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

16_Evaluation of Patient with Diarrhea - Heagy

Pdf Summary

This document provides an evaluation of patients with diarrhea, focusing on acute and chronic cases. Diarrhea is defined as increased liquidity, frequency, or decreased consistency of stools, typically occurring at least three times in a 24-hour period. Acute diarrhea lasts for 14 days or fewer and is usually of infectious origin. The evaluation of acute diarrhea involves assessing the duration and characteristics of symptoms, associated symptoms, potential exposures, medical and sexual history, and conducting physical exams and lab tests. Antibiotic exposure, immunocompromised status, and certain medical conditions should be considered in specific patient groups.<br /><br />Management of acute diarrhea includes supportive measures, fluid replacement when necessary, and empiric antibiotic treatment for select patients with severe disease or suspected invasive bacterial infection. Persistent diarrhea, lasting 14 to 30 days, should be worked up by culture and/or culture-independent microbiologic assessment, followed by treatment with antimicrobial agents specifically targeted at the identified cause.<br /><br />Chronic diarrhea, lasting more than 30 days, can be classified into different categories such as malabsorptive, secretory, inflammatory, motility-related, and osmotic diarrhea. A meticulous history, physical exam, and diagnostic testing are essential in the evaluation of chronic diarrhea. Common causes include irritable bowel syndrome, bile acid diarrhea, dietary factors, inflammatory bowel disease, medications, and recurrent Clostridium difficile infection.<br /><br />Red flags for chronic diarrhea requiring further evaluation include age of onset after 50, rectal bleeding or melena, unexplained weight loss, iron deficiency anemia, and elevated inflammatory markers. Diagnostic testing may include blood tests, stool studies (for analysis of white blood cells, occult blood, pathogens), endoscopy (flex sigmoidoscopy or colonoscopy with biopsies), and radiology.<br /><br />Treatment of chronic diarrhea involves addressing the underlying etiology, empirical therapy if needed, and symptomatic management. The document highlights a case of chronic diarrhea caused by microscopic colitis, which was diagnosed via colonoscopy and biopsy.<br /><br />Overall, the document emphasizes the importance of history-taking, physical examination, and appropriate testing to determine the underlying cause of diarrhea and guide treatment. It also provides practice pearls and references for further reading.

Keywords

acute diarrhea

chronic diarrhea

infectious diarrhea

evaluation of symptoms

empiric antibiotic treatment

persistent diarrhea

malabsorptive diarrhea

irritable bowel syndrome

diagnostic testing

microscopic colitis