ASGE Annual GI Advanced Practice Provider Course - Day Two (On-Demand) | April 2022-16_Evaluation of Patient with Diarrhea

16_Evaluation of Patient with Diarrhea - Heagy

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The document discusses the evaluation of patients with diarrhea. Diarrhea is defined as increased liquidity, frequency, or decreased consistency of stools and is characterized by loose or watery stools occurring at least three times in a 24-hour period. The duration of diarrhea can be acute (14 days or fewer), persistent (more than 14 but fewer than 30 days), or chronic (more than 30 days). <br /><br />In cases of acute diarrhea, most are of infectious etiology and can be managed with symptomatic treatment alone. Common infectious causes include viruses (such as norovirus and rotavirus), bacteria (such as salmonella and campylobacter), and protozoa (such as cryptosporidium and giardia). Evaluating acute diarrhea involves taking a detailed history, performing a physical exam, and considering the need for infectious stool studies and other laboratory tests.<br /><br />Chronic diarrhea, which accounts for 30% of patients in GI practices, can have various underlying causes. It is categorized as malabsorptive/maldigestive, secretory, inflammatory, motility-related, or osmotic. Evaluation of chronic diarrhea involves a meticulous history, physical exam, and diagnostic testing, including blood tests, stool studies, endoscopy, and radiology as necessary. The management of chronic diarrhea aims to treat the underlying cause and may involve empiric therapy and symptomatic treatment.<br /><br />Alarm features in patients with chronic diarrhea that warrant further evaluation include age of onset after 50, rectal bleeding or melena, unexplained weight loss, iron deficiency anemia, and a family history of inflammatory bowel disease or colon cancer.<br /><br />The document emphasizes the importance of a thorough history in aiding diagnosis and highlights the most prevalent causes of chronic diarrhea, such as irritable bowel syndrome, inflammatory bowel disease, malabsorption syndromes, and chronic infections. The most critical therapy for diarrheal illness is volume repletion, and empiric antibiotic treatment for acute diarrhea is not recommended unless there are high-risk features.

Keywords

diarrhea

acute diarrhea

chronic diarrhea

infectious etiology

infectious stool studies

malabsorptive/maldigestive

inflammatory diarrhea

alarm features

irritable bowel syndrome

volume repletion