkers
when is upper endoscopy indicated ?
malabsorption syndromes
what are the alarming features if present require endoscopic evaluation ?
age of onset >50 years rectal bleeding or melena progressive abdominal pain unexplained weight loss family history of IBD lab abnormalities
