TY - CHAP M1 - Book, Section TI - Chapter 5. Acute Diarrheal Disorders A1 - Trier, Jerry S. A2 - Greenberger, Norton J. A2 - Blumberg, Richard S. A2 - Burakoff, Robert PY - 2012 T2 - CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 2e AB - High fever, frequent bloody stools, severe abdominal pain, dehydration, and no improvement after 3–4 days of initial supportive treatment are worrisome features.Sigmoidoscopy and biopsy are indicated in patients with bloody dysenteric stools and tenesmus lasting more than 3–4 days.Upper endoscopy and biopsy are indicated in patients with persistent diarrhea and evidence of malabsorption.Routine stool cultures aid in identifying Salmonella, Shigella, and Campylobacter but rarely provide useful information if diarrhea develops 2–3 days after hospitalization.Clinical features of shigellosis, salmonellosis, and Campylobacter colitis (diarrhea, tenesmus, fever, abdominal cramps) often overlap.Consider Clostridium difficile infection after both recent and remote (within 3 months) use of antibiotics and if diarrhea develops during hospitalization.Risk factors for severe C difficile infection include age >65, renal failure, immunosuppression, and white blood cell count >20,000/μL.Consider enterohemorrhagic Escherichia coli (E coli O157:H7) in patients with bloody diarrhea, abdominal pain, leukocytosis, and little or no fever, especially if uremia or microangiopathic anemia develops; if suspected, avoid antibiotics.Giardiasis is best diagnosed using stool enzyme-linked immunosorbent assay (ELISA) directed against Giardia antigens as an adjunct to microscopic stool exam.Up to 10% of patients who have had infectious diarrhea may develop a postinfectious irritable bowel syndrome. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/29 UR - accessmedicine.mhmedical.com/content.aspx?aid=55955421 ER -