Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, non-bloody, watery diarrhea (>4 weeks duration) associated with significant weight loss, malabsorption symptoms, and abdominal bloating. Patient is known HIV-positive with [CD4 count] and [viral load]. Denies recent travel, antibiotic use, or infectious contacts. Symptoms refractory to standard anti-motility agents.
Clinical Examination Findings
General: Patient appears cachectic with signs of muscle wasting. Abdomen: Soft, non-tender, hyperactive bowel sounds, no organomegaly. Skin: Signs of dehydration (decreased turgor, dry mucous membranes). Rectal: No masses or blood on digital rectal exam. Vitals: Stable but may show orthostatic hypotension.
Treatment Protocol
1. Optimize antiretroviral therapy (ART) to achieve viral suppression. 2. Nutritional support: High-calorie, low-residue diet; vitamin/mineral supplementation (B12, folate, zinc). 3. Symptomatic management: Loperamide or Crofelemer for diarrhea control. 4. Monitor for opportunistic infections (CMV, Cryptosporidium) if symptoms persist. 5. Gastroenterology referral for endoscopy/biopsy to confirm villous atrophy.