ASGE Annual GI Advanced Practice Provider Course (Virtual) - Clinical Case-Based Learning (Day Two) | March 2024-Evaluation Patient Acute and Chronic Diarrhea

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This document discusses acute and chronic diarrhea, providing information on their definitions, evaluation, and management. Acute diarrhea is characterized by increased liquidity, frequency, or decreased consistency of stools, lasting for less than two weeks. It is often caused by infectious agents such as viruses, bacteria, and protozoa. Evaluation involves assessing symptoms, potential exposures, medical history, physical examination, and laboratory testing. Supportive measures, oral hydration, and symptomatic treatment are the main management strategies for acute diarrhea.<br /><br />Chronic diarrhea is defined as a persistent alteration in stool consistency and increased frequency for at least four weeks. It can be categorized into malabsorptive, secretory, inflammatory, motility-related, or osmotic diarrhea. Malabsorptive diarrhea is caused by nonabsorbable solutes or impaired digestion, while secretory diarrhea involves abnormal movement of electrolytes. Inflammatory diarrhea results from inflammation of the gut, and motility-related diarrhea is associated with deranged bowel motility. Osmotic diarrhea occurs due to poorly absorbable osmotically active solutes.<br /><br />The evaluation of chronic diarrhea includes a detailed history, physical examination, blood tests, stool studies, endoscopy, and radiology. Identifying the underlying cause is crucial for appropriate management. Treatment involves addressing the underlying etiology and providing empiric therapy based on the specific cause. Medications, dietary modifications, and symptomatic therapy may be prescribed.<br /><br />Alarm features in patients with chronic diarrhea, such as age of onset after 50, rectal bleeding, unexplained weight loss, and iron deficiency anemia, require further evaluation with endoscopy and imaging. Common causes of chronic diarrhea include irritable bowel syndrome, inflammatory bowel disease, malabsorption syndromes, and chronic infections. Less common and rare causes include immune-mediated colitis, hormonal imbalances, autonomic neuropathy, and medications.<br /><br />In summary, acute diarrhea is usually self-limiting, and treatment focuses on supportive measures. Empiric antibiotic therapy is not recommended unless high-risk features or hosts are present. Alarm features in chronic diarrhea require endoscopic evaluation and imaging. Meticulous history-taking is essential for the diagnosis of chronic diarrhea. The most prevalent causes are irritable bowel syndrome, inflammatory bowel disease, malabsorption syndromes, and chronic infections. Evaluation and management should be tailored to the specific cause.

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Jill Olmstead, DNP, ANP-BC, FAANP

Keywords

acute diarrhea

chronic diarrhea

evaluation

management

infectious agents

symptomatic treatment

malabsorptive diarrhea

secretory diarrhea

inflammatory diarrhea

osmotic diarrhea