Diarrhea

HISTORY:

Diarrhea for ‍ ‍hoursdays

Type: ‍wateryloose

Bowel movement episodes occurred ‍ times ‍per dayoverall

Worsening factors: ‍none

Treatments tried: ‍nonedietary modifications, ‍effectiveineffective

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍

‍hematemesis

‍hematochezia

‍dark, tarry stools

‍loss of appetite

‍bloating

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍dehydration signs

‍rectal urgency



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Gastroenteritis ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍CRP, ‍electrolytes, ‍creatinine, ‍glucose, ‍LFTs, ‍lipase, ‍TSH, ‍anti-transglutaminase

- Stools: ‍bacterial culture, ‍parasitic culture, ‍rotavirus, ‍C. difficile toxin, ‍calprotectin, ‍stool occult blood, ‍stool fat

- CT scan of the abdomen

- Colonoscopy

- Encourage hydration

- Oral rehydration therapy

- ‍Antidiarrheals

- ‍Probiotics

- ‍Antibiotics

- Dietary modifications: ‍BRAT diet (bananas, rice, applesauce, toast), ‍avoid dairy, ‍avoid spicy foods, ‍avoid fatty foods

- Referral to gastroenterologist

- Referral to dietitian

- Follow-up in ‍ ‍daysweeks

- Return if diarrhea persists or if new symptoms develop such as fever, severe abdominal pain, or blood in stools