Diarrhea

Diarrhea is a topic covered in the Washington Manual of Medical Therapeutics.

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Washington Manual

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  • Diarrhea is a common side effect of many chemotherapies (irinotecan, 5FU, capecitabine), targeted agents (erlotinib, cetuximab, sunitinib, lapatinib), and newer immunotherapies (ipilimumab, nivolumab, pembrolizumab).
  • Diarrhea can also be a symptomatic manifestation of the underlying cancer (such as carcinoid syndrome in neuroendocrine tumors).
  • Obtaining a good history and accurately assessing the type of cancer a patient has, treatments received and their timing, history of bone marrow transplantation (GVHD), immunosuppressant regimen, recent dose adjustments, and recent antibiotic use are all very crucial.
  • Imaging of the abdomen, Clostridium difficile testing, and even obtaining a colonoscopy might be required in selected patients (e.g., ipilimumab-related colitis).
  • Special attention should be paid to transplant patients because testing serum levels of immunosuppressants and testing for opportunistic infections constitute an important part of workup.

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