Acute diarrhea overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Hereditary pancreatitis from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
There is insufficient evidence to recommend routine screening for acute diarrhea.
Natural History, Complications, and Prognosis
Untreated cases of acute diarrhea may progress to develop symptoms of fluid depletion including altered mental status, electrolyte imbalances, dehydration, metabolic acidosis and malnutrition. Common complications of acute diarrhea include confusion, convulsions, sepsis, and death. Prognosis is generally good when the underlying cause is identified and treated early.
Diagnosis
Diagnostic Criteria
There is no established diagnostic study of choice for acute diarrhea as it is generally self-limited. Specific diagnostic studies are performed if symptoms last >7 days, in moderate-to-severe cases, dysentery, and to determine etiology in order to enable directed pathogen-specific therapy.
History and Symptoms
Physical Examination
Laboratory Findings
Laboratory investigations performed in the evaluation of patients with acute diarrhea include spot stool analysis, detection of occult blood, white blood cells, stool culture, quantitative stool analysis, fecal weight, stool osmotic gap, fecal pH, fecal fat concentration and analysis for laxative abuse. According to the ACG guidelines, stool culture is done only in cases where the patient is at high risk of spreading the disease to others. Stool diagnostic studies are performed when symptoms last for >7 days, patient has dysentery or moderate-to-severe diarrhea and to determine etiology to enable directed pathogen-specific therapy. Antibiotic sensitivity testing for management of acute diarrhea is not advised.
Electrocardiogram
There are no ECG findings associated with acute diarrhea.
X-ray
An x-ray may be helpful in the diagnosis of some of the rare causes of acute diarrhea. Findings on an x-ray suggestive of organic causes acute diarrhea include intestinal dilation, irregular mucosal surface and increased luminal fluid.
Ultrasound
There are no ultrasound findings associated with acute diarrhea.
CT scan
CT scan is not routinely performed for cases of acute diarrhea. However, it may help in the detection of certain rare causes of acute diarrhea such as inflammatory bowel disease, intestinal lymphoma, carcinoid syndrome, and other neuroendocrine tumors.
MRI
There are no MRI findings associated with acute diarrhea.
Other Imaging Findings
There are no other imaging findings associated with acute diarrhea.
Other Diagnostic Studies
Sigmoidoscopy and colonoscopy may help in the diagnosis of conditions such as melanosis coli due to laxative abuse, amebiasis, polyps, ulceration, Crohn's disease, and ulcerative colitis. Upper GI endoscopy and biopsy help in the diagnosis of Crohn's disease, giardiasis, intestinal lymphoma, lymphangiectasia, eosinophilic gastroenteritis, Whipple's disease, mastocytosis, abetalipoproteinemia, fungal and protozoal infections.
Treatment
Medical Therapy
The majority of cases of acute diarrhea are self-limited and require only supportive care. Symptomatic treatment for diarrhea includes consumption of adequate amounts of water, mixed with electrolytes to replace water and salt depletion. According to the ACG Clinical Guideline, use of balanced electrolyte rehydration is recommended in patients with traveller’s diarrhea, excessively watery and severe diarrhea. Medical supervision is required in infants with diarrhea, moderate or severe diarrhea in young children, bloody diarrhea, diarrhea for more than two weeks and diarrhea associated with non-cramping abdominal pain, fever and weight loss. Empiric therapy is used as an initial treatment for diagnostic testing, after testing has failed to confirm a diagnosis, when there is no specific treatment or when specific treatment fails to effect a cure. Pharmacotherapy for acute diarrhea includes the use of antibiotics, anticholinergics, antimotility agents and other nonspecific antidiarrheal agents (probiotics).
Surgery
Surgical intervention is not recommended for the management of acute diarrhea.
Primary Prevention
Primary prevention of acute diarrhea includes measures such as counseling in patients and their close contacts. In addition, counseling prior to travel and hand washing using alcohol-based sanitizers are other recommended practices. Hand washing is particularly important for prevention of community-acquired diarrhea outbreaks in cruise ships or institutions.
Secondary Prevention
There are no established measures for the secondary prevention of acute diarrhea.