DIARRHEA, ACUTE

DIARRHEA, ACUTE: Excerpt from Differential Diagnosis in Primary Care

Acute diarrhea is most likely infectious. Beginning with the smallest organism and working up to the largest will help recall the most common types of infectious diarrhea. The smallest organism prompts the recall of viral gastroenteritis. A midsized organism would suggest staphylococcus, Salmonella, cholera, botulism, and bacillary dysentery. Moving up to the next largest organism, one would recall amebic dysentery and giardiasis. Both of theses conditions move on to become a chronic diarrhea (page 123) if left untreated. Patients with acquired immunodeficiency syndrome (AIDS) may have acute diarrhea from cryptosporidiosis. This organism is responsible for worldwide epidemics of diarrhea. Finally, larger organism such as trichinella spirilas may also be associated with acute diarrhea. Acute diarrhea is also caused by many drugs such as antibiotics, colchicine, ethacrynic acid, digitalis, and quinidine. Pseudomembranous enterocolitis is a severe diarrhea that follows antibiotic administration. Another form of noninfectious acute diarrhea is associated with ulcerative colitis. This is often characterized by grossly bloody stools.

Approach to the Diagnosis

The history may help differentiate many causes of acute diarrhea. Fever would help to distinguish salmonella, shigella, and campylobacter jejuni. Blood in the stool also suggests salmonella, shigella, and campylobacter, but may also be due to ulcerative colitis, amebic dysentery, or pseudomenbranous colitis. If there is no blood in the stool, the patient most likely has viral gastroenteritis, staphylococcal toxin diarrhea, or travelers diarrhea. If other members of the family are experiencing the same symptoms, the clinician should look for staphylococcal toxin diarrhea or botulism. Vomiting is associated with toxic staphylococcal gastroenteritis and viral gastroenteritis, but unlikely with giardiasis and pseudomembranous colitis. All patients need to provide a stool sample for occult blood, culture, and smear for ovum and parasites. If there is a history of antibiotic use, the stool should be tested for clostridium difficile toxin B.

Other Useful Tests

1. Stool smear for leukocytes
2. Culture for campylobacter or yersenia
3. Sigmoidoscopy
4. Colonoscopy
5. Stool for giardia antigen

Pictures

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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