Characteristics of stool like pea soup are seen in which disease?

Appeared in: AIIMS Delhi NO - 2017

Explanation

Typhoid fever, caused by the bacterium Salmonella typhi, classically presents with 'pea soup' diarrhea.
This characteristic stool is greenish, watery, and foul-smelling, resulting from the inflammation and ulceration of Peyer's patches in the small intestine.
The symptom typically appears in the second or third week of the illness, sometimes after an initial period of constipation.

Option A: Stool is typically normal in Dengue fever. In severe cases, known as Dengue Hemorrhagic Fever, gastrointestinal bleeding can occur, leading to black, tarry stools (melena), which is different from pea soup stool.
Option B: While non-specific diarrhea can occur in Malaria, it is not a defining feature. The stool does not have the characteristic pea soup appearance.
Option D: This is a very general term. While viral gastroenteritis can cause watery diarrhea, it is not typically green and is not described as 'pea soup' like.

Clinical Relevance

Nursing practice connection: Knowing Clinical manifestations of Typhoid fever helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Recognizing 'pea soup' stool is a critical assessment finding that should prompt a nurse to suspect Typhoid fever, especially in a patient with prolonged, step-ladder fever.
This finding necessitates the immediate implementation of enteric precautions (contact precautions) to prevent the fecal-oral transmission of S. typhi to others.
A nurse must monitor for severe complications of typhoid, such as intestinal perforation or hemorrhage, which can be life-threatening.

How to Approach the Question

First, identify the key clinical sign presented in the question, which is 'pea soup' stool.
Recognize that this is a classic, almost pathognomonic, sign associated with a specific infectious disease.
Systematically review the options provided, considering the typical gastrointestinal manifestations of each disease.
Eliminate Dengue and Malaria, as their primary symptoms are different (hemorrhagic signs or cyclical fevers, respectively), and they do not cause this type of stool.
Eliminate 'Viral fever' as it is a non-specific category, whereas 'pea soup' stool is a highly specific sign.
Conclude that Typhoid fever, an enteric (intestinal) infection, is the disease known for this characteristic stool.

Concept Tested & Keywords

Concept Tested: Clinical manifestations of Typhoid fever
Stem keywords: stool, pea soup
Lead-in keywords: seen in which disease
Clinical cues: 'Pea soup' stool is a classic pathognomonic sign for a specific enteric fever.

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E6 Medicine Davidson Principles Practice 24e p. 280-282

E6 Nutrition Kumud Khanna 2e p. 196-198

Practise the full AIIMS Delhi NO - 2017

Attempt every question from this paper in a timed mock, then review the full solution for each one.