Diarrhea
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 5 November 2017
⏱️ 7 minutes
🧾️ Download transcript
Summary
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)
Transcript
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| 0:00.0 | Hello, med students. |
| 0:02.6 | My name is Zach Olson, and thank you for downloading this week's episode of the EM Clerkship |
| 0:09.3 | Podcast. |
| 0:11.9 | Common topic this week. |
| 0:13.8 | This week, we are going to discuss the approach to the patient with diarrhea. |
| 0:19.4 | This is a very unique complaint in emergency medicine in that |
| 0:22.8 | diarrhea is usually not an emergency. I can pretty confidently say that it's a very low risk |
| 0:30.3 | complaint compared to some of the other stuff we see because it's statistically almost always |
| 0:36.5 | a viral illness. |
| 0:38.6 | No big deal. |
| 0:40.0 | Patients who are well appearing with less than 24 hours of non-bloody diarrhea as their chief |
| 0:46.2 | complaint and no other concerning symptoms don't overthink it. |
| 0:52.0 | Anti-diereals treat it with loparamide, which is amodium, or bismith, which is |
| 0:57.3 | peptobismal, or diphenoxylate, which is lomodal, and that's it, home. Just remember that there are |
| 1:06.6 | three big causes of non-viral diarrhea that you need to remember to, that you've learned about |
| 1:13.6 | in medical school, that even if they're uncommon, you have to at least consider. |
| 1:18.8 | They're the three icky eyes of diarrhea, eschemia, infections, and inflammatory bowel disease. |
| 1:27.4 | The three icky eyes. Eschemia, infections, inflammatory bowel disease. The three icky eyes. Aschemia infections, |
| 1:29.8 | inflammatory bowel disease like Crohn's or ulcerative colitis. I'm going to overview the |
| 1:35.1 | treatment of these at the end, but first I'm going to give you just the five steps, the five |
| 1:41.0 | questions that you're going to be asking patients with diarrhea so that you don't |
| 1:45.4 | miss these. If you're diarrheaing patient answers, no, no, no, you're done. So your first question, |
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