Acute diarrhea physical examination

Acute Diarrhea Microchapters
Home
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
Case #1
Acute diarrhea physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Acute diarrhea physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Acute diarrhea physical examination
CDC on Acute diarrhea physical examination
Acute diarrhea physical examination in the news
Blogs on Acute diarrhea physical examination
Directions to Hospitals Treating Psoriasis
Risk calculators and risk factors for Acute diarrhea physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]

Overview

Patients with Acute diarrhea usually appear ill, dehydrated or lethargic. Common physical examination findings of Acute diarrhea include hypotension and other signs of volume depletion(depressed consciousness, sunken anterior fontanel, dry mucous membranes, poor skin turgor and delayed capillary refill), abdominal tenderness and distension, increased peristalytic activity(borborygmi).

Physical Examination

• Physical examination of patients with Acute diarrhea shows signs of dehydration( dry mouth and tongue, sunken eyes, sunken anterior fontanel, Poor skin turgor, hypotension,altered consciousness,absent tears), abdominal tenderness and distension, increased peristalytic activity,perineal erythema and signs of malnutrition.

Appearance of the Patient

• Patients with acute diarrhea may appear ill, dehydrated, or lethargic depending upon the severity of diarrhea.

Vital Signs

• Hypotension
• Fever
• Orthostasis
• Tachycardia or bradycardia
• Tachypnea

Assessment of dehydration:

• Dehydration is the major cause of morbidity and mortality in diarrhea.
• Every patient with diarrhea should be assessed for signs, symptoms, and severity.
• Common findings of volume depletion on physical exam include Lethargy, depressed consciousness, diminshed skin turgor, sunken anterior fontanel, dry mucous membranes, sunken eyes, lack of tears, and delayed capillary refill are obvious and important signs of dehydration.

	Mild dehydration (<5%)	Moderate dehydration (5-10%)	Severe dehydration
Eyes	Normal	Sunken	Very sunken
Tears	Present	Absent	Absent
Thirst	Normal	Thirsty	Poor
Mouth	Moist	Dry	Very dry
Urine output	Normal	Decreased	Oliguric
Fontanelle	Normal	Sunken	Sunken
Respirations	Normal	Tachypnea	Tachypnea
Mental status	Normal	Irritable	Altered
Blood pressure	Normal	Hypotension	Hypotension

Skin

• Skin examination of patients with diarrhea can be done by pinch test.
• If the skin on the thigh, calf, or forearm is pinched , it will immediately return to its normally flat state when the pinch is released in normal patients.
  • Mild dehydration(0-5%): Pinch retracts immediately
  • Moderate dehydration(5-10%): Pinch retracts slowly
  • Severe dehydration(>10%): Pinch remain folded
• Delayed capillary refill

Heart

• Hypotension
• Tachycardia/ Bradycardia
• Decreased jugular venous pressure

Abdomen

• Abdominal distention
• Diffuse Abdominal tenderness
• Borborygmi
• Rigidity and rebound abdominal tenderness
• Hepatospleenomegaly is associated with certain infections (eg: Mycobacterium Avium complex, Salmonellosis)

Perineal erythema

• In children mostly, frequent passage of stools cause perineal skin breakdown.
• Carbohydrate malabsorption seconadary to diarrhea may be responsible for more acidic stools that results in erythema.
• Bile acid malabsorption leads to diaper dermatitis that is severe, appears as burnt perianal skin.

Failure to thrive and malnutrition

• Reductions in muscle and fat mass or peripheral edema may be present in presence of underlying carbohydrate, fat, and/or protein malabsorption.
• Giardia organisms can cause intermittent diarrhea and fat malabsorption.

Lungs

• Examination is usually normal.
• Tachypnea caused by metabolic acidosis as aresult of severe volume depletion.

HEENT

• Sunken anterior fontanelle
• Oral mucosal lesions and angular stomatitis in Tropical sprue.
• Dry mucous membranes and tongue.

Neuromuscular

• Irritability or lethargy
• Muscle weakness and convulsions because of moderate to severe electrolyte imbalance.