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

Video Transcription

Video Summary

Erika Hagee, a nurse practitioner with the Oregon Clinic, discusses the evaluation of patients with diarrhea in this video. She begins by defining diarrhea as increased liquid frequency and consistency of the stools, specifically loose, watery stools passed three times in a 24-hour period. Acute diarrhea lasts for 14 days or fewer and is usually self-resolving with symptomatic treatment. Infections such as norovirus, rotavirus, bacterial infections like salmonella, shigella, and protozoa like cryptosporidium and giardia are common causes of acute diarrhea. The evaluation includes assessing symptoms, duration, stool characteristics, associated symptoms, potential exposures, medical history, and sexual history. The physical exam includes assessing volume depletion and vital signs. Lab tests can be performed if necessary, including infectious stool studies and electrolyte and renal function tests. Antibiotic exposure should raise concerns about C. diff. Management of acute diarrhea is generally supportive with oral hydration, a bland diet, and fluid replacement if necessary. Empiric antibiotic treatment is reserved for severe cases or invasive bacterial infections. Chronic diarrhea, lasting more than 30 days, is more complex and requires a meticulous history, physical exam, and diagnostic testing. Causes of chronic diarrhea can include malabsorptive, secretory, inflammatory, motility-related, and osmotic etiologies. Evaluation usually involves blood tests, stool tests, endoscopy with biopsies, and imaging. Treatment involves addressing the underlying cause and considering symptomatic therapy, such as Imodium and fiber. Patients with red flag symptoms require expedited evaluation. The video concludes with practice pearls and references.

Asset Subtitle

Erica Heagy, MSN, FNP-BC

Keywords

Erika Hagee

nurse practitioner

diarrhea evaluation

acute diarrhea

chronic diarrhea

diagnostic testing