Diarrhea Diarrhea Acute Diarrhea • Passage of abnormally liquid or unformed stools at an increased frequency, stool mass and fluidity Persistent 90 % caused by infectious agents 10% other causes Chronic Inflammatory Acute Diarrhea Noninflammatory Inflammatory Non-Inflammatory Patient Stool Characteristics -Loose to watery - Often with blood, pus, or mucus -Watery - Without blood or mucus -foul smelling -watery Associated Symptoms -Lower abdominal cramping pain -often rectal urgency -tenesmus -fever -Nausea -vomiting -periumbilical cramping pain -Temperature normal or slightly elevated -crampy abdominal pain -Temp= 37.5C Common Pathogens Colonization or invasion of intestinal mucosa -nontyphoid Salmonella, Shigella, Yersinia, Campylobacter, enteropathic E. coli, Entamoeba histolytica Toxic producing bacterium -E.coli, S. aureus, B. cereus, C. perfringens, Giardia BATE’S Guide to Physical Examination and History Taking 10th ed p458 Infectious Noninflammatory Noninfectious Non-infectious Patient Medications (commonly) -antibiotics -antihypertensives -certain antidepressants -bronchodilators -laxatives none -cardiac antidysrhythmics -NSAIDs -chemotherapeutic agents -antacids Occlusive or non-occlusive ischemic colitis Watery then bloody diarrhea, vomiting, nausea, abdominal pain Occulisive ischemic colitis- emboli which is cardiac in origin, recent MI, atrial fibrillation Non-occlusive ischemic colitis- occurs in older (50+y/o) patients; respiratory failure, severe hypotension from cardiogenic or septic shock 68 years old Crampy abdominal pain Watery diarrhea only Vomiting, dizziness T=37.5 No dyspnea, colds, hemoptysis, chest heaviness, palpitations and orthopnea Toxin Ingestion -organophosphate insecticides -amanita and other mushrooms -arsenic -preformed environmental toxins in seafood, such as ciguatera and scombroid none Inflammatory Acute Diarrhea Noninflammatory Infectious Noninflammatory Noninfectious Viral Infectious Bacterial Parasitic • Patient Infectious – Vomiting – Abdominal pain – T=37.5 – Watery stools – Onset: 1hr after eating Anne Concepcion Pozon Viral Infectious Bacterial Parasitic Bacillus cereus Bacteria Staphyloccocus aureus Diarrhea Acute NonInflammatory Infectious Viral Bacterial Parasitic Chronic Inflammatory NonInfectious Occlusive or Non Occlusive Ischemic Colitis Toxic Ingestion Medications Infectious NonInfectious Secretory Inflammatory Osmotic Dysmotile Steatorrheal Factitial Iatrogenic