1. When do you send stool cultures, stool ovum and parasites, and/or fecal WBC? How do you use the results in diagnosis and management?
3. Which patients do you treat with antibiotics?
4. What other medications do you use? Loperamide, Pepto, Lomotil? What about probiotics?
1. When do you send stool cultures, stool ovum and parasites, and/or fecal WBC?–>when there is blood in the stool, fever, prolonged diarrhea, or possible precipitating etiology (ie drinking stream water) How do you use the results in diagnosis and management? Culture and o&p give the causative agent, fecal leuk not as helpful
2. When do you get bloodwork? When do you pursue imaging? Blood work for pronged diarrhea, blood in stool, severe abdominal pain. Imaging for severe abdominal pain 3. Which patients do you treat with antibiotics? Cdiff, blood in stool 4. What other medications do you use? Loperamide, Pepto, Lomotil? What about probiotics? Don’t use Imodium unless absolutely necessary. Never use lomotil. Intermittently recommend probiotics, probably should use this more
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1. Stool mcs (always plus cdt) if sick enough to be admitted, unusual features eg bloody stools, high fevers, prolonged illness… Basically if suspecting bacterial. Or if known or suspected contact of known outbreak. Ocp if rfs for parasitic, eg travel, prolonged diarrhoea, rivers.
2. Bloods almost always, unless young healthy pt with short hx of typical infectious gastro.
3. Almost never for infectious gastro (even if suspected bacterial), unless for some specific bugs (eg clostridia, typhoid – in these cases ID usually need to be involved), or immunocompromised and suspected bacterial, or septic, or surgical problem (eg diverticulitis).
4. Loperamide rarely. Only in young / otherwise healthy patients, not too unwell, and then only if they’re really keen for symptom amelioration. I always explain to them it doesn’t help with their actual disease and in some cases may prolong it.