Diarrhoea

A Basic Approach

Definition: >3 Loose stools in a day

Basic classification:

• Bloody vs. watery
• Chronic (14d or longer) vs. acute

History: travel (65% of complaints in travel clinic), ill contacts

Exam: abdo, hydration status (alertness/lethargy, sunken eyes, skin turgor, mucous membranes,

Investigations:

• Stool microscopy (wet mount and iodine for ova, cysts and parasites) [The Fresher the Better! Shigella dries and dies]
• Stool WBCs
• Stool culture

Causative Organisms

• Bacteria: Shigella, Salmonella, Campylobacter, E. Coli (ETEC, EHEC)
• Viruses: Rotavirus
• Parasites: Giardia

Small Bowel vs. Large Bowel

	Small Bowel	Large Bowel
Quantity	+++	+
Blood		+
Tenesmus		+
Organisms	Giardia Cholera Strongyloides Salmonella	Entamoeba histolytica Shigella E. Coli