Acute diarrhea physical examination

Patients with acute diarrhea usually appear ill, dehydrated or lethargic. Common physical examination findings of acute diarrhea include hypotension and other signs of volume depletion (depressed consciousness, sunken anterior fontanelle, dry mucous membranes, sunken eyes, poor skin turgor and delayed capillary refill), abdominal tenderness and distension, increased peristaltic activity (borborygmi).

Physical examination of patients with acute diarrhea shows signs of dehydration (dry mouth and tongue, sunken eyes, sunken anterior fontanelle, poor skin turgor, hypotension, altered consciousness, absent tears), abdominal tenderness and distension, increased peristaltic activity, perineal erythema and signs of malnutrition.

• Patients with acute diarrhea may appear ill, dehydrated, or lethargic depending upon the severity of diarrhea.

• Hypotension
• Fever
• Orthostasis
• Tachycardia or bradycardia
• Tachypnea

Assessment of dehydration:^[1][2]

• Dehydration is the major cause of morbidity and mortality in diarrhea.
• Every patient with diarrhea should be assessed for signs, symptoms, and severity.
• Common findings of volume depletion on physical examination include lethargy, depressed consciousness, diminshed skin turgor, sunken anterior fontanelle, dry mucous membranes, sunken eyes, lack of tears, and delayed capillary refill are obvious and important signs of dehydration.

• Skin examination of patients with diarrhea can be done by pinch test.
• If the skin on the thigh, calf, or forearm is pinched, it will immediately return to its normal flat state when the pinch is released in normal patients.
  • Mild dehydration (0-5%): Pinch retracts immediately
  • Moderate dehydration (5-10%): Pinch retracts slowly
  • Severe dehydration (>10%): Pinch remain folded
• Delayed capillary refill

• Hypotension
• Tachycardia/ Bradycardia
• Decreased jugular venous pressure

• Abdominal distention
• Diffuse abdominal tenderness
• Borborygmi
• Rigidity and rebound abdominal tenderness
• Hepatospleenomegaly is associated with certain infections (Mycobacterium Avium complex, Salmonellosis)

Perineal erythema

• In children mostly, frequent passage of stools cause perineal skin breakdown.
• Carbohydrate malabsorption secondary to diarrhea may be responsible for more acidic stools, that results in erythema.
• Bile acid malabsorption leads to diaper dermatitis that is severe, appears as burnt perianal skin.

Failure to thrive and malnutrition

• Reductions in muscle and fat mass or peripheral edema may be present in presence of underlying carbohydrate, fat, and/or protein malabsorption.
• Giardia can cause intermittent diarrhea and fat malabsorption.

• Examination is usually normal.
• Tachypnea caused by metabolic acidosis as a result of severe volume depletion.

• Sunken anterior fontanelle
• Oral mucosal lesions and angular stomatitis in tropical sprue
• Dry mucous membranes and tongue

• Muscle weakness and convulsions because of moderate to severe electrolyte imbalance

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