CLINICAL PRESENTATION n Small bowel diarrheas –large, loose stools –periumbilical or RLQ pain n Large bowel diarrheas –frequent, small, loose stools –crampy, LLQ pain or tenesmus

ACUTE DIARRHEA n Viral gastroenteritis n Staphylococcus aureus n Clostridium perfringens n Salmonella n Shigella n Cryptosporidiosis n Drug-induced diarrhea n Clostridium difficile

TRAVELER’S DIARRHEA n Toxigenic E. coli n Entamoeba histolytica n Giardia lamblia n Choleria

CHRONIC & RECURRENT DIARRHEAS n Irritable bowel syndrome n Inflammatory bowel disease n Pseudomembranous colitis n Diabetic enteropathy n Dumping syndrome n Malabsorption of lactose n Chronic laxative use

HISTORY n Nature of bowel movements n Associated symptoms n Epidemiologic information –travel –food intake –personal contact –HIV status n Drug history

PHYSICAL n Vital sign n Skin n Lymph nodes n Abdomen n Rectal

LABORATORY TESTS n Gram’s stain for leukocytes n Stool for C&S n CBC n Electrolytes n Stool for O&P, C. difficile (if indicated) n LFTs & PT time n Amylase, glucose

MANAGEMENT n Acute diarrhea –maintain hydration –absorbent products lomotil immodium –antibiotics n Traveler’s diarrhea –prophylactic –treatment