Diarrhea is usually foul-smelling, watery or mushy in consistency, may also be greasy oily, and may contain admixtures of blood. Other complaints that often accompany diarrhea (diarrhea) are:
- Anorexia (loss of appetite).
- Nausea (nausea)
- Vomiting
- Meteorism (flatulence)
- Abdominal pain, dull or colicky
- Fever
- Weight loss
- Desiccosis (dehydration)
- Skin changes such as circumscribed skin redness
- Headache
Warning signs (red flags) for somatic causes of disease
The following anamnestic information or symptoms require further diagnosis to exclude a somatic (physical) disease:
- Anamnestic information:
- Family history of chronic inflammatory bowel disease (e.g., ulcerative colitis, Crohn’s disease).
- In the basic laboratory: anemia (anemia) and inflammatory signs.
- Paradoxical diarrhea; diarrhea alternating with constipation → suspected colon carcinoma (colon cancer).
- Blood in the stool (hematochezia)
- Pencil stool → think of: Rectal carcinoma (rectal cancer).
- Fatty stools (steatorrhea)
- Fever
- Fever and diarrhea longer than two weeks:
- In children → think of: Intestinal infections with Yersinia, Lamblia and parasites.
- Immunocompromised patients → think of: Cryptosporidia, Cytomegalovirus (CMV) and Mycobacteria.
- Weight loss > 10% with unchanged food intake.
- Performance kink
- Pain localize
- Nocturnal discomfort or waking up due topain or symptoms.
- Pain away from the navel (in children).
- Palpable resistances
In one study, loose stool was shown to be the best predictor of an organic cause of diarrhea according to the Bristol Stool Shape Scale-compared with the traditional definition of chronic diarrhea (≥ 3 bowel movements/day with a stool weight greater than 200 g and a duration of at least 4 weeks).
Infants and young children
Dehydration (lack of fluids) and shock
The following children are at increased risk:
- Infants with low birth weight
- Infants, with signs of malnutrition
- Children under one year of age, especially children under 6 months.
- Children who have had > 5 diarrheal stools within the last 24 hours
- Children who have vomited more than twice within the past 24 hours
- Children who have not previously received supplemental fluids or have been unable to tolerate them
- Children in whom breastfeeding has been discontinued during the disease.
Warning signs (red flags) in children (= possible indicators of other diagnoses) [NICE recommendations; 1, 2 ]
- Fever > 38 °C in children younger than 3 months of age.
- Fever > 39 °C in children over 3 months of age
- Shortness of breath or tachypnea (“rapid breathing“).
- Changes in consciousness
- Meningismus (painful stiffness of the neck)
- Bulging fontanelle in infants
- Rash that can not be pushed away
- Blood or mucus accumulation in the stool
- Bilious (greenish) vomiting
- Severe or localized abdominal pain
- Distended abdomen or pain on release
