DIARRHEA

Acute  diarrhea  is ≤14 days in duration  and is commonly due to infections with viruses and bacteria . Most cases are self limited ,but work up is indicated in the following instances: Profuse watery diarrhea with signs of hypovolemia Passage of many small volume stools containing blood and mucus Bloody diarrhea Temperature ≥38.5ºC (101.3ºF) Passage of ≥6 unformed stools per 24 hours or a duration of illness >48 hours Severe abdominal pain Recent use of antibiotics or hospitalized patients Diarrhea in the elderly (≥70 years of age) or the immunocompromised

Stool cultures on initial presentation in the following groups of patients: Immunocompromised patients Patients with more severe, inflammatory diarrhea (including bloody diarrhea) Patients with underlying inflammatory bowel disease Some employees, such as food handlers, occasionally require negative stool cultures to return to work Treatment General measures such as hydration and alteration of diet. Boiled starches and cereals ( potatoes, rice ) with salt, crackers, bananas, soup, and boiled vegetables are indicated in patients with watery diarrhea. Secondary lactose malabsorption is common following infectious enteritis and temporary avoidance of lactose-containing foods may be reasonable. Antimotility agent loperamide (Imodium) can  be used for the symptomatic treatment of patients with acute nonbloody diarrhea in whom fever is absent

Antibiotic therapy is not required in most cases since the illness is usually self-limited.

Chronic diarrhea, defined as the production of loose stools with or without increased stool

frequency for more than 4 weeks, is a common symptom that has prevalence in the United

States of approximately 3%–5%.

CAUSES Irritable bowel syndrome Inflammatory bowel disease   ( Crohn’s  and Ulcerative colitis) Infections -   Clostridium difficile, Camyplobacter, Giardia, Amebae Medications

DIAGNOSIS

A detailed medical history often points to the underlying cause of chronic diarrhea.

Blood tests and stool evaluation should be done prior to endoscopic evaluations

 

TREATMENT Treat the underlying cause ( such as Colitis) Relieve the diarrhea (peptobismol, psyllium, Loperamide, Lomotil) Address any complications that result from long-standing or severe diarrhea

For more information please see www.nlm.nih.gov/medlineplus/healthtopics.html www.cdc.gov/ www.niddk.nih.gov www.gastro.org www.ccfa.org www.ibsgroup.org www.aboutibs.org