Diarrhea

Question 1

Differentials

Answer 1

Irritable bowel syndrome
Inflammatory bowel disease
Acute Gastroenteritis 
Celiac Disease
Carcinoid Tumor
COLORECTAL CANCER

Question 2

IBS

Answer 2

• NON-INFLAMMATORY diarrhea
• Alternating patterns of Constipation and Diarrhea
• Abdominal pain
• Pain relieved after bowel movement
• NO vomiting or weight loss
• Abdominal bloating and flatus

Question 3

IBD

Answer 3

• BLOODY (INFLAMMATORY) diarrhea
• Diarrhea lasts for few months (persistent or chronic)
• Oral ulcers **
• weight loss

Question 4

Colorectal cancer

Answer 4

• Weight Loss
• Inflammatory (blood in the stool)
• CHRONIC diarrhea
• Fatigue
• Family History

Question 5

Carcinoid Tumor

Answer 5

• Bloody Diarrhea
• Flushing (Redness, or feeling of warmth in the skin)
• Nausea/ Vomiting
• Abdominal pain

Question 6

Celiac Disease

Answer 6

Symptoms triggered by gluten-based foods
Watery oily/frothy foul-smelling diarrhea
Flatulence and Borborygmus
Weight loss
Fatigue
Dermatitis herpetiformis
Neurologic symptoms: weakness, sensory loss and ataxia

Question 7

Plan

Answer 7

1. CBC
2. Colonoscopy (for IBD)
3. Stool Culture
4. Blood test (for parasites)
5. Urine Test (5-HIA for Carcinoid tumor)

Question 8

PE

Answer 8

Inspection
 Contour and symmetry
 Skin
 Umbilicus
 Abnormal movements (pulsations or peristalsis)
 Assess for hernia

Auscultation
 Bowel Sounds
 Bruits
o Aortic
o R + L Renal
o R+ L Iliac

General Percussion
 All nine regions

General Palpation
 Superficial (light) palpation for tenderness, guarding or rigidity
 Deep palpation for masses
Organomegaly
 Liver
o Percuss the liver span
o Palpate the liver edge
 Kidneys
 Spleen
o Percuss the spleen
o Palpate the spleen

Question 9

Additional exam

Answer 9

Auscultate for heart sound

recheck HR, RR, BP