The ability to presumptively localize the pathologic process to the small intestine or colon is valuable in directing and streamlining a diagnostic workup. Important information often can be obtained from the clinical history. The symptoms related to small intestinal infection are typical of malabsorption. Patients complain of 3 to 10 nonbloody bowel movements per day, with urgency but no tenesmus. When severe, the diarrhea is associated with dehydration and electrolyte abnormalities. The diarrhea does not occur consistently throughout the day and is often worst at night or early in the morning. There may be no specific food intolerances, as diarrhea is worsened by any significant food intake. However, stool volumes are decreased by fasting. The infections producing malabsorption usually are not associated with fever or anorexia, though food intake may be decreased voluntarily to avoid diarrhea. A notable exception to this rule is Mycobacterium avium complex (MAC), a disorder in which spiking fevers may be seen. Weight loss typically is slow and progressive. In contrast, enterocolitic diseases produce numerous, small volume bowel movements that occur at regular intervals throughout the day and night. Cramping and tenesmus may occur but usually are not severe. The clinical course often is associated with fever, anorexia, rapid and progressive weight loss, and extreme debilitation.
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