Gastroenterology Book

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Acute DiarrheaAka: Diarrhea, Gastroenteritis

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  1. Definition of Diarrhea
    1. Adults: >200 g/day of stool
    2. Children: >20 g/kg/day of stool
    3. Frequent liquid stools
  2. Pathophysiology
    1. Small intestine secretes and reabsorbs 10 liters/day
      1. Extrusion of Chloride from villus crypt cell (cAMP)
      2. Absorption at villus tip
    2. Diarrhea classified as:
      1. Watery Diarrhea
        1. Secretory Diarrhea
          1. Stool Sodium high (60-120 meq/L)
        2. Osmotic Diarrhea (osmotic loss of free water)
          1. Stool Sodium low (30-40 meq/L)
          2. Results from damage to intestinal microvilli
      2. Inflammatory Diarrhea
        1. Stool with pus or blood present
      3. Fatty diarrhea (Malabsorption)
        1. Large greasy, frothy pale stools with foul odor
    3. Serum Electrolyte loss
      1. Serum Bicarbonate loss
      2. Serum Potassium loss
  3. Etiologies (General)
    1. Infectious Diarrhea Causes
      1. Viruses (30-40% of episodes)
      2. Bacteria and Parasites (20-30% of episodes)
        1. Campylobacter jejuni (most common bacteria)
        2. Salmonella
        3. Shigella
        4. E. coli 0157:H7 (30% of infectious bloody stool)
      3. Other Infectious Disease
        1. Otitis Media
        2. Sepsis
        3. Sexually Transmitted Disease
    2. Noninfectious Causes
      1. See Osmotic Diarrhea
      2. See Secretory Diarrhea
      3. Common Causes
        1. Intestinal Obstruction
        2. Toxic Ingestions
        3. Inflammatory and Allergic Conditions
  4. Risk Factors
    1. Recent travel to endemic area
      1. See Traveler's Diarrhea
    2. Foodborne Illness
    3. Waterborne Illness
    4. Day care exposure
    5. High-risk sexual behavior
      1. See Diarrhea from Sexually Transmitted Disease
    6. Antibiotic use within 6 months (Clostridium difficile)
    7. Immunosuppression
  5. Evaluation Protocol
    1. See Labs and Endoscopy below
    2. Community-acquired, Traveler's Diarrhea or Dysentery
      1. Stool Cultures
        1. Salmonella
        2. Shigella
        3. Campylobacter
        4. Escherichia coli 0157:H7 (STEC: Shiga Toxin E coli)
          1. Shiga Toxin (if bloody stool)
          2. Avoid antimicrobial agents
      2. Clostridium difficile Toxins
        1. Indicated for recent antibiotics or Chemotherapy
      3. Consider antibiotic coverage (if not STEC)
        1. Quinolone if suspected Shigellosis
        2. Macrolide for suspected Campylobacter
    3. Nosocomial Diarrhea (after 3 days of hospitalization)
      1. Clostridium difficile Toxins
      2. Consider community acquired labs as above
      3. Discontinue antibiotics if possible
      4. Consider Flagyl if worsens or persists
    4. Persistent Diarrhea >7 days (esp. immunocompromised)
      1. Fecal Leukocytes or Fecal Lactoferrin
      2. Parasitic Infection evaluation
        1. Giardia
        2. Cryptosporidium
        3. Cyclospora
        4. Isospora belli
      3. Opportunistic infection in HIV positive patients
        1. Community acquired labs as above
        2. Microsporidia
        3. Mycobacterium Avium Intracellulare Complex
  6. Labs
    1. Multiple stool specimens (Increased yield)
      1. Fecal Leukocytes
      2. Consider Stool Culture
      3. Consider Stool Ova and Parasites (>7 days diarrhea)
    2. Consider sending stool for antigen evaluation
      1. Giardia lamblia antigen
        1. Indicated for diarrhea >7 days and >10 stools/day
      2. Clostridium difficile Toxin
        1. Indicated if recent antibiotics or hospitalization
      3. Rotavirus antigen
        1. Indicated for defining local outbreak
    3. Serum Electrolytes (e.g. Chem8)
      1. Hyponatremia
      2. Hypernatremia
      3. Metabolic Acidosis
      4. Hypoglycemia
  7. Endoscopy
    1. Does not distinguish Infectious from Inflammatory
    2. Sexually Transmitted Disease (STD)
      1. Lesions in Distal 15 cm in homosexual men
      2. Herpes Virus
      3. Neisseria Gonorrhea
        1. Nonspecific findings limited to rectum
        2. Biopsy and Culture show superficial exudates
      4. Syphilis
        1. Rectal Papules, chancres, and ulcers
      5. Chlamydia (Lymphogranuloma venereum)
        1. Similar to Inflammatory Bowel Disease
  8. References
    1. Guerrant (2001) Clin Infect Dis 32:331

Diarrhea (C0011991)

Definition (MSH)An increased liquidity or decreased consistency of FECES, such as running stool. Fecal consistency is related to the ratio of water-holding capacity of insoluble solids to total water, rather than the amount of water present. Diarrhea is not hyperdefecation or increased fecal weight.
Definition (CSP)increased liquidity or decreased consistency of feces, such as running stool; fecal consistency is related to the ratio of water-holding capacity of insoluble solids to total water, rather than the amount of water present; diarrhea is not hyperdefecation or increased fecal weight.
Definition (NCI)A condition of frequent and watery bowel movements.
ConceptsSign or Symptom (T184)
ICD9787.91, 787.91
MSHD003967
BasqueBERAZKOA
DanishDiare
DutchDiarree
EnglishD - Diarrhea, D - Diarrhoea, diarrhea, Diarrhea symptom, Diarrhea symptoms, Diarrheas, DIARRHOEA, Diarrhoea symptom, Diarrhoea symptoms, Finding of diarrhea, Finding of diarrhoea, Fluid stool, Loose bowel motions, Loose bowel movement, Loose faeces, Loose feces, Loose motion, LOOSE STOOL, LOOSE STOOLS, LS - Loose stools, Observation of diarrhea, Observation of diarrhoea, Passage of loose stools, Runny stool, STOOLS LOOSE
FinnishRIPULI
FrenchDiarrhee
GermanDurchfall/Diarrhoee
Hebrewshilshul
Hungarianhasmenes
ItalianDiarrea
NorwegianDIARE
PortugueseDiarreia
Spanishdiarrea, hallazgo de diarrea, heces desligadas, heces disgregadas, sintoma de diarrea, sintomas de diarrea
SwedishDIARRE
Parent ConceptsDigestive symptom (C0476288), Intestinal Diseases (C0021831), Entercolon (C0549524), SMALL/LARGE BOWEL (C0549617), Other symptoms involving digestive system (C0159061), Gastrointestinal system (C0012240), Symptoms and Complaints Component (C0497525), Signs and Symptoms, Digestive (C0037089), Disturbance in Bowel Function (C1333310), Gastrointestinal complication (C0161819), Diarrhea (C0011991), [D]Abnormal feces NOS (C0162287), [D]Change in bowel habit (C0278008), Duplicate concept (C1274013), Consistency of stool - finding (C1287101), Ambiguous concept (C1274012)
SourcesAOD, COSTAR, CSP, CST, DXP, ICD9CM, ICPC, ICPCBAQ, ICPCDAN, ICPCDUT, ICPCFIN, ICPCFRE, ICPCGER, ICPCHEB, ICPCHUN, ICPCITA, ICPCNOR, ICPCPOR, ICPCSPA, ICPCSWE, LCH, LNC, MEDLINEPLUS, MSH, MTH, MTHICD9, NCI, NDFRT, OMIM, PDQ, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Gastroenteritis (C0017160)

Definition (MSH)INFLAMMATION of any segment of the GASTROINTESTINAL TRACT from ESOPHAGUS to RECTUM. Causes of gastroenteritis are many including genetic, infection, HYPERSENSITIVITY, drug effects, and CANCER.
Definition (CSP)inflammation of any segment of the gastrointestinal tract from esophagus to rectum; causes of gastroenteritis are many including genetic, infection, hypersensitivity, drug effects, and cancer.
ConceptsDisease or Syndrome (T047)
ICD9009.0
MSHD005759
EnglishGastroenteritides, Gastroenteritis, GE - Gastroenteritis
Spanishgastroenteritis
Parent ConceptsGastrointestinal Diseases (C0017178), Digestive System Disorders, General, Functional and NEC (C0549522), GASTRIC/DUODENAL (C0549614), SMALL/LARGE BOWEL (C0549617), Gastrointestinal infections (C0687715), Gastritis (C0017152), Inflammatory Bowel Diseases (C0021390)
SourcesCOSTAR, CSP, CST, DXP, LCH, MEDLINEPLUS, MSH, MTHICD9, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Acute diarrhea (C0740441)

ConceptsDisease or Syndrome (T047)
EnglishAcute diarrhea, Acute diarrhoea
Spanishdiarrea aguda
Parent ConceptsDiarrheal disorder (C1290807)
SourcesSCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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