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    Back to Module 10: Common Physical Symptoms
    Specific Symptoms

     
    Breathlessness (Dyspnea)
    Nausea and Vomiting
    Constipation
    Diarrhea Anorexia/Cachexia
    Fatigue/Weakness
    Fluid Balance/Edema
    Skin
    Odors
    Insomnia

    Diarrhea

    Case Example

    SD is a 79-year-old tax attorney with advanced congestive heart failure. He is debilitated and has difficulty with mobility. Due to a curative resection of a large transverse mass some years ago, he has chronic diarrhea. Getting up to go to the bathroom 12–15 times per day is exhausting.

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    Definition/Description

    • Stools that are looser than normal and that may be increased in numbers
    • If persistent, diarrhea can lead to:
      • Dehydration
      • Malabsorption
      • Fatigue
      • Hemorrhoids
      • Perianal skin breakdown

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    Causes

    • Infections
    • GI Bleeding
    • Malabsorption
    • Medications
    • Obstruction
    • Overflow incontinence
    • Stress

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    General Management

    • Establish normal bowel pattern (wide variation)
    • Avoid gas-forming foods, particularly lactose
    • Increase bulk (e.g., psyllium, bran, pectin)

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    Specific Management

    • Transient, mild
      • Attapulgite 30ml or 2 tabs prn
      • Bismuth salts 15–30 cc bid–qid
    • Persistent
      • loperamide 2–4 mg PO q 6h, or higher
      • Diphenoxylate/atropine 2.5–5.0 mg PO q 6h or higher
      • Tincture of opium 0.7 cc PO q 4h and titrate
    • For persistent, severe secretory diarrhea
      • octreotide 50 mg SC q 8–12h, then titrate up to 500 mg q 8h SC, or higher, or 10–80 mg q 1h by continuous SC, IV infusion

      • parenteral fluid support, as needed, and appropriate
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