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diarrhea

Classification: - acute diarrhea - chronic diarrhea - infectious diarrhea - traveler's diarrhea - diarrhea in patients with AIDA - osmotic diarrhea - secretory diarrhea - inflammatory diarrhea [1] - malabsorptive diarrhea (see steatorrhea) Etiology: - acute diarrhea (< 2 weeks duration) is generally infectious diarrhea - chronic diarrhea (> 4 weeks duration) is generally non-infectious History: 1) onset 2) duration 3) frequency 4) volume 5) timing (daytime only with mucous stools suggests irritable bowel syndrome) 6) fever 7) abdominal pain 8) cramping 9) tenesmus 10) nausea/vomiting 11) ability to keep foods down 12) bloating 13) light-headedness 14) myalgias 15) arthralgia 16) headache 17) buoyancy 18) blood or mucus 19) pus 20) oily? 21) odor 22) spoiled, raw or undercooked poultry (Salmonella) 23) milk 24) seafood 25) restaurants 26) travel 27) effect of fasting (fasting decreases osmotic diarrhea, but has no effect on secretory diarrhea) 28) laxative abuse 29) ill contacts 30) diabetes 31) inflammatory bowel disease 32) alcoholism 33) hyperthyroidism 34) family history of celiac disease 35) immunodeficiency or immunosuppression Management: 1) see specific etiology a) acute diarrhea b) chronic diarrhea c) infectious diarrhea 2) see antidiarrheal agent - anti-motility agents contraindicated with bloody or inflammatory diarrhea* 2) antibiotic treatment of mild diarrhea does not expedite recovery & may prolong shedding of Salmonella [1] * toxic megacolon is complication

Related

antidiarrheal agent pharmaceutical agents associated with diarrhea

Specific

acute diarrhea bloody diarrhea; inflammatory diarrhea chronic diarrhea congenital diarrhea diarrhea in patients with AIDS hereditary diarrhea HIV1/AIDS-associated diarrhea infectious diarrhea; infectious colitis osmotic diarrhea secretory diarrhea traveler's diarrhea

General

intestinal disease sign/symptom

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2018.
  2. Kent AJ, Banks MR. Pharmacological management of diarrhea. Gastroenterol Clin North Am. 2010 Sep;39(3):495-507 PMID: 20951914
  3. Sweetser S. Evaluating the patient with diarrhea: a case-based approach. Mayo Clin Proc. 2012 Jun;87(6):596-602. PMID: 22677080 Free PMC Article
  4. Schiller LR. Diarrhea and malabsorption in the elderly. Gastroenterol Clin North Am. 2009 Sep;38(3):481-502. Review. PMID: 19699409
  5. ARUP Consult: Diarrhea The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/diarrhea - ARUP Consult: Diarrhea in Healthy Pediatric Patients Testing Algorithm https://arupconsult.com/algorithm/diarrhea-healthy-pediatric-patients-testing-algorithm - ARUP Consult: Diarrhea in Hospitalized Adult Patients Testing Algorithm https://arupconsult.com/algorithm/diarrhea-hospitalized-adult-patients-testing-algorithm - ARUP Consult: Diarrhea in Immunocompromised Hosts Testing Algorithm https://arupconsult.com/algorithm/diarrhea-immunocompromised-hosts-testing-algorithm - ARUP Consult: Diarrhea in Primary Care Adults Testing Algorithm https://arupconsult.com/algorithm/diarrhea-primary-care-adults-testing-algorithm - ARUP Consult: Diarrhea in Returned Traveller or Immigrant Testing Algorithm https://arupconsult.com/algorithm/diarrhea-returned-traveller-or-immigrant-testing-algorithm
  6. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Diarrhea https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea