Approach to a patient with Diarrhea c1.pptx

Useful revision tool for undergraduate medical students

1. Approach to a patient with Diarrhea Yirgalem H ( MD, Internist)

2. Introduction Definition Classification Evaluation History P/E

3. Definition Diarrhea is a symptom, not a disease. Three or more loos stools /day or >200gm/day (Western countries).

4. Classification Several ways : time course (acute (<14 days )vs . chronic (>14 days)), volume (large vs. small), pathophysiology (secretory vs. osmotic), stool characteristics (watery vs. fatty vs. inflammatory), and epidemiology. For the clinician, classification is useful only if it delineates a diagnostic and management approach in a given patient. In this regard, no single scheme is perfect; the experienced physician uses all these classifications to facilitate patient care.

5. DDX

6. DDx …

7. DDx …Chronic

8. Evaluation… Hx What to ASK? Duration: Acute vs Chronic Stool characteristics : Bloody: malignancy or IBD ( chronic) infection with an invasive organism ( acute). Watery : suggest an osmotic or secretory process, and presence of oil or food particles is suggestive of malabsorption , maldigestion

9. Time of the day: Nocturnal diarrhea strongly suggests organic causes rather than functional causes like IBS. Relation with meal : ceases with fasting Osmotic diarrhea Persists despite fasting Secretory diarrhea Associated factors : Weight loss,fever , abdominal pain,vomiting,flatulence,bloating …

10. Medication Hx : Temporal pattern Travel Hx Diet type: Cocked vs uncocked Home or at restaurant Heated /reheated vs newly prepared Type of meal

11. Immune status: Immunocompetent Vs immunocompromized Hx of radiation,surgery Factitious Diarrhea

12. P/E More useful in determining the severity of diarrhea than in determining its cause . Volume Status: Orthostatic changes in BP and or pulse Shock Signs of dehaydration (dry tongue,dry bucal mucusa , sunken eye balls,decreased skin turgor, absent/decreased capillary refill ) Abdominal tenderness, guarding or rigidity