approach to diarrhea

diarrhea

Diarrhea is a non-specific symptom that can arise from the GI tract, surrounding structures systemic causes or exposures–and can cause cardiovascular, electrolyte and renal complications in addition to complications related to the underlying cause. A systems-based approach can help diagnose and treat

A

  • Anaphylaxis
  • Stevens-Johson

B: CHEST

  • Sick: pneumonia, especially Legionella

C: CARDIOVASCULAR

  • Volume depletion as complication
  • Lactate: sepsis, toxic shock
  • Adrenal crisis

D

E: ENDO

  • Electrolyte complications
  • hOrmones: pancreatic insufficiency, adrenal insufficiency, carcinoid, hyperthyroid, VIPoma, mastocytosis, Zollinger-Ellison

F: PELVIS, CREATININE

  • Ectopic
  • Infectious causes (PID, pyelo
  • renal failure complication

G: ABDOMINAL

  • Ammonia: cirrhosis
  • Biliary disease
  • D
  • O
  • Mesenteric ischemia
  • I
  • No motion: obstruction, tumour
  • Appy, diverticulitis
  • Loose stool: colitis, infectious (virus, bacteria, parasite) and inflammatory

H

I: INTOX

  • Ingest: alcohol
  • Natural: caffeine
  • Treat: opioid withdrawal, antibiotics, chemo, cochicine, diuretic, synthroid
  • OTC: laxative, NSAID
  • X poison: scombroid, heavy metal, ciguatera

J

 

Putting this together

  • A: assess airway
  • B: oxygen, consider CXR if elderly
  • C: fluids, r/o septic or adrenal shock
  • D
  • E: replace electrolytes, consider hormonal causes
  • F: r/o pregnant, infectious, assess renal function
  • G: abdo exam +/ US or CT, consider stool cultures/Cdif
  • H
  • I: consider exposures

diarrhea

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