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diarrhea

diarrhea. intro. Generally > 3 stools per day daily stool weight exceeding 200 grams Up to 5% of ER visits Four mechanisms: increased intestinal secretion decreased intestinal absorption increased osmotic load abnormal intestinal motility . Clinical features. History Camping Travel

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diarrhea

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  1. diarrhea

  2. intro • Generally > 3 stools per day • daily stool weight exceeding 200 grams • Up to 5% of ER visits • Four mechanisms: • increased intestinal secretion • decreased intestinal absorption • increased osmotic load • abnormal intestinal motility

  3. Clinical features • History • Camping • Travel • Recently hospitalized • Abdominal pain • Physical exam • Rectal • Stool cultures if febrile, toxic

  4. treatment • Mild diarrhea: 30 to 50 mL/kg over the next 4 hours • Moderate diarrhea: 100 mL/kg over the next 4 hours • Soup and crackers • BRAT diet

  5. Traveler’s diarrhea • Most common causes depend on region travelled to • Fever and bloody stools: Salmonella, Shigella, Campylobacter, and E coli O157:H7 • Persistant diarrhea: E. histolytica antigen, G. intestinalis antigen, and Cryptosporidium parvum antigen

  6. treatment • Cipro is indicated for all patient with presumed infectious diarrhea • Can also use bactrim • Avoid anti-motility agents in bloody diarrhea

  7. C. diff • Most common cause of infectious diarrhea in hospitalized patients • anaerobic bacillus that causes infection ranging from diarrhea to pseudomembranous colitis • clindamycin, cephalosporins, ampicillin/amoxicillin, and, recently, fluoroquinolones

  8. C. diff • profuse diarrhea (20 to 30 stools per day), crampy abdominal pain, fever, leukocytosis, dehydration, and hypovolemia • Stools for c diff toxins • colonoscopy

  9. treatment • Oral metronidazole, 500 milligrams every 6 hours for 10 to 14 days for moderate disease • Oral vancomycin, 125 to 250 milligrams four times a day for 10 days for severe disease

  10. Crohn’s disease • chronic granulomatous inflammatory disease affecting anywhere mouth to anus • Affects one million in U.S. • Women > men • Family history in 10-15%

  11. Crohn’s • Involves all layers of bowel • Is discontinuous “skip lesions” • fissures, fistulas, and abscesses

  12. Clinical features • Abdominal pain, anorexia, diarrhea, and weight loss • Extraintestinal features • Arthritis • Ocular • Hepatobiliary • anemia

  13. treatment • Sulfasalazine, 3 to 5 grams per day • Mesalamine (Asacol®, Claversal®, Salofalk®, Lialda®), 2 to 4 grams per day • prednisone (40 to 60 milligrams per day) provides relief but does not shorten course • Ciprofloxacin (1.0 to 1.5 milligrams/kg/d) induces remission in percentages equal with mesalamine.

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