3. In patients with acute diarrhea who have had recent hospitalization or recent antibiotic use, look for clostridium difficile.
Suspect if antibiotic use within the last 2 months or discharge from hospital within last 72 hours; can happen with almost all antibiotics (although clinda is the classical example). Presents with watery diarrhea that is rarely bloody, crampy abdo pain, malaise, fever, anorexia.
Can lead to fulminant colitis and toxic megacolon
4. In patients with acute diarrhea, counsel about the timing of return to work/school (re: the likelihood of infectivity).
No return to work until no diarrhea for at least 48 hours
Food handlers/daycare workers/health care workers may require negative stool samples on 2 occasions at least 24 hrs apart prior to returning to work to prevent outbreaks
5. Pursue investigation, in a timely manner, of elderly with unexplained diarrhea, as they are more likely to have pathology.
Any change in bowel habit should raise possibility of colorectal cancer
6. In a young person with chronic or recurrent diarrhea, with no red flag symptoms or signs, use established clinical criteria to make a positive diagnosis of irritable bowel syndrome (do not over investigate).
Red flags: fevers/chills, weight loss, bloody stool, mucousy stool, nocturnal diarrhea, large volume stool, greasy stool, FHx of IBD or cancer, anemia, persistent daily diarrhea or constipation, severe pain
Rome III criteria:
Recurrent abdominal pain or discomfort for at least 3 days per month in the last 3 months associated with 2 or more of the following: