5-Minute Emergency Consult
Diarrhea, Adult
Diarrhea, Adult is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Description
Bowel movements characterized as frequent (>3/d), loose, and watery owing to an infectious or toxin exposure
Etiology
Etiology
- Viruses:
- 50–70% of all cases
- Invasive bacteria:
- Campylobacter:
- Contaminated food or water, wilderness water, birds, and animals
- Most common bacterial diarrhea
- Gross or occult blood is found in 60–90%
- Salmonella:
- Contaminated water, eggs, poultry, or dairy products
- Typhoid fever (Salmonella typhi) characterized by unremitting fever, abdominal pain, rose spots, splenomegaly, and bradycardia
- Shigella:
- Fecal or oral route
- Vibrio parahaemolyticus:
- Raw and undercooked seafood
- Yersinia:
- Contaminated food (pork), water, and milk
- May present as mesenteric adenitis or mimic appendicitis
- Campylobacter:
- Bacterial toxin:
- Escherichia coli:
- Major cause of traveler's diarrhea
- Ingestion of food or water contaminated by feces
- Staphylococcus aureus:
- Most common toxin-related disease
- Symptoms 1–6 hr after ingesting food
- Bacillus cereus:
- Classic source – fried rice left on steam tables
- Symptoms within 1–36 hr
- Clostridium difficile:
- Antibiotic-associated enteritis linked to pseudomembranous colitis
- Incubation period within 10 d of exposure or initiation of antibiotics
- Aeromonas hydrophila:
- Aquatic sources primarily
- Affects children <3 yr of age
- Fecal leukocytes absent
- Cholera:
- Caused by enterotoxin produced by Vibrio cholerae
- Profuse watery stools with mucus (classic appearance of rice-water stools)
- Escherichia coli:
- Protozoa:
- Giardia lamblia:
- Most common cause of parasite gastroenteritis in North America
- High-risk groups: Travelers, children in day-care centers, institutionalized people, homosexual men, and campers who drink untreated mountain water
- Cryptosporidium parvum:
- Commonly carried in patients with AIDS
- Entamoeba histolytica (entamebiasis):
- 5–10% extraintestinal manifestations (hepatic amebic abscess)
- Giardia lamblia:
Pediatric Considerations
- Most are viral in origin and self-limited
- Rotavirus accounts for 50%
- Shigella: Infections associated with seizures
- Focus evaluation on state of hydration
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Basics
Description
Description
Bowel movements characterized as frequent (>3/d), loose, and watery owing to an infectious or toxin exposure
Etiology
Etiology
- Viruses:
- 50–70% of all cases
- Invasive bacteria:
- Campylobacter:
- Contaminated food or water, wilderness water, birds, and animals
- Most common bacterial diarrhea
- Gross or occult blood is found in 60–90%
- Salmonella:
- Contaminated water, eggs, poultry, or dairy products
- Typhoid fever (Salmonella typhi) characterized by unremitting fever, abdominal pain, rose spots, splenomegaly, and bradycardia
- Shigella:
- Fecal or oral route
- Vibrio parahaemolyticus:
- Raw and undercooked seafood
- Yersinia:
- Contaminated food (pork), water, and milk
- May present as mesenteric adenitis or mimic appendicitis
- Campylobacter:
- Bacterial toxin:
- Escherichia coli:
- Major cause of traveler's diarrhea
- Ingestion of food or water contaminated by feces
- Staphylococcus aureus:
- Most common toxin-related disease
- Symptoms 1–6 hr after ingesting food
- Bacillus cereus:
- Classic source – fried rice left on steam tables
- Symptoms within 1–36 hr
- Clostridium difficile:
- Antibiotic-associated enteritis linked to pseudomembranous colitis
- Incubation period within 10 d of exposure or initiation of antibiotics
- Aeromonas hydrophila:
- Aquatic sources primarily
- Affects children <3 yr of age
- Fecal leukocytes absent
- Cholera:
- Caused by enterotoxin produced by Vibrio cholerae
- Profuse watery stools with mucus (classic appearance of rice-water stools)
- Escherichia coli:
- Protozoa:
- Giardia lamblia:
- Most common cause of parasite gastroenteritis in North America
- High-risk groups: Travelers, children in day-care centers, institutionalized people, homosexual men, and campers who drink untreated mountain water
- Cryptosporidium parvum:
- Commonly carried in patients with AIDS
- Entamoeba histolytica (entamebiasis):
- 5–10% extraintestinal manifestations (hepatic amebic abscess)
- Giardia lamblia:
Pediatric Considerations
- Most are viral in origin and self-limited
- Rotavirus accounts for 50%
- Shigella: Infections associated with seizures
- Focus evaluation on state of hydration
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Citation
Schaider, Jeffrey J., et al., editors. "Diarrhea, Adult." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307522/all/Diarrhea__Adult.
Diarrhea, Adult. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307522/all/Diarrhea__Adult. Accessed September 22, 2021.
Diarrhea, Adult. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th edition). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307522/all/Diarrhea__Adult
Diarrhea, Adult [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2021 September 22]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307522/all/Diarrhea__Adult.
* Article titles in AMA citation format should be in sentence-case
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