The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 7: Gastrointestinal Symptoms• The existence of associated symptoms, such as abdominal pain or fever• Dietary practicesWhen 26 the picas diarrhea is chronic, an attempt should be made to classify it by pathogenic mechanism:inflammatory (e.g., Crohn’s disease, cytomegalovirus [CMV] colitis), osmotic (e.g., pancreaticinsufficiency and malabsorption), secretory (e.g., hormone-mediated diarrheas such ascarcinoid syndrome), altered intestinal motility (e.g., irritable bowel syndrome) or factitious(laxative abuse).Medications should be carefully reviewed as a possible cause of the diarrhea, and suspect medicationsdiscontinued. A number of HAART medications (especially the protease inhibitors) arecommonly associated with diarrhea. Medical records should be reviewed carefully to see if thepatient has been diagnosed previously with any enteric opportunistic infections, since symptomsoften will be secondary to reactivation of that pathologic process. In addition, medicalrecords can give the palliative care team important insight into the success of previously triedtherapies.Depending on the duration and severity of the diarrhea, it may be appropriate to undertake alimited, noninvasive diagnostic work-up. Stools should be sent for routine culture and sensitivity,acid-fast bacilli culture, ova and parasites and Clostridium dificile toxin. CMV colitis shouldbe considered in patients with advanced immunosuppression (CD4