How Do I Approach the Patient with Diarrhea? Key History, Physical Examination, and Diagnostic Considerations

  • Alexa R. GaleEmail author
  • Matthew Wilson


Acute gastroenteritis accounts for 179 million outpatient visits, approximately 500,000 hospitalizations, and >5000 deaths in the United States each year. The evaluation of diarrhea begins with a thorough history to determine potential causes to customize initial diarrheal illness management, followed by a careful physical examination to assess the patient’s level of dehydration, determine supportive care requirements, and refine the diagnostic workup. Causative etiologies can be elucidated with a five-question approach. Labs and imaging are rarely required.


Diarrhea Dehydration Abdominal pain Enteritis E. coli 


  1. 1.
    Scallan E, Griffin PM, Angulo FJ, Tauxe RV, Hoekstra R. Foodborne illness acquired in the United States – unspecified agents. Emerg Infect Dis. 2011;17:16–22.CrossRefGoogle Scholar
  2. 2.
    Sweetser S. Evaluating the patient with diarrhea: a case based approach. Mayo Clin Proc. 2012;87(6):596–602.CrossRefGoogle Scholar
  3. 3.
    Thielman NM, Guerrant RL. Acute infectious diarrhea. N Engl J Med. 2004;350:38–47.CrossRefGoogle Scholar
  4. 4.
    Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV, et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001;32:331–50.CrossRefGoogle Scholar
  5. 5.
    Crawford C. Cryptosporidiosis outbreaks on the rise, CDC warns [document on the Internet]. AAFP News, American Academy of Family Physicians; 2015 July 1. Available from:
  6. 6.
    Schiller LR, Sellin JH. Diarrhea. In: Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran’s gastrointestinal and liver disease. Philadelphia: Saunders Elsevier; 2010. p. 211–32.CrossRefGoogle Scholar
  7. 7.
    Bardhan PK, Beltinger J, Beltinger RW, Hossain A, Mahalanabis D, Gyr K. Screening of patients with acute infectious diarrhoea: Evaluation of clinical features, faecal microscopy, and faecal occult blood testing. Scan J Gastroenterol. 2000;3591:54–60.Google Scholar
  8. 8.
    Rhodes F, Carty E. Laxatives: a rational approach to prescribing. Br J Hospital Med. 2014;75(8):C114–8.CrossRefGoogle Scholar
  9. 9.
    Churgay CA, Aflab Z. Gastroenteritis in children: part I. Diagn Am Fam Physician. 2012;85(11):11.Google Scholar
  10. 10.
    Steiner MJ, DeWalt DA, Byerley JS. Is this child dehydrated? JAMA. 2004;291(22):2746–54.CrossRefGoogle Scholar
  11. 11.
    Teach SJ, Yates EW, Feld LG. Laboratory predictors of fluid deficit in acutely dehydrated children. Clin Pediatr (Phila). 1997;36(7):395–400.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Georgetown University School of Medicine, MedStar Washington Hospital CenterDepartment of Emergency MedicineWashington, DCUSA

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