What is the clinical presentation of diarrhea in AIDS?
When evaluating an HIV-infected patient with diarrhea, careful attention should be directed to the history and physical examination. Enteritis (small bowel diarrhea) is associated with voluminous, watery bowel movements, abdominal bloating, cramping, borborygmi, and nausea. Abdominal pain, if present, tends to be periumbilical or diffuse. Abdominal examination reveals an increase in number and frequency of bowel sounds, which may be high-pitched. Conversely, colitis (large bowel diarrhea) is characterized by frequent, small bowel movements, with the presence of mucus, pus, or blood (dysentery). Patients with prominent involvement of the distal colon also have proctitis symptoms, such as tenesmus, dyschezia (pain on defecation), and proctalgia (rectal pain).