ASGE Annual GI Advanced Practice Provider Course (On-Demand) - Clinical Case-Based Learning (Day Two) | April 2023-Evaluation of Acute and Chronic Diarrhea

Pdf Summary

Acute diarrhea is defined by increased liquidity, frequency, or decreased consistency of stools, typically occurring at least 3 times in a 24-hour period. Most cases resolve with symptomatic treatment and are of infectious origin, caused by viruses, bacteria, or protozoa. Evaluation includes assessing the duration and frequency of symptoms, associated symptoms, potential exposures, medical and sexual history, and physical examination for volume depletion. Antibiotic exposure and immunocompromised status are also considered. Supportive measures, oral hydration, and a bland diet are recommended, and empiric antibiotic treatment is reserved for select patients.<br /><br />Chronic diarrhea is characterized by persistent alterations in stool consistency and increased frequency, lasting for over 4 weeks. It accounts for 30% of patients in gastroenterology practices and can be categorized as malabsorptive, secretory, inflammatory, motility-related, or osmotic. Malabsorptive diarrhea results from nonabsorbable solutes, carbohydrate malabsorption, bile acid diarrhea, or pancreatic insufficiency. Secretory diarrhea is due to abnormal electrolyte movement, often caused by bile acids, while inflammatory diarrhea arises from inflammation of the small bowel or colonic mucosa. Motility-related diarrhea involves deranged motility affecting fluid absorption, and osmotic diarrhea results from poorly absorbable osmotically active solutes in the gut lumen.<br /><br />When evaluating chronic diarrhea, a thorough history is crucial, including duration, frequency, consistency, medication use, previous surgeries, and risk factors. Red flags that warrant further evaluation include anemia, rectal bleeding, unexplained weight loss, nocturnal pain or diarrhea, and abnormal laboratory results. Diagnosis involves blood tests, stool studies, endoscopy with biopsies, and radiological imaging. Treatment aims to address the underlying cause and may involve empiric therapy, such as lactose restriction or cholestyramine for bile acid diarrhea.<br /><br />In conclusion, most acute diarrhea cases are self-limited and require volume repletion. Empiric antibiotic treatment is generally not recommended. Chronic diarrhea necessitates a meticulous history, and the most common causes are IBS, IBD, malabsorption syndromes, and chronic infections. Red flags should prompt further evaluation, and management focuses on treating the underlying etiology.

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Jill Olmstead, DNPc, ANP-BC, CCS-P, FAANP

Keywords

acute diarrhea

infectious origin

chronic diarrhea

malabsorptive

secretory

inflammatory

motility-related

osmotic

red flags

management