ASGE Annual GI Advanced Practice Provider Course (Virtual) - Clinical Case-based Learning (Day Two) | March 2025-Clinical Vignettes-Approach to Acute and Chronic Diarrhea

Pdf Summary

The clinical vignette on the approach to diarrhea, both acute and chronic, provides a comprehensive review by Jill Olmstead, a healthcare professional with extensive expertise. The document delves into definitions, durations, evaluations, and management strategies for diarrhea.<br /><br />Diarrhea is defined by increased liquidity and frequency of stools, and acute diarrhea lasts less than 14 days, while persistent diarrhea continues beyond this duration up to 30 days. Acute diarrhea is predominantly caused by infectious agents like viruses, bacteria, and protozoa, and usually resolves with supportive care. Chronic diarrhea, lasting over 30 days, may be due to various factors including malabsorption, secretory conditions, inflammation, and motility disorders.<br /><br />For evaluation, a comprehensive history is essential, including the duration, frequency, consistency of stool, and associated symptoms. Physical examination should assess for dehydration and other potential indicators of volume loss. Lab tests, including stool studies and, if needed, blood tests, help in identifying causative pathogens or underlying conditions. Management includes supportive measures, fluid replacement, and in certain cases, empirical antibiotic therapy when the risk is high or if complications exist.<br /><br />Chronic diarrhea accounts for a significant portion of patient visits in gastroenterology, often linked to conditions like IBS, IBD, malabsorption syndromes, and chronic infections. A detailed evaluation, considering patient history, travel, diet, and medication use, is crucial. Alarm features that warrant further investigation include onset after age 50, rectal bleeding, nocturnal symptoms, and weight loss. Diagnostic testing could involve blood tests, stool analysis, endoscopy, and imaging studies to pinpoint the cause and guide appropriate treatment.<br /><br />The document emphasizes the importance of hydration and empiric approaches only in specific high-risk cases, ensuring that more serious underlying causes of chronic diarrhea are promptly evaluated and addressed.

Asset Subtitle

Jill Olmstead, DNP, ANP-BC, FAANP

Keywords

diarrhea

acute diarrhea

chronic diarrhea

evaluation

management

infectious agents

malabsorption

gastroenterology

hydration

diagnostic testing