35-year-old man

comes to the clinic

complaining of diarrhoea

35-year-old man

• middle aged men

• immune system well developed

comes to the clinic

• not severe

• not need immediate treatment

• maybe just small pain and uncomfortable

complaining of diarrhea

• can due to infection (bacteria, parasitic, viral)

• can due to contaminated food (infection (foodborne disease))

• can due to medicine

• maybe lactose intolerance

• physiological factors (stress and anxiety)

bacteria infection

parasitic infection

viral infection

food poisoning

IBD (Crohn disease/ulcerative colitis)

food intolerance

• allergies

• lactose intolerance

• celiac disease

drug induced diarrhea

endocrine disorder

stress and anxiety

pancreatic deficiency

IBS

HOPI

• s -do you feel pain anywhere

• o- when you start diarrhea? , how long?

• c- stool color and characteristic ( blood, pus, watery, fatty)

• r- do you feel pain anywhere else?

• a- fever, nausea, vomiting, weight loss, fatigue, dehydration

• t - how often, is it everytime, how many time you go to toilet?

• e- any medication you take?, is it something that induce you diarrhea?

• s- scale (rate umconfortability)

PMH

• any hospitalization

• any surgery, any illness/allergy

• any cancer (chemotherapy)

• drug history (laxative, fluroquinolone)

SH

• alcohol

• smoke

• dietary habit

• hygiene

• work

• physiological trauma

FH

• cancer?

• diabetes?

• hypertension?

• any family member have the same symptom?

travel history

• go anywhere before?

diaphoretic - excessive sweating

5 bowel movements - defecate 5 times

started about 2 days ago

first symptom was loss of appetite while eating breakfast

unable to finish breakfast

nauseated and diaphoretic during 20-minute drive to work

low-grade fever and abdominal cramping when arrived at work and vomiting soon after

next 24 hours, 5 bowel movements with diarrhea

watery stool and brown without blood

no medical problems, no meds/supplements

no recent changes in diet and only home food for the last week

bus driver and no travel out of country and no close contacts

PMH, allergy and meds none

non smoker and no alcohol

started about 2 days ago

• acute

first symptom was loss of appetite while eating breakfast

• anorexia

• maybe due to infection

unable to finish breakfast

• due to LOA

nauseated and diaphoretic during 20-minute drive to work

• body responds to toxins and inflammation

• feverish

• nausea causes LOA

• nausea could be due to motion sickness

low-grade fever and abdominal cramping when arrived at work and vomiting soon after

• indicates infection, inflammatory condition or heat exposure

• due to hormonal changes

• vomit after cramps due to GI discomfort

• cramps were due to accumulation of fluid

next 24 hours, 5 bowel movements with diarrhea

• high volume of fluid loss

• can cause dehydration

watery stool and brown without blood

• could be secretory or osmotic diarrhea

• no lesion/ulcers because no blood

• no liver problem

no medical problems, no meds/supplements

• not due to any meds or past diseases

no recent changes in diet and only home food for the last week

• eating according to his normal daily intake

• rule out traveler's diarrhea

bus driver and no travel out of country and no close contacts

• only one experiencing diarrhea

• he probably ate something contaminated by himself

PMH, allergy and meds none

• immunocompetent

• not drug-induced diarrhea

• not food intolerance/allergy

non smoker and no alcohol

• immunocompetent

• no liver cirrhosis

bacteria infection

parasitic infection

viral infection

food poisoning

IBD (Crohn disease/ulcerative colitis)

food intolerance

• allergies

• lactose intolerance

• celiac disease

drug induced diarrhea

endocrine disorder

stress and anxiety

pancreatic deficiency

IBS

vital signs

• bp

• temp

• rr

• pr

general apearance

• signs of dehydrations (decreased skin turgor, dry mucous membranes, sunken eyes)

abdominal PE

• auscultation

• palpation

• percussion

bacteria infection

parasitic infection

viral infection

food poisoning

IBD (Crohn disease/ulcerative colitis)

food intolerance

• allergies

• lactose intolerance

• celiac disease

drug induced diarrhea

endocrine disorder

stress and anxiety

pancreatic deficiency

IBS

gastroenteritis

FBC

stool c&s

CRP

ESR

PCR

BUSE

All normal EXCEPT CRP HIGH - indicating inflammation