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Gastroenterology and Hepatology Autoimmu ne Pancreatitis Diagnosis Diagnostic criteria include findings of a narrowed main pancreatic duct or parenchymal swelling ("sausage-shaped" pancreas) and response to glucocorticoids. It is important to exclude pancreatic cancer; biopsy may be necessary. Type l AIP is seen in older men and may be associated with other lgG4-related diseases, such as Sj0gren syndrome, PSC, bile duct strictures, autoimmune thyroiditis, retroperitoneal fibrosis, sclerosing sialoadenitis, and interstitial nephritis. Serum IgG4 level is increased. Type 2 AIP is associated with chronic pancreatitis and IBD and is less likely to include elevated IgG4 levels. Treatment Most patients with type 1 or 2 AIP respond to glucocorticoids. Patients with relapsed disease tlpically respond to glucocorticoid retreatment. Acute Diarrhea Diagnosis Healthy patients with watery diarrhea of less than 3 days' duration require no testing or microscopic assessment. If diarrhea does not resolve in 1week, evaluation is recommended with stool testing for common bacterial pathogens and toxins, including Clostridioides dfficile. Patients with mucoid or bloody diarrhea (dysentery), fever, or suspected sepsis and those who are immunocompromised or require hospitalization should have diagnostic assessment of their stool to guide antimicrobial use. Yersiniaenterocolitica colitis can mimic appendicitis or Crohn disease. Cryptosporidiosis develops most often in patients with AIDS, but outbreaks also occur in immunocompetent patients, often related to public swimming pools, and cause a self-limited secretory diarrhea. Treatment Supportive care with oral hydration and antidiarrheal medications is sufficient for most patients with acute diarrhea. Dysentery with temperatures >101 oF should be treated with empiric azithromycin (after microbiologic assessment). Treat travel-associated diarrhea with empiric azithromycin. Diarrhea caused by parasites (Giardia lamblia or Entamoebq histolAticq) requires therapy with metronidazole, tinidazole, or nitazoxanide. DON'T BE TRICKED . Do not choose antibiotics for EHEC colitis. . Do not choose loperamide or diphenoxylate for acute diarrhea with fever or blood in the stool. Both agents are associated with HUS in EHEC colitis and toxic megacolon in C. dfficile infection. 91