Diarrhea

If the patient is completely non-toxic and doesn’t have any red flags, they can usually go home without further testing!!!



3 Big (Non-Viral) Causes of Diarrhea



* The Icky ‘I’s* Ischemia* Frequently require surgery consult* Infection* Frequently require antibiotics* Inflammatory bowel disease* Frequently require GI consult, steroids, or salicylates



5 Red Flags



* Is it bloody? * Consider performing a guaiac test* Bloody diarrhea usually isn’t “just a virus”* Is it severely painful? * (Viral gastroenteritis may cause gas cramping but shouldn’t be tender or severely painful)* Bonus red flag!!!* POST-PRANDIAL pain* Consider mesenteric ischemia* Recent antibiotics or hospitalization?* Consider C. difficile* Treat with PO vancomycin* Recent travel? * ~80% travelers diarrhea is bacterial* Treat with ciprofloxacin* Note: See FDA black box for fluoroquinolones prior to prescribing* Do you have history of atrial fibrillation? * Increases risk for mesenteric ischemia and ischemic colitis



Consider Testing if Patient is Ill or has Red Flags



* CBC* Electrolytes* Stool studies* Stool WBCs* Stool culture* C-diff* Ova/Parasite* CT abdomen/pelvis with IV contrast



Common Antidiarrheals



* Loperamide (Imodium)* Bismuth (Pepto-Bismol)* Dphenoxylate (Lomotile)



Additional Reading



* Fluoroquinolone Black Box Update (FDA)