Snapshot A 3-year-old boy with no significant past medical history is brought to urgent care for 2 days of watery diarrhea. He had been attending daycare 2 times a week, and several other kids have also experienced similar symptoms. He has had 5-6 bowel movements per day and has not been able to eat much. His parents have been encouraging him to drink oral electrolyte solution. On physical exam, he is noted to have sunken eyes, poor skin turgor, and increased capillary refill time. Introduction Overview login to view 3 more bullets Epidemiology Incidence login to view 4 more bullets Demographics login to view 2 more bullets Etiology Infections login to view 3 more bullets Drug-induced login to view 4 more bullets Food allergies Toxic ingestions Autoimmune Small intestine bacterial overgrowth, often secondary to scleroderma or diabetes Pathogenesis types of diarrhea login to view 25 more bullets Infectious Bloody Vs Watery Diarrhea Bloody Diarrhea Watery Diarrhea Campylobacter E. histolytica Enterohemorrhagic E. coli Enteroinvasive E. coli Non-thypoidal Salmonella Shigella Y. enterocolitica C. difficile C. perfringens Enterotoxigenic E. coli Giardia Cryptosporidium V. cholerae Rotavirus Norovirus Adenovirus S. aureus High Yield Risk Factors Exposure Risk Factors Associated Organisms Daycare Rotavirus, astrovirus, calicivirus, Campylobacter, Shigella, Giardia, Cryptosporidium Food Dairy Eggs Beef Poultry Pork Seafood Oysters Rice/Pasta Campylobacter and Salmonella Salmonella E. coli Campylobacter C. perfringens Y. enterocolitica Astrovirus Vibrio Calicivirus Bacillus cereus Water exposure Swimming Pools Contaminated water with cysts Shigella Giardia, E. histolytica, and Cryptosporidium Travel history "Traveler's" diarrhea Cruise ships Camping/hiking E. coli, Giardia, Salmonella, Shigella, and Campylobacter Norovirus Giardia Past medical history Antibiotics/hospitalization C. difficile and rotavirus Pets Dog feces Turtles/reptiles Other animals/pets Yersinia enterocolitica Non-typhoidal Salmonella Campylobacter Presentation Symptoms login to view 12 more bullets Physical exam login to view 5 more bullets Studies Acute diarrhea does not routinely require laboratory evaluation, unless clinical presentation includes login to view 6 more bullets Serum labs login to view 1 more bullet Stool studies login to view 7 more bullets Differential Chronic diarrhea, which lasts 4 weeks or more, suggests other etiologies, such as fat malabsorption syndrome Radiation injury login to view 1 more bullet Chronic DiarrheaMalabsorption syndromesCeliac diseaseLactose intolerancePancreatic insufficiencyDiabetic neuropathyInflammatory bowel diseaseCrohn diseaseUlcerative colitisOther gastrointestinal causesMicroscopic colitisIrritable bowel syndromeEndocrinologicalCarcinoidGastrinomaDrug-inducedQuinidineColchicineChemotherapyOtherSevere combined immunodeficiencyArsenic poisoningVitamin C toxicityVitamin B3 deficiency Treatment Medical login to view 19 more bullets Complications Dehydration