Gastroenterology - Acute Diarrhea: By John Kargbo M.D.

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Gastroenterology – Acute Diarrhea: What You Need to Know
Whiteboard Animation Transcript
with John Kargbo, MD
https://medskl.com/Module/Index/acute...

Acute diarrhea is the passage of frequent, unformed stool, more than 3 times/day for less than three weeks.

It is most commonly caused by infections but non-infectious causes must also be considered.

The presence of blood in stool, severe abdominal pain, and (+/-) fever would indicate an infectious inflammatory cause or invasive pathogen like Salmonella, Shigella, Campylobacter, Enterohemorrhagic E. coli, Yersina, Entamoeba histolytica, and C. difficile

Think of C. difficile with recent hospitalization, antibiotic use or nursing home resident.

Infectious non-inflammatory diarrhea presents with non- bloody stools and vomiting. Causes include viruses like Norwalk, parasites like giardia, and Bacteria preformed toxins, like Staph. aureus, B. cereus, and botulism.

Non-infectious diarrhea may present similarly to infectious diarrhea and must be considered. Here are some important causes of non-infectious acute diarrhea that you cannot miss:

1. Think about diverticulitis or inflammatory bowel disease with fever, abdominal pain, and (+/-) bloody diarrhea.
2. Think about mesenteric ischemia in an elderly patient with bloody diarrhea and severe abdominal pain out of proportion to physical findings.
3. Think about hyperthyroidism in a patient with diarrhea, heat intolerance, and anxiety.
4. Fecal impaction especially in the elderly, presenting as diarrhea, can be ruled out by
rectal exam.
5. Medications like antibiotics and metformin can cause diarrhea. Stopping them is the initial step.

Physical exam must include assessment of hydration status, as rehydration is the most important aspect of management.

Antibiotics are rarely indicated and may increase risk of hemolytic uremic syndrome and hence MUST be avoided when EHEC is suspected or confirmed.