Diarrhea: Medical History

Medical history (history of illness) represents an important component in the diagnosis of diarrhea (diarrhea). Family history

• What is the general health of your family members?
• Are there any diseases of the gastrointestinal tract in your family that are common?
• Are there any hereditary diseases in your family?

Social history

• What is your profession?
• Are you exposed to harmful working substances in your profession?
• Is there any evidence of psychosocial stress or strain due to your family situation?

Current medical history/systemic history (somatic and psychological complaints).

• Describe your diarrhea:
  • Duration, i.e. when did your diarrhea start?
  • Frequency, i.e., how often do you need to pass stool?
  • Consistency:
    • Bristol type 5: Individual soft, clear smooth-edged lumps, easy to excrete.
    • Bristol type 6: Single loose soft clumps with frayed irregular edge.
    • Bristol type 7: Liquid / watery, without solid components / no pieces.
  • Volume, i.e. how large is the amount of stool?
  • Color, ie what color is the chair?
  • Impurities, ie are deposits such as blood* , mucus or pus* visible?
• Is there a connection with the food intake?
• Do you also have diarrhea when you do not eat?
• Do you also have to pass stool at night?
• Do you have any additional complaints such as abdominal pain, nausea/vomiting or fever/night sweats?
• Do you have pain during bowel movements?
• Do you have fecal incontinence (inability to retain stool)?
• Do you have abnormalities in urination?
• Have you noticed any skin changes?
• Do you have increased headaches?

Vegetative anamnesis including nutritional anamnesis.

• Have you been on vacation recently? In which country?
• Have you eaten raw foods in southern countries?
• Has your appetite changed?
• Have you lost body weight unintentionally?
• Do you regularly take laxatives?
• Do you smoke? If so, how many cigarettes, cigars or pipes per day?
• Do you drink alcohol? If yes, what drink(s) and how many glasses per day?
• Do you use drugs? If yes, what drugs and how often per day or per week?

Self history incl. medication history.

• Pre-existing conditions (gastrointestinal diseases, infectious diseases).
• Operations
• Irradiations
• Allergies
• Environmental history (arsenic, chromium, tuber leaf fungus, organophosphate insecticides, mercury, ciguatera (seafood)).

Medication history

• 5-α-reductase inhibitor (finasteride).
• Alkaloids (colchicine)
• Alpha-glucosidase inhibitors (acarbose, miglitol).
• Analgesics
  • Non-steroidal anti-inflammatory drugs (acetylsalicylic acid (ASA))
    • Arylacetic acid derivatives (diclofenac).
    • Propionic acid derivatives (ibuprofen, flurbiprofen, naproxen, ketoprofen, tiaprofenic acid).
• Angiotensin II antagonists (synonyms: Angiotensin II receptor antagonists, AT1 antagonists, AT1 receptor antagonists, AT1 blockers, sartans) – azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan.
• Angiotensin receptor neprilysin antagonists (ARNI) – dual drug combination: sacubitril/valsartan.
• Antacids (aluminum hydroxide, magnesium hydroxide, magnesium trisilicate).
• Antibiotics
  • Aminoglycoside antibiotic (paromomycin).
  • Aminopenicillins (amoxicillin)
  • Aminopenicillins with ß-lactamase inhibitor (sultamicillin).
  • Benzylpenicillins (penicillin G, penicillin V).
  • Β-lactam antibiotics (cefuroxime).
  • Quinolones (ciprofloxacin, levofloxacin, ofloxacin).
  • Ketolides (telithromycin)
  • Lincosamide (clindamycin)
  • Oxazolidinones (linezolid)
  • Nitroimidazoles (metronidazole)
  • Rifampicin
  • Staphylococcal penicillins (flucloxacillin)
  • Tetracyclines (chlortetracycline oxytetracycline demeclocycline)
• Antidepressants
  • Melatonin receptor agonists (MT1/MT) and serotonin 5-HT2C receptor antagonists – agomelatine; contraindicated in patients 75 years of age and older.
  • Noradrenergic and specific serotonergic antidepressants (NaSSA) – mirtazapine.
  • Selective norepinephrine reuptake inhibitor (NARI) – reboxetine, viloxazine.
  • Selective serotonin reuptake inhibitor (SSRI) (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, trazodone).
  • Selective serotonin–norepinephrine reuptake inhibitors (SSNRIs) – duloxetine, venlafaxine.
• Antidiabetic drugs
  • Biguanides (metformin)
• Antiemetics (metoclopramide)
• Antifibrinolytic (tranexamic acid)
• Antihistamines (azelastine, clemastine, terfenadine).
• Antimalarials (artemetherm atovaquone, quinine, chloroquine, hydroxychloroquine, lumefantrine, mefloquine, primaquine).
• Antifungals (itraconazole).
  • Azoles (voriconazole)
  • Triazole derivatives (fluconazole, ketoconazole).
• Antiretroviral therapeutics
  • Nucleoside analogues (abacavir, didanosine, entecavir, lamivudine, stavudine, telbivudine, tenofovir, zidovudine).
  • Protease inhibitors (atazanavir, fosamprenavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir).
• Antisympathicotonics (alpha-methyldopa).
• Antivertiginosa (betahistine)
• Antiviral therapeutics
  • Membrane protein inhibitors (amantadine)
• Antitussives (pentoxyverine).
• Arsenic trioxide
• Dipping resins (colestyramine, ursodeoxycholic acid, UDCS).
• Chelating agents (D-penicillamine)
• Beta blocker
  • Β1-selective beta-blockers (acebutolol, atenolol, esmolol, metoprolol).
  • Non-selective beta-blockers (oxprenolol, propranolol).
• Bisphosphonates (alendronate, clodronate, etidronate, ibandronate, pamidronate, risedronate, tiludronate, zoledronate/zoledronic acid).
• Calcimimetic (etelcalcetide).
• Calcium-containing phosphate binders (calcium acetate, calcium carbonate).
• COMT (catechol-O-methyl transferase) inhibitors (entacapone).
• Diuretics
  • Potassium-sparing diuretics
    • Aldosterone antagonists (amiloride, epleronone, spironolactone, triampterene)
  • Loop diuretics (etacrynic acid, furosemide, piretanide, torasemide).
• EGFR tyrosine kinase inhibitor (lapatinib).
• Enzymes (pancreatin, porcine pancreatin preparations).
• Fumaric acid esters
• Glutamate modulator (acamprosate)
• Guanyltacyclase c agonist (linaclotide)
• HCV inhibitors (boceprevir)
• Cardiac glycosides (digitalis) (digoxin, ß-acetyldigoxin, ß-methyldigoxin, digitoxin).
• Hormones
  • Antiestrogens (fulvestrant)
  • Aromatase inhibitors (anastrozole, letrozole, testolactone).
  • Gonadotropins (FSH, LH)
  • Estrogens (17ß-estradiol ester, estradiol, ethinyl estradiol, conjugated estrogen, estriol).
  • Parathyroid hormone anatgonist (calcitonin).
  • Progesterone receptor antagonist (mifepristone).
  • Prostaglandins (alprostadil, iloprost. alprostadil).
  • Somatostatin analogues (lanreotide, octreotide).
• H2 antihistamines (H2 receptor antagonists, H2 antagonists, histamine H2 receptor anatgonists) (cimetidine, famotidine, lafutidine, nizatidine, ranitidine, roxatidine).
• Immunosuppressants (leflunomide, mycophenolate mofetil).
• Immunotherapeutics (mitoxantrone).
• Laxatives
• Lipid-lowering agents
  • Cholesterol absorption inhibitor (ezetimibe)
  • Colestyramine
  • HMG-CoA reductase inhibitors (statins) (atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin).
• Monoclonal antibodies
  • Nivolumab (checkpoint inhibitor).
  • Pertuzumab, trastuzumab
• Mucolytics (acetylcysteine (ACC), bromhexine, N-acetylcysteine (NAC); N-acetyl-L-cysteine).
• N-methyl-D-aspartate recptor antagonist (Memantine).
• Neurokinin antagonists (aprepitant, fosaprepitant).
• Olmesartan (angiotension II receptor antagonists; count as antihypertensives) → celiac disease-like enteropathy with diarrhea with or without nausea, vomiting, and weight loss.
• Parasympathomimetics
  • Direct parasympatheticomimetic (pilocarpine).
  • Indirect parasympathomimetics (cholinesterase inhibitors): alkylphosphates, distigmine, donepezil, galantamine, neostigmine, physostigmine, pyridostigmine, rivastigmine, tacrine
• Perchlorate
• Phosphodiesterase-3 inhibitors (enoximone, milrinone).
• Phosphodiesterase-4 inhibitor/PDE-4 inhibitor/tsDMARDs (target synthetic DMARDs) (apremilast).
• Phytotherapeutics (saw palmetto fruit (Sabal serrulata))
• Prokinetics
  • Cholinergics (e.g., carbachol)
  • Dopamine receptor antagonists (e.g., metoclopramide, domperidone).
  • 5-HT4 receptor agonists (e.g., cisapride).
• Proton pump inhibitors (PPIs) – esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole.
• Rheologics naftidrofuryl, (pentoxifylline).
• Sedatives
  • Benzodiazepines (alprazolam bentazepam, bromazepam, brotizolam, clobazam, clonazepam, clorazepate, clotiazepam, diazepam, etizolam, flunitrazepam, flurazepam, loprazolam, Lorazepam, Lormetazepam, Medazepam, Nitrazepam, Nordazepam, Oxazepam, Phenazepam, Prazepam, Temazepam, Tetrazepam* , Triazolam) [* Suspension of prescriptions since August 2013 due to. Serious skin reactions such as Stevens-Johnson syndrome or erythema multiforme.
• Selective prostacyclin IP receptor agonists (selexipag).
• Sterols (sterols) – ursodeoxycholic acid.
• Strontium salt (strontium ranelate)
• Thrombin inhibitor (dabigatran)
• Thrombopoietin receptor agonist (eltrombopag)
• Antiplatelet agents (TAH): acetylsalicylic acid (ASA), dipyridamole, clopidogrel, prasugrel, ticlopidine.
• Thyrostatic agents
  • Thionamides (carbimazole, propylthiouracil, thiamazole).
• Tuberculostatics (isoniazid, rifampicin).
• Tyrosine kinase inhibitors (TKi) / angiogenesis inhibitors (cabozantinib, lenvatinib, nintedanib, pazopanib, sorafenib, sunitinib, vandetanib).
• Uricostats (allopurinol, febuxostat).
• Vasoactive substances (cilostazol, naftidrofuryl).
• Antivirals
  • Nucleoside analogues (aciclovir, brivudine, cidofovir, famciclovir, ganciclovir, valganciclovir).
  • Other (foscarnet)
• Bismuth (bismuth nitrate, bismuth subcitrate, bismuth subsalicylate).
• Xanthine (theophylline)
• Cytokines (glatiramer acetate, interferon ß-1a, interferon ß-1b).
• Cytostatics
  • Antimetablite (methotrexate (MTX))
  • Topoiosmerase inhibitors (etoposide, irinotecan).
  • 5-FU
• Cytotoxic substances (mycophenolate).

* If this question has been answered with “Yes”, an immediate visit to the doctor is required! (Information without guarantee)