Assessment of chronic diarrhoea

Most cases of chronic diarrhoea can be evaluated in the outpatient setting; however, certain features require a faster approach.

Red flags

Individuals experiencing rapid weight loss, dehydration, gastrointestinal bleeding, anaemia, or severe abdominal pain are more likely to have a serious cause of their diarrhoea and should have an expedited evaluation, potentially in an inpatient setting.

Urgency of evaluation and treatment should be based on systemic signs. Any patients with signs of toxicity (tachycardia, dehydration, pyrexia, or hypotension) require urgent assessment. In these cases the patient should be admitted to the hospital for the following:

• Intravenous rehydration and correction of electrolyte imbalances

• Intravenous antibiotics if pyrexial

• Abdominal x-ray to exclude toxic dilatation

• Referral for a surgical consult

• Consideration of rigid or limited flexible sigmoidoscopy, provided no toxic dilatation

• Transfusion if necessary.