Definition
• Frequent, watery stools. Specifically, >3 loose stools/day OR >250 mL water in stool/day.
Approach
• Nature: Bloody, mucus present, duration, frequency, volume; recent travel or abx
• Labs: Consider BMP for electrolyte derangement; consider CBC, LFTs, heme occult
Infectious Diarrhea
History
• Diarrhea ± blood/fever, recent ingestion of meats/poultry/dairy/shellfish/sea food/unrefrigerated food, sick contacts, recent travel (last 6 mo), antibiotic use
• Invasive bacterial enteritis is a clinical Dx: Fever, blood in stool, tenesmus, abd pain
Physical Findings
• Dehydration, mild abd tenderness. If invasive: Heme-positive stool, fever.
Evaluation
• Labs: Increased WBC (Salmonella), low WBC (Shigella), eosinophilia (parasites) hypokalemia, metabolic acidosis
• Stool culture, fecal WBC & O&P appropriate if ill appearing, severe diarrhea, extremes of age, chronic, or immunocompromised
Treatment
• IV fluid resuscitation if needed, electrolyte repletion
• Abx: TMP-SMX, ciprofloxacin or azithromycin (recent travel, ill appearing, fever, immunocompromised), OR metronidazole (C. difficile, Giardia, E. histolytica)
• Antimotility agents may be used for traveler’s diarrhea
• Constipating diet (BRAT: Bananas, rice, applesauce, toast) for a short time
Disposition
• Admit if unable to keep up w/ volume loss or toxic
Pearl
• Significant abdominal pain in not common & should be evaluated further
Irritable Bowel Syndrome
Definition: Disorder of the colon: Causes cramping, bloating, diarrhea, constipation (F > M)
History: Must have recurrent abdominal pain >3 d/mo over the last 3 mo. Plus 2 or more of the following: Improvement w/ defecation, onset w/ change in frequency of stools, onset w/ change in form of stools. No constitutional sxs.
Physical Findings: May have mild lower abdominal tenderness, heme-negative stools
Treatment: Fiber for constipation, antimotility for diarrhea, antispasmodics (Bentyl) for pain
Disposition: D/c, outpt management
Pearl: Dx of exclusion. Unlikely if age of onset >35 or associated constitutional sxs.