DIARRHEA, ACUTE

Ask the following questions:

1. Is there blood in the stool? From the algorithm, blood in the stool should indicate that there is Salmonella , Shigella , Campylobacter jejuni , ulcerative colitis, and amebic dysentery. Without blood in the stool, it is more likely that the acute diarrhea is due to a staphylococcal toxin, giardiasis, traveler's diarrhea, a virus, or contaminated food.
2. Is there a fever? Fever, especially with an elevated white count and blood in the stool, would suggest Salmonella , Shigella , Campylobacter jejuni , or ulcerative colitis in its acute stage. The absence of fever would suggest amebic dysentery or giardiasis, although there may be fever in amebic dysentery in the severe cases. Even traveler's diarrhea and toxic staphylococcal gastroenteritis do not usually give more than a low-grade temperature at best. Pseudomembranous colitis may result in a significant elevation of the temperature once the patient becomes severely dehydrated.
3. Is there severe vomiting? Severe vomiting is seen in toxic staphylococcal gastroenteritis! This follows 2 to 4 hr after eating food poisoned with the toxin. Traveler's diarrhea and viral gastroenteritis may also cause severe vomiting, as may food that is contaminated. On the other hand, there is little or no vomiting in giardiasis and pseudomembranous colitis.
4. Did several members of the family experience acute diarrhea also? This is a key question because it indicates whether there is a possibility of toxic staphylococcal gastroenteritis or the possibility of a contagious condition such as infection with Salmonella , Shigella , or Campylobacter . If only one member of the family was suffering from diarrhea and everyone is eating the same food, then it is less likely to be a contagious condition, and one must consider ulcerative colitis, pseudomembranous colitis, and conditions listed under chronic diarrhea.
5. Was there recent foreign travel? Recent foreign travel would suggest the possibility of traveler's diarrhea, cholera, shigellosis, salmonellosis, and giardiasis.
6. Is there neurologic symptomatology? This should point one in the direction of botulism, and generally a little epidemiologic research will disclose that other people in the community have been suffering from the same condition.

DIAGNOSTIC WORKUP

The first thing to do is a stool for occult blood. This will help distinguish those patients who are having obvious infectious disease of the large intestine or maybe even the small intestine. It will also make one suspicious of ulcerative colitis. All patients need a stool culture and stool for ova and parasites. A stool for Giardia antigen can also be done. Serologic studies will not be of much help in the acute condition, but they may help later on in cases of salmonellosis and amebiasis. The clinician himself should do a methylene blue smear for leukocytes and examine a wet saline preparation of the stool. If there is a history of antibiotic uses, a stool should be tested for Clostridium difficile toxin B. Leukocytes on a smear suggest bacterial cause and a culture should be done. The laboratory should be alerted if Campylobacter or Yersinia are suspected because special culture media are needed. If the diarrhea persists or if there is blood, sigmoidoscopy or colonoscopy should be performed. It is always important to examine the rectum for hemorrhoids and anal fissures that may be causing the positive stool for occult blood. When the diarrhea persists and becomes chronic, the diagnostic workup should include the studies that are listed under chronic diarrhea.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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