|Differential Diagnosis||Differentiating Signs/Symptoms||Differentiating Tests|
|Pseudomembranous Colitis (c.diff)||Diarrhea, Abdominal pain, Fever, Nausea and vomiting, Abdominal distension, Abdominal tenderness, Symptoms of shock||
-Colonoscopy will demonstrate if ischemia is present.
-Stool cultures may reveal causative organism.
-CT may show marked thickening of colon with Clostridium difficile.
Form of inflammatory bowel disease that affects the rectum
and extends proximally. Characterized by diffuse
inflammation of the colonic mucosa and a relapsing,
Patients commonly experience bloody diarrhea, chronic diarrhea (or both), lower abdominal pain, fecal urgency, and extraintestinal manifestations, particularly those related to activity of the colitis.
|Diagnosis requires endoscopy with biopsy and negative stool culture.|
Inflammatory bowel disease that may involve the entire gastrointestinal tract..
Common presenting symptoms include chronic diarrhea, weight loss, and right lower quadrant abdominal pain mimicking acute appendicitis.
|Diagnosis confirmed by colonoscopy with ileoscopy and tissue biopsy.|
|Fulminant Colitis||Fever, Diarrhea, Abdoninal pain.||CT Abd. High Lactic acid. Very High WBC|
History of stroke, hypotension,
heart failure, diabetes, or
abdominal radiation exposure.
Symptoms of bloody diarrhea, abdominal pain, vomiting, and fever.
Colonoscopy reveals inflamed
mucosal surface or ischemic
Angiography reveals arterial flow disruption
|Gastroenteritis*||May have similar clinical features. Possible history of sick contacts. May have a significant component of nausea and vomiting. Pain is often less profound than in patients with ischemia.||CT may demonstrate thickened loops of small bowel or mesenteric lymphadenopathy without evidence of ischemia or infarcti|
|Diverticulitis||Symptomatic disease may have similar clinical features to ischemic bowel disease. Fever common in diverticulitis; diarrhea common, usually no hematochezia||CT may demonstrate focal colonic thickening and evidence of diverticulosis and diverticulitis|
Admit Orders: Colitis/Diarrhea
1. Admit to:
2. Diagnosis: Colitis (infectious)
4. Vital Signs: q6h; call physician if BP >160/90, <80/60; P >120; R>25; T >38.5°C.
5. Activity: Up ad lib.
6. Nursing: Daily weights, inputs and outputs.
7. Diet: NPO. Advance to clear liquids as tolerated.
8. IV Fluids: 0.5-2 L NS over 1-2 hr then, D5 ½ NS at 125 cc/hr. NG tube at low intermittent suction (if obstructed).
9. Special Medications:
(Flagyl) 500 mg q8h IV/PO
400 mg IV/PO q12h [STOP
if C.Diff Positive]
(Augmentin) 875/125 mg twice daily.
500 mg PO q6h
400 mg PO bid.
if C.Diff Positive]
10. Symptomatic Medications:
- Morphine sulfate 5-10 mg IV push prn pain.
11. Extras: Acute abdomen series, CXR PA and LAT, ECG, CT of abdomen w/ PO & IV Contrast, ultrasound, surgery and GI consults.
12. Labs: CBC with differential, CMP, amylase, lipase, blood cultures x 2, drug levels peak and trough 3rd dose. UA, urine C&S. Stool WBC, culture for enteric pathogens, ova and parasites x 3, clostridium difficile toxin.