bloody (inflammatory) versus non-bloody (non-inflammatory) diarrhea

Etiology

• bloody diarrhea (inflammatory)
  • Shigella
  • Campylobacter jejuni (diarrhea generally not bloody)
  • enterohemorrhagic E. coli (Shiga toxin producing E. coli) is the most common cause of bloody diarrhea in the U.S.
  • Vibrio parahaemolyticus
  • Clostridium difficile
  • amebiasis (Entamoeba histolytica)
  • intestinal ischemia
  • inflammatory bowel disease
    • Crohn's disease
    • ulcerative colitis
  • colchicine toxicity
• non-bloody (non-inflammatory)
  • rotavirus
  • Norwalk agent
  • enterotoxigenic E. coli
  • Giardia lamblia
  • Vibrio cholera
  • Staphylococcal enterotoxin
  • Salmonella
  • Yersinia enterocolitica
  • Campylobacter jejuni (diarrhea generally not bloody)
  • bile acid diarrhea
  • malabsorption
  • laxatives

Pathology

• inflammatory diarrhea - colonic inflammation

Clinical manifestations

(also see acute diarrhea)

• inflammatory diarrhea
  • small volume diarrhea
  • clinically more severe
  • may be fever
• non-inflammatory
  • large volume, watery stools
  • nausea, anorexia & volume depletion may occur

Laboratory

(also see acute diarrhea)

• inflammatory diarrhea
  • fecal leukocytes
  • shiga toxin gene, immuoassay for shiga toxin
• non-inflammatory diarrhea
  • no fecal leukocytes

Management

(also see acute diarrhea)

• acute non-inflammatory diarrhea is self limited
  • resolves spontaneously with 5-7 days
  • oral rehydration with an electrolyte solution is generally adequate for most adults
• acute inflammatory diarrhea - avoid antidiarrheal agents

Additional terms

• acute diarrhea
• dysentery