Clostridium difficile infection 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.

Overview

Patients with C. difficile infection typically have low-grade fever and abdominal tenderness on physical examination. Additional signs on physical examination may be suggestive of worsening infection, complicated disease, or failure of antimicrobial therapy. Significant findings on physical examination include significant derangements in vital signs, including high-grade fever, tachycardia, or hypotension, signs of dehydration, peripheral edema which might be suggestive of hypoalbuminemia, or worsening abdominal tenderness, distention, palpable masses, or inactive bowel sounds, which may suggest toxic megacolon, abscess development, or ileus.

Physical Examination

Patients with C. difficile infection typically have low-grade fever and abdominal tenderness on physical examination. Additional signs on physical examination may be suggestive of worsening infection, complicated disease, or failure of antimicrobial therapy.

Vital Signs

• Fever (may be either high-grade or low-grade)
• Tachycardia
• Tachypnea
• Hypotension (in case patient is severely dehydrated)

Skin

• Pallor

HEENT

• Dry mucus membranes
• Conjunctival pallor

Abdomen

• Abdominal distention
• Hyperactive bowel sounds (may be hypoactive or inactive if patient develops ileus)
• Abdominal tenderness (diffuse or localized to one quadrant)
• Abdominal mass on palpation may suggest visceral or intraabdominal abscess.

Lower Extremities

• Peripheral edema (due to hypoalbuminemia)