Acute diarrhea physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]

Overview

Patients with acute diarrhea usually appear ill, dehydrated or lethargic. Common physical examination findings of acute diarrhea include hypotension and other signs of volume depletion (depressed consciousness, sunken anterior fontanel, dry mucous membranes, sunken eyes, poor skin turgor and delayed capillary refill), abdominal tenderness and distension, increased peristaltic activity (borborygmi).

Physical Examination

Appearance of the Patient

  • Patients with acute diarrhea may appear ill, dehydrated, or lethargic depending upon the severity of diarrhea.

Vital Signs

Assessment of dehydration:[1] [2]

  • Dehydration is the major cause of morbidity and mortality in diarrhea.
  • Every patient with diarrhea should be assessed for signs, symptoms, and severity.
  • Common findings of volume depletion on physical examination include lethargy, depressed consciousness, diminshed skin turgor, sunken anterior fontanel, dry mucous membranes, sunken eyes, lack of tears, and delayed capillary refill are obvious and important signs of dehydration.
Mild dehydration (<5%) Moderate dehydration (5-10%) Severe dehydration
Eyes Normal Sunken Very sunken
Tears Present Absent Absent
Thirst Normal Thirsty Poor
Mouth Moist Dry Very dry
Urine output Normal Decreased Oliguric
Fontanelle Normal Sunken Sunken
Respirations Normal Tachypnea Tachypnea
Mental status Normal Irritable Altered
Blood pressure Normal Hypotension Hypotension

Skin

  • Skin examination of patients with diarrhea can be done by pinch test.
  • If the skin on the thigh, calf, or forearm is pinched , it will immediately return to its normally flat state when the pinch is released in normal patients.
    • Mild dehydration (0-5%): Pinch retracts immediately
    • Moderate dehydration (5-10%): Pinch retracts slowly
    • Severe dehydration (>10%): Pinch remain folded
  • Delayed capillary refill

Heart

Abdomen

Perineal erythema

Failure to thrive and malnutrition

Lungs

HEENT

Neuromuscular


References

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  1. Vega RM, Bhimji SS. PMID 28613793. Missing or empty |title= (help)
  2. Nemeth V, Pfleghaar N. PMID 28846339. Missing or empty |title= (help)