Intern Report 10/20 – Bloody Diarrhea

Teaching Pearls

  • Duration of Diarrhea
    • Acute < 14 days
    • Chronic >4 weeks
  • Types of Diarrhea
    • Secretory
      • Stool osmole gap <50
    • Osmotic
      • Stool osmole gap >100
    • Inflammatory
      • Evidence of blood and/or mucoid stools
    • Malabsorption
      • Protein-losing enteropathy
      • CHO malabsorption
      • Fat malabsorption
  • Bacterial Causes of Blood Diarrhea
    Source Presentation Complications Treatment
    STEC (EHEC) Uncooked hamburger meat.

    Fecal-oral route

    Abd pain with bloody diarrhea +/- fever HUS No antibiotics indicated; supportive care
    Shigella Shellfish, fecal oral route Dysentery (bloody mucoid stools), tenesmus, fever, abdominal pain Reiters Disease Flouroquinolone; 3rd generation cephalosporin
    Salmonella Undercooked raw eggs, chicken, fruits Fever, abdominal pain, occult/overt bleeding Bacteremia, aortitis, osteomyelitis in those with sickle cell disease Only treat when symptoms are severe
    Campylobacter Poultry Occult bleeding Reiters disease, Guillain-Barre Syndrome Treat only if severe with macrolides

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