Change in the consistency of stool (loose watery stools)
Increased frequency of defecation
More than 200g of stool in 24 hours
Diarrhea
The crucial clue or pivotal information you have to elicit in order to diagnose diarrhea is the
ONSET and DURATION of the diarrhea
Type of diarrhea that suddenly develops usually 1-2 days and lasts for less than 2 weeks
Acute diarrhea
duration of 4 weeks or more
Chronic diarrhea
ALARM SYMPTOMS
Weight loss (sudden)
Fever (may point to an infectious problem that will need antibiotics)
Bloody stools (may point to a structural problem like colonic CA or inflammatory bowel disease)
Awakening from sleep (may point to colonic CA)
Family history of cancer, IBD, MEN (multiple endocrine neoplasm) and celiac disease
Age >50
Immunocompromised host
Non-infectious cause of acute diarrhea
Medications/ingested substances 10 % of cases Always ask the past medical history Intake of diarrhea-inducing drugs: Laxatives Chemotherapy drugs Antibiotics Metformin
Malabsorption
May due to intestinal resection (increase transit time)
Post-operative diarrhea
Infectious origin of acute diarrhea
- Viral
Most common cause is viral
Adults: Norovirus
Pedia: Rotavirus
Self-limiting and does not need antibiotic
- Bacterial
- Toxin-mediated
Appearance of stools
Greenish: Entamoeba histolytica (ameobiasis)
Rice watery/ White/Cloudy/Milky: Cholera
Red/Bloody: Invasive bacterial disease like
Shigella, Salmonella, EHEC
Non bloody: Viral cause
Amount/ Volume
Voluminous: Small intestines
Small in amount: Large intestines
Steatorrhea: Floating (high in fat or oil), voluminous and yellow
Strong urge or sensation to defecate without actually defecating
Tenesmus
Tenesmus and diarrhea
Proctitis
Ameobiasis
Shigellosis
Vomiting before diarrhea (prominent nausea and vomiting)
Mild abdominal cramping
Low grade fever
The stool is not bloody
is the most common (80% of infectious gastroenteritis)
Do they need antibiotics? DEFINITELY NOT. Tell patient that it is a SELF-LIMITING DISEASE and that they only should replace the fluid that was lost.
What is the most common viruses involved? ROTAVIRUS and NOROVIRUS.
Viral cause of diarrhea
BM >6x per day
Higher fever than viral cause
Depending on etiology, dysentery may occur specially if it is SHIGELLA
some etiologies of bacterial gastroenteritis? E.COLI, SALMONELLA, VIBRIO, SHIGELLA
Bacterial cause of diarrhea
Similar presentation as viral gastroenteritis with RECENT SUSPECT FOOD INTAKE
What will you ask if you are considering? LAST MEAL INTAKE or TYPE OF FOOD na kinain niya
Less than 12hrs from food intake, usually, nagdidiarrhea na agad yan
What type of foods? PROTEIN RICH FOODS, FOODS WITH DAIRY PRODUCTS
What bacterial agent is involved in reheated rice? BACILLUS. What about in meat? CLOSTRIDIUM PERFRINGENS
toxin-mediated diarrhea
Susceptible ethnic background (Asians, Africans, Middle Easterns, Mediterraneans, Caucasians)
Chronic symptoms of belching, bloating, flatulence, diarrhea, or abdominal pain
Acute onset with infection or dietary change (Infection can trigger the diarrhea without intake of lactose containing foods)
Tx: Lactose free diet
Lactose intolerance
Nausea and vomiting are rare
2 types: Not associated with Clostridium difficile and Clostridium difficile infection (CDI)
Not associated with clostridium difficile: mild diarrhea
CDI: presence of risk factors like advance age, recent hospitalization and antibiotic use
Any antibiotic can cause diarrhea
Most common: Clindamycin (notorious) Cephalosporin, Ampicillin, Amoxicillin and Co-amoxyclav
What other drugs aside from your antibiotics that can cause CDI? PPI’s
Why do we need to differentiate between CDI and non clostridium associated diarrhea? TREATMENT. CDI will need antibiotics. Non-clostridium diarrhea will not need antibiotics, but you can give probiotics.
ANTIBIOTIC ASSOCIATED DIARRHEA
Acute or chronic diarrhea
Nausea, abdominal cramping, bloating, flatulence
Foul-smelling, greasy stools (giardiasis can cause malabsorption, that’s why greasy ang stools)
Weight loss
(due to chronic giardiasis and malabsorption)
Exposure to infected water supplies
Giardiasis
Thirst
Dry mouth
Decreased axillary sweat
Decreased UO
Ask how often or how many times he/ she went to urinate
Ask color of urine
Concentrated: Orange
Slight weight loss
Mild dehydration
Orthostatic hypotension
Skin turgor
Skin remains elevated after being pulled and released
Sunken eyeballs
Moderate dehydration
Lethargic/Obtunded
Lethargic: Apathetic
Obtunded: Borderline to comatose and responds to painful stimuli
Feeble/ Thready pulse
Hypotension
Frank shock
Severe dehydration
No identifiable cause
Functional
