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Acute Diarrhea - Signs & Symptoms
By peace | April 3, 2006
Patients with diarrhea present with various clinical features depending on the underlying cause. Diarrhea due to small-intestinal disease is typically high-volume, watery, and often associated with malabsorption, and dehydration is frequent. Diarrhea due to colonic involvement is more often associated with frequent small-volume stools, with the presence of blood and a sensation of urgency.
Patients with acute infectious diarrhea typically present with nausea, vomiting, abdominal pain, fever, and frequent stools, which may be watery, malabsorptive, or bloody depending on the specific pathogen. In general, small-intestinal pathogens are noninvasive, and ileocolonic pathogens are more likely to be invasive.
Patients ingesting toxins or those with toxigenic infection typically have nausea and vomiting as prominent symptoms along with watery diarrhea but rarely have a high fever. Vomiting that begins within several hours of ingesting a food should suggest food poisoning due to preformed toxin. Parasites that do not invade the intestinal mucosa, such as Giardia lamblia and Cryptosporidium, usually cause only mild abdominal discomfort. Giardiasis may be associated with mild steatorrhea, gaseousness, and bloating.
Invasive bacteria such as Campylobacter, Salmonella, and Shigella organisms, and organisms that produce cytotoxins such as Clostridium difficile and enterohemorrhagic E coli (serotype O157: H7), cause severe intestinal inflammation, abdominal pain, and often fever; occasionally peritoneal signs may suggest a surgical abdomen. Yersinia organisms often infect the terminal ileum and caecum and present with right lower-quadrant pain and tenderness, suggestive of acute appendicitis.
Watery diarrhea is a typical symptom of organisms that invade the intestinal epithelium with minimal inflammation, such as enteric viruses, or organisms that adhere to but do not destroy the epithelium, such as enteropathogenic E coli, protozoa, and helminths. Some organisms such as Campylobacter, Aeromonas, Shigella, and Vibrio species (eg, V parahemolyticus) both produce enterotoxins and also invade the intestinal mucosa; patients therefore often present with watery diarrhea followed within hours or days by bloody diarrhea.
Hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura can occur in infections with enterohemorrhagic E coli and Shigella organisms, particularly in young children and the elderly. Yersinia infection and other enteric bacterial infections may be accompanied by Reiter’s syndrome (arthritis, urethritis, and conjunctivitis), thyroiditis, pericarditis, or glomerulonephritis. Enteric fever, caused by Salmonella typhi or Salmonella paratyphi, is a severe systemic illness manifested initially by prolonged high fevers, prostration, confusion, and respiratory symptoms, followed by abdominal tenderness, diarrhea, and rash.
Dehydration can occur if diarrhea is severe and oral intake is limited due to nausea and vomiting, particularly in very young and elderly patients. It is manifested as increased thirst, decreased urinary output with dark urine, inability to sweat, and orthostatic changes. In severe cases, it may lead to acute renal failure and mental status changes like confusion and drowsiness.
Topics: Diseases |
