Traveler's diarrhea physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Serge Korjian M.D.

Overview

Physical examination of patients with traveler's diarrhea may be remarkable for abdominal tenderness, fever (occasionally), and signs of dehydration, such as abnormal orthostatic vital signs, reduced skin turgor, slow capillary refill, and dry mucous membranes. Physical examination among patients with severe dehydration may be remarkable for altered mental status. Physical examination may also be remarkable for findings suggestive of complications of the traveler's diarrhea (e.g. hemolytic uremic syndrome, abscess formation, cognitive dysfunction, ocular disease).

Physical Examination

General Appearance

• Ill-appearing
• Crying (in pediatric patients)

Vital Signs

• Fever
• Tachycardia
• Tachypnea
• Orthostatic hypotension may be suggestive of dehydration (due to diarrhea and/or vomiting)

Skin

• Reduced skin turgor
• Slow capillary refill
• Skin pallor or petechiae may be suggestive of hemolysis among patients who develop hemolytic uremic syndrome

HEENT

• Sunken fontanelles in infants
• Ocular inflammation may be suggestive of ocular manifestations of traveler's diarrhea (commonly in giardiasis)
• Sunken eyes
• Absent tears in children
• Dry mucous membranes

Abdomen

• Abdominal tenderness (usually diffuse)
• Right upper quadrant tenderness may be present among patients with amebiasis, suggestive of amebic liver abscess
• Bloody stools and/or rectal tenderness may be present on rectal examination

Neurologic

• Altered mental status may be present in cases of severe dehydration, especially among elderly and pediatric patients