Diarrhea

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of diarrhea

Described as ‍wateryloose

Bowel movement episodes occurred ‍ times ‍per dayoverall

Occurs most frequently during the ‍day

Worsening factors: ‍none

Alleviating factors: ‍nonedietary modifications, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍loss of appetite

‍bloating

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍dehydration signs

‍rectal urgency



Contributing factors:

‍sick contact with symptoms

‍recent travel

‍recent hospitalization

‍untreated water drinking

no history of: ‍immunodeficiency, ‍suspected food poisoning, ‍irritable bowel syndrome, ‍Crohn's disease, ‍ulcerative colitis, ‍celiac disease, ‍C. difficile infection, ‍food intolerances, ‍cholecystectomy

no use of: ‍antibiotics, ‍laxatives, ‍anti-acid, ‍metformin, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Gastroenteritis ‍likelysuspectedpossible

DDx: viral gastroenteritis, bacterial gastroenteritis, parasitic infection, C. difficile infection, irritable bowel syndrome, inflammatory bowel disease, celiac disease, food intolerance, lactose intolerance, medication-induced diarrhea, malabsorption syndrome, hyperthyroidism, chronic pancreatitis, colorectal cancer, diverticulitis, ischemic colitis, radiation enteritis, small intestinal bacterial overgrowth, traveler's diarrhea





PLAN:

Investigations:

- 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

Treatments:

- Encourage hydration

- Oral rehydration therapy

- ‍Antidiarrheals

- ‍Probiotics

- ‍Antibiotics

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

Further care:

- 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