18 DIARRHEA General Discussion Diarrhea is a change in stools, usually defined clinically as the passage of 3 or more loose or watery stools or 1 or more bloody stool in 24 hours. Acute diarrhea lasts less than 14 days, persistent diarrhea lasts more than 14 days, and chronic diarrhea lasts more than 1 month. Patients who present with acute diarrhea are more likely to have an infectious cause. Patients with chronic diarrhea have a much broader group of diagnoses to consider. The list below provides an outline of most causes for diarrhea. Most cases of acute diarrhea are self-limited and do not require further evaluation. Indications for stool studies in acute diarrhea include fever, bloody diarrhea, history of travel to an endemic area, recent antibiotic use, a history of inflammatory bowel disease, exposure to infants in day care centers, and a history of anal intercourse. If the patient does not meet these criteria but the diarrhea persists for more than a few days, a more detailed evaluation is warranted. The medical history is the key to the evaluation of most patients presenting with diarrhea and can help guide the diagnostic work-up. Important historical features are outlined below. Medications That May Cause Diarrhea • Antacids containing calcium or magnesium • Antibiotics • Colchicine • Enteral tube feeds • Laxatives • Sorbitol gums (acarbose) Causes of Diarrhea Bacteria • Aeromonas • Campylobacter • Clostridium difficile • Enterotoxigenic E. coli • Other E. coli • Salmonella (non-typhoid) • Shigella • Tuberculosis • Vibrio (non-cholera) Congenital syndromes Diabetic autonomic neuropathy Diverticulitis Endocrine causes • Addison’s disease • Carcinoid syndrome • Gastrinoma • Hyperthyroidism • Mastocytosis • Medullary carcinoma of the thyroid • Somatostatinoma • VIPoma Ileal bile acid malabsorption Inflammatory bowel disease Intestinal ischemia Irritable bowel syndrome Malabsorption syndromes • Carbohydrate malabsorption • Celiac disease • Short bowel syndrome Malignancy • Colon cancer • Lymphoma Medications Other • Mixed infection Pancreatic exocrine insufficiency Parasites • Cryptosporidium Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA GYNECOMASTIA INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on DIARRHEA Full access? Get Clinical Tree
18 DIARRHEA General Discussion Diarrhea is a change in stools, usually defined clinically as the passage of 3 or more loose or watery stools or 1 or more bloody stool in 24 hours. Acute diarrhea lasts less than 14 days, persistent diarrhea lasts more than 14 days, and chronic diarrhea lasts more than 1 month. Patients who present with acute diarrhea are more likely to have an infectious cause. Patients with chronic diarrhea have a much broader group of diagnoses to consider. The list below provides an outline of most causes for diarrhea. Most cases of acute diarrhea are self-limited and do not require further evaluation. Indications for stool studies in acute diarrhea include fever, bloody diarrhea, history of travel to an endemic area, recent antibiotic use, a history of inflammatory bowel disease, exposure to infants in day care centers, and a history of anal intercourse. If the patient does not meet these criteria but the diarrhea persists for more than a few days, a more detailed evaluation is warranted. The medical history is the key to the evaluation of most patients presenting with diarrhea and can help guide the diagnostic work-up. Important historical features are outlined below. Medications That May Cause Diarrhea • Antacids containing calcium or magnesium • Antibiotics • Colchicine • Enteral tube feeds • Laxatives • Sorbitol gums (acarbose) Causes of Diarrhea Bacteria • Aeromonas • Campylobacter • Clostridium difficile • Enterotoxigenic E. coli • Other E. coli • Salmonella (non-typhoid) • Shigella • Tuberculosis • Vibrio (non-cholera) Congenital syndromes Diabetic autonomic neuropathy Diverticulitis Endocrine causes • Addison’s disease • Carcinoid syndrome • Gastrinoma • Hyperthyroidism • Mastocytosis • Medullary carcinoma of the thyroid • Somatostatinoma • VIPoma Ileal bile acid malabsorption Inflammatory bowel disease Intestinal ischemia Irritable bowel syndrome Malabsorption syndromes • Carbohydrate malabsorption • Celiac disease • Short bowel syndrome Malignancy • Colon cancer • Lymphoma Medications Other • Mixed infection Pancreatic exocrine insufficiency Parasites • Cryptosporidium Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA GYNECOMASTIA INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on DIARRHEA Full access? Get Clinical Tree
