Acute diarrhea overview

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Acute Diarrhea Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Acute Diarrhea from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Guidelines for Management

Case Studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hereditary pancreatitis from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

There is insufficient evidence to recommend routine screening for acute diarrhea.

Natural History, Complications, and Prognosis

Untreated cases of acute diarrhea may progress to develop symptoms of fluid depletion including altered mental status, electrolyte imbalances, dehydration, metabolic acidosis and malnutrition. Common complications of acute diarrhea include confusion, convulsions, sepsis, and death. Prognosis is generally good when the underlying cause is identified and treated early.

Diagnosis

Diagnostic Criteria

There is no established diagnostic study of choice for acute diarrhea as it is generally self-limited. Specific diagnostic studies are performed if symptoms last >7 days, in moderate-to-severe cases, dysentery, and to determine etiology in order to enable directed pathogen-specific therapy.

History and Symptoms

Physical Examination

Laboratory Findings

Laboratory investigations performed in the evaluation of patients with acute diarrhea include spot stool analysis, detection of occult blood, white blood cells, stool culture, quantitative stool analysis, fecal weight, stool osmotic gap, fecal pH, fecal fat concentration and analysis for laxative abuse. According to the ACG guidelines, stool culture is done only in cases where the patient is at high risk of spreading the disease to others. Stool diagnostic studies are performed when symptoms last for >7 days, patient has dysentery or moderate-to-severe diarrhea and to determine etiology to enable directed pathogen-specific therapy. Antibiotic sensitivity testing for management of acute diarrhea is not advised.

Electrocardiogram

There are no ECG findings associated with acute diarrhea.

X-ray

An x-ray may be helpful in the diagnosis of some of the rare causes of acute diarrhea. Findings on an x-ray suggestive of organic causes acute diarrhea include intestinal dilation, irregular mucosal surface and increased luminal fluid.

Ultrasound

There are no ultrasound findings associated with acute diarrhea.

CT scan

CT scan is not routinely performed for cases of acute diarrhea. However, it may help in the detection of certain rare causes of acute diarrhea such as inflammatory bowel disease, intestinal lymphoma, carcinoid syndrome, and other neuroendocrine tumors.

MRI

There are no MRI findings associated with acute diarrhea.

Other Imaging Findings

There are no other imaging findings associated with acute diarrhea.

Other Diagnostic Studies

Sigmoidoscopy and colonoscopy may help in the diagnosis of conditions such as melanosis coli due to laxative abuse, amebiasis, polyps, ulceration, Crohn's disease, and ulcerative colitis. Upper GI endoscopy and biopsy help in the diagnosis of Crohn's disease, giardiasis, intestinal lymphoma, lymphangiectasia, eosinophilic gastroenteritis, Whipple's disease, mastocytosis, abetalipoproteinemia, fungal and protozoal infections.

Treatment

Medical Therapy

The majority of cases of acute diarrhea are self-limited and require only supportive care. Symptomatic treatment for diarrhea includes consumption of adequate amounts of water, mixed with electrolytes to replace water and salt depletion. According to the ACG Clinical Guideline, use of balanced electrolyte rehydration is recommended in patients with traveller’s diarrhea, excessively watery and severe diarrhea. Medical supervision is required in infants with diarrhea, moderate or severe diarrhea in young children, bloody diarrhea, diarrhea for more than two weeks and diarrhea associated with non-cramping abdominal pain, fever and weight loss. Empiric therapy is used as an initial treatment for diagnostic testing, after testing has failed to confirm a diagnosis, when there is no specific treatment or when specific treatment fails to effect a cure. Pharmacotherapy for acute diarrhea includes the use of antibiotics, anticholinergics, antimotility agents and other nonspecific antidiarrheal agents (probiotics).

Surgery

Surgical intervention is not recommended for the management of acute diarrhea.

Primary Prevention

Primary prevention of acute diarrhea includes measures such as counseling in patients and their close contacts. In addition, counseling prior to travel and hand washing using alcohol-based sanitizers are other recommended practices. Hand washing is particularly important for prevention of community-acquired diarrhea outbreaks in cruise ships or institutions.

Secondary Prevention

There are no established measures for the secondary prevention of acute diarrhea.

References


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