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Old 09-16-2011
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Question Traveller's Diarrhea vs Tropical Sprue

how do we differentiate travellers diarrhea d/t giardia n tropical sprue clinically??

both have h/o travel ( to developing countries in 1st n to tropics in 2nd, but that's not helpful as most developing countries fall in tropics)

n both present with diarrhea, fat malabsorption, cramping, bloating..

i came across a question in uworld saying pt has 4 weeks diarrhea n same features as above with h/o travel and I selected colonoscopy (to diagnose sprue)...but the answer was metronidazole empirically...

do we give a trial of metronidazole to every1 before jumping to rare diagnosis?
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Old 09-16-2011
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What was the explanation in UWorld?

Or if you can post the whole question here, maybe there were other hints.
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Old 09-16-2011
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Quote:
Originally Posted by Govinda View Post
What was the explanation in UWorld?

Or if you can post the whole question here, maybe there were other hints.

34yr old Caucasian male + presenting with 4 weeks of diarrhea + just returned from south America + where he developed foul smelling fatty stools, cramping bloating, took cipro for 3days..not relieved
next step?
colonoscoopy
ct abdomen
metronidazole
repeat cipro
give ampicillin

n in the explanation they didn't say anything about spru..they said its travelers diarrhea, by giardia,,which is empirically treated with metronidazole. n colonoscopy is done in chronic unexplained diarrhea.


so i thought may b first we treat all possible n common causes n then go to more invasive procedures?? but the question is same...is there any clinical difference??
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Old 09-16-2011
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You don't jump into colonoscopy for acute diarrhea, try some meds first.
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Old 09-16-2011
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A pt presents with diarrhea, first differential to consider is Infectious diarrhea.

Past h/o of travel can point us towards giardia, if they mentioned any thing like mountains, ponds, fresh water springs etc.

Second, if we assume this pt has infectious diarrhea and we treated with Cipro for 3 days. Still no response then its likely to be giardia because its the only one left which is associated with history of travel & does not respond to cipro.

For tropical sprue first we have to establish the malabsorption, by doing assessment of fecal fat content. If there is steatorrhea, then we can proceed with the colonoscopy.
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Old 09-17-2011
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yes u r right....!!
but i just wanted to know if there is any clinical hint?? that cud differentiate??
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Old 09-17-2011
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Quote:
Originally Posted by aasiaafzal View Post
yes u r right....!!
but i just wanted to know if there is any clinical hint?? that cud differentiate??
Clinically, tropical sprue usually presents with chronic diarrhea & symptoms of malabsorption like weight loss & vitamin deficiencies.
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