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.
Inflammatory Colitis:
Form of inflammatory bowel disease that affects the rectum and extends proximally. Characterized by diffuse inflammation of the colonic mucosa and a relapsing, remitting course.

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
Ischemic Colitis 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 ulcers.
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)

3. Condition:

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:

Inpatient Regimen:

-Metronidazole (Flagyl) 500 mg q8h IV/PO

Ciprofloxacin (Cipro) 400 mg IV/PO q12h [STOP if C.Diff Positive]

-Amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily.

Outpatient Regimen:

-Metronidazole (Flagyl) 500 mg PO q6h

Ciprofloxacin (Cipro) 400 mg PO bid.  [STOP if C.Diff Positive]

10. Symptomatic Medications:

 - Morphine sulfate 5-10 mg IV push prn pain.
 - Zolpidem (Ambien) 5-10 mg qhs PO prn insomnia.
 - Zofran 4mg IV q4-6h prn
 -Acetaminophen (Tylenol) 650 mg 2 tab PO/PR q4-6h prn temp >38°C or pain.
 -Docusate sodium (Colace) 100 mg PO qhs.
 -Famotidine (Pepcid) 20 mg IV/PO q12h.
 -Heparin 5000 U SQ q12h or pneumatic compression stockings

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.


Source: Epocrates, Tintinalli ED 7