Info
🌱 來自: Huppert’s Notes
Acute Diarrhea (3 weeks)🚧 施工中
Acute Diarrhea (<3 weeks)
Infection
Bloody:
• shigella
• Salmonella:
• E. coli 0157/STEC (“Shiga toxin–producing E. coli”): Classically from exposure to undercooked food (especially beef) or petting zoos; person-to-person transmission can also occur. Incubation period averages 3 days (range 1–10 days). Classic presentation is diarrhea, abdominal pain, vomiting, and fever that start approximately 72 hours after ingestion, followed by conversion from watery to bloody diarrhea about 48 hours later. If TTP-HUS occurs (i.e., fever, hemolytic anemia, thrombocytopenia, AKI, neurologic symptoms), the onset is typically 1–2 weeks after the onset of diarrhea. Treatment: Self limited, provide support/rehydration. Do not give antibiotics, which may increase the risk of HUS.
• Yersinia:
Non-bloody:
• Any cause of bloody diarrhea can also present with non-bloody diarrhea
• Viruses:
- Rotavirus:
- Norovirus:
• Bacteria:
- Clostridium perfringens: Commonly due to consumption of improperly refrigerated meat. Incubation period averages 12 hours. Treatment: Self limited, provide support/rehydration.
- B. cereus: Classically, infection is due to consumption of reheated rice. More commonly causes vomiting than diarrhea. Treatment: Self limited, provide support/rehydration.
- E. coli (“traveler’s diarrhea”/ETEC): Fecal-oral transmission. Causes malaise, anorexia, abdominal cramps, followed by sudden-onset diarrhea. Treatment: Self limited, provide support/rehydration; if severe, consider fluoroquinolone or azithromycin.
- Vibrio vulnificus: Transmitted by consumption of infected shellfish; higher risk for infection if the patient has underlying disease or heavy alcohol use. Treatment: Self limited, provide support/rehydration; if severe, consider doxycycline or fluroquinolone.
- Clostridium difficile (C.diff): See Infectious Diseases Chapter 8.
• Parasites:
- Only test for parasites if diarrhea for 7+ days
- Giardia: Transmission from contaminated water (e.g., outdoor streams), or can occur person-to-person (e.g., via sexual contact). Incubation period 7–14 days. Classic presentation is steatorrhea (foul-smelling, fatty stool) with long-standing malabsorption (symptoms may last up to 4 weeks). Treatment: Tinidazole or nitazoxanide; alternative is metronidazole.
Medications
• Medications that may cause diarrhea: Antibiotics (via side effects; also increase risk for C. difficile infection), laxatives, prokinetic agents, antacids, digitalis, colchicine, chemotherapy agents, alcohol