When the change in stool excretion persists for longer than seven to ten days, an evaluation is in order. Freshly collected stool should be submitted or properly preserved for analysis for ova and parasites. Bacterial culture for common offenders, such as Salmonella, Shigella, Campylobacter jejuni and special strains of E. coli, is recommended. If persistent diarrhea is caused by one of these organisms, appropriate antibiotic or antiparasitic therapy is indicated.
Many acute intestinal infections by bacteria or viruses are self-limiting and do not require drug therapy.
Crohn's disease can effect any part of the colon...
|Symptoms||Local only (cramping tenemus)
|Prominent cramps, borderline fatigue
|Fatuigue, anorexia, weight loss, sleep requirement
|Apathy, muscle wasting
General abd. tenderness
|Laboratory Tests||Usually normal
ESR > 25 (in minority)
|Hct 35 to normal; WBC nl
ESR > 25; Alb > 3.5
|Hct < 30 to 35; WBC > 15K
ESR > 30; Alb < 3.0; Often Alk.Phos.
|Colonoscopy||Frialbiality; granularity; visible ulcers (Crohn's)||Distortion, very friable; large ulcers (Crohn's)||Universal involvement; marked mucosa distortion
|Segmental or distal disease||Usually 50% of colon involved
Often mural thickening
|Total colon involved
|Therapy2||Sulfasalazine 2-4 Gm/d
5-ASA enemas for distal disease
|Usually same as for Mild
Prednisone 20 mg/day, if no response to local Rx
|NPO; i.v. fluids
Prednisone 40-80 mg/d
Cyclosporin 4 mg/day i.v.x4d; then 8 mg/day p.o.
Colectomy if no response by 48 hrs