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Year 1 SBA revision > 101 - Diarrhoea > Flashcards

101 - Diarrhoea Flashcards

1
Q

What is diarrhoea

A

Passage of 3 or more loose/liquid stools per day (or more frequent passage than is normal for the individual.

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2
Q

3 clinical types of diarrhoea - describe the diarrhoea

A

Acute watery diarrhoea
Acute bloody diarrhoea
Persistant diarrhoea

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3
Q

What is acute bloody diarrhoea called?

A

Dysentery

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4
Q

How long does persistent diarrhoea last?

A

> 14days

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5
Q

Red flag symptoms of clinical dehydration

A

Appears unwell/deteriorating

Altered responsiveness or irritability

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6
Q

Symptoms of clinical dehydration

A

Decreased urine output
Appears unwell/deteriorating
Altered responsiveness or irritability

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7
Q

Red flag signs of clinical shock

A 
Altered responsiveness
Sunken eyes
Tachycardia
Tachypnoea
Reduced skin turgor
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8
Q

Signs of clinical shock

A 
Decreased consciousness
Pale, mottled skin
Cold extremities
Tachycardia
Tachypnoea
Weak peripheral pulses
Prolongued capillary refill
Hypotension
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9
Q

Red flag symptoms in diarrhoea - what do they indicate?

A

Increased risk of progression to shock

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10
Q

When do you treat as shock?

A

If one or more red flag signs is present

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11
Q

Clinical dehydration - % dehydration

A

5-7% dehydration

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12
Q

Clinical shock - % dehydration

A

~10% dehydration. Need to treat - likely fatal if not.

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13
Q

Can meningitis present with just diarrhoea and vomiting?

A

Yes

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14
Q

If patient has diarrhoea - always need to ask about what?

A

Vomitting

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15
Q

Skin turgor test - how long should the childs abdomen take to return to normal after pinching? What does a slow skin pinch indicate?

A

Normal = immediate
Slow = 1 sec
Very slow = 2 or more secs
Slow skin pinch indicates severe dehydration

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16
Q

What is osmotic diarrhoea

A

Diarrhoea due to too much water drawn into bowels through osmosis

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17
Q

What mechanisms can cause osmotic diarrhoea? (Mechanism and 3 causes)

A

Large amounts of hypertonic substances in lumen.
Can be due to:
Ingested hypertonic substances
General malnutrition
Defects in absorption of hypertonic substances

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18
Q

What about diarrhoea would make you think osmotic? (3)

A

Moderately increased stool volume,
Diarrhoea stops when fasting
Normal-increased stool osmolarity

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19
Q

What is secretory diarrhoea?

A

Diarrhoea due to active secretion of fluid and electrolytes from gut wall.
May be due to irritants or hormones.

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20
Q

Most common cause of secretory diarrhoea?

A

Cholera

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21
Q

What about diarrhoea would make you think secretory? (3)

A

Very large increase in stool volume, diarrhoea continues when fasting, normal stool osmolarity

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22
Q

What mechanisms cause secretory diarrhoea?

A

Toxin mediated

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23
Q

Symptoms of inflammatory diarrhoea

A

Pain, bloody, mucoid stools, weight loss

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24
Q

Main causes of inflammatory diarrhoea (4)

A

Infections, auto-immune disease (IBD), food sensitivity (Coeliac) & others (radiation exposure)

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25
Q

Consequences of diarrhoea (5)

A

Can be fatal
Dehydration
Loss of electrolytes - disordered physiology
Can cause malnutrition if prolonged
Inflammation - can cause mucosal damage, gastrointestinal haemorrhage, perforation and sepsis.

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26
Q

Rotavirus facts

A

Vaccinated against
Leading case of gastroenteritis worldwide
Causes up to 40% cases of severe diarrhoea in infants
Shed in high titres in stools for up to 21 days post onset of symptoms

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27
Q

Norovirus facts

A

Most commonly in winter in closed communities. Highly contagious.

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28
Q

Campylobacter facts

A

Birds/animals are infection reservoirs.
Faeces is source of infection.
Transmission by contaminated water, food and milk as well as person to person. Second most common cause of travellers diarrhoea.

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29
Q

Salmonella facts

A

Mainly transmitted by contaminated animal foods. Mostly affects young children. Shedding can persist and antibiotics can prolong shedding. 1% become chronic carriers and continue to shred for >1year

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30
Q

E. Coli facts

A

Transmitted by direct contact or contaminated food. 5 strains - 2 key.
EHEC - Enterohaemorrhagic - Most common cause diarrhoea in USA.
ETEC - Major cause travellers diarrhoea in countries with poor sanitation.

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31
Q

Cholera facts

A

Endemic to most countries with poor sanitation. Outbreaks esp after contamination of water supplies.

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32
Q

C. diff facts

A

Commensal gut bacteria. Diarrhoea associated with toxin secretion. Can be life threatening in elderly. Majority of healthcare acquired diarrhoea.

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33
Q

3 major risk factors for C.diff

A

Recurrent antibiotic use, admission to hospital, aged over 65.

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34
Q

Giardiasis facts

A

Most common parasitic diarrhoea. Human and animal reservoirs. Transmission through direct contact or ingesting cysts from faecally contaminated water.

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35
Q

What is chyme?

A

Semi-fluid mass of partially digested food that is expelled by the stomach into the duodenum. Acidic.

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36
Q

Action of the duodenum

A

Chyme neutralised by bile and bicarbonate and further digested by enzymes from pancreas, liver and small intestine.

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37
Q

Role of the small intestine

A

Site of most nutrient absorption and removal of largest volume of water

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38
Q

Role of the large intestine

A

Remove as much remaining water as possible and absorb electrolytes, complex carbohydrates and fibre.

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39
Q

Treatment of diarrhoea - therapeutic objective?

A

Replace lost fluid
Address underlying case
Reduce passage of stools

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40
Q

How do oral rehydration salts work?

A

Contain NaCl and glucose. Replace lost ions to allow the water to be absorbed by osmosis

41
Q

Water lost in mild dehydration

A

1-2L

42
Q

Water lost in moderate dehydration

A

2-4.5L

43
Q

Water lost in severe dehydration

A

> 4.5L

44
Q

When are oral rehydration salts not suitable as treatment for diarrhoea?

A

Severely dehydrated
Tachycardic.
Patients at risk of serious consequences from dehydration
May need IV fluids instead

45
Q

How fast does dehydration need to be corrected by for oral rehydration to be appropriate

A

Within 4hrs. If will take longer then IV fluids needed.

46
Q

Antibiotics to treat E.Coli 0157

A

Contraindicated

47
Q

Antibiotics for cholera

A

Doxycyclin

48
Q

Antibiotics for Giardia

A

Metronidazole

49
Q

Antibiotics for C.diff

A

Metronidazole or vancomycin

50
Q

How does reducing passage of stools help diarrhoea?

A

Doesn’t help address cause or correct dehydration. Convenience of patient.

51
Q

Side effects for reduction of stools

A

Toxins can be retained. Can cause problems if gut is susceptible to damage from holding on to waste.

52
Q

Mechanism of action for loperamide (Imodium)

A

Opioid receptor agonist. Acts on surface receptors in bowel to decrease motility by decreased peristalsis and increases sphincter tone. Increases transit time so more water is absorbed.

53
Q

Drug trial into efficacy of loperamide showed:

A

When given as recommended - showed reduction in stool number of ~50% for 1st two days.

54
Q

When should racecadotril be used?

A

Most patients - no additional benefit and is very expensive. Reduces hyper secretion without affecting transit time.. Reduction in constipation as a side effect compared to loperamide.

55
Q

Common name for Loperamide

A

Imodium

56
Q

4 stages for drug disposition

A

Absorption
Distribution
Metabolism
Excretion

57
Q

2 ways for drugs to move around body

A

Bulk flow - in blood, lymph, CSF.

Diffusion - short distances only.

58
Q

Drug diffusion - what affects ability to cross hydrophobic diffusion barriers

A

Lipid solubility

59
Q

What mainly affects rate of diffusion of a substance

A

Molecular size

60
Q

How can small molecules cross cell membranes (4)

A

Diffusing through liquid
Combination with solute carrier
Pinocytosis
Diffusing through membrane pores

61
Q

What does mucosal resistance determine?

A

How effectively liquid can cross the membrane and be absorbed.

62
Q

How much water should faeces contain

A

~100mL. More = Diarrhoea, Less = constipation.

63
Q

Why do gastric secretions get removed in the large intestine

A

Role of secretions complete.

64
Q

How does most water reabsorption take place in the bowels and where does it mainly occur.

A

Via Na+ driven transport across a sodium-potassium pump, active transport. Creates osmotic gradient so water moves out of the lumen and across the membrane.

Mainly occurs in small intestine.

65
Q

How is surface area of small intestine increased and why?

A

Increased by villi coated in microvilli - increases x600 compared to smooth tube of same diameter. Increased surface area allows increased nutrient absorption.

66
Q

Where are there more villi in the small intestine.

A

At the start as more nutrients absorbed at the start of the small intestine than the end.

67
Q

What does the duodenum do?

A

Small part of small intestine. Site of neutralisation of chyme.

68
Q

Role of jejunum

A

Absorbs >95% macronutrients.

69
Q

Role of Ileum

A

Absorbs nutrients not absorbed in jejunum, fibre, bile acids, Vit B12, water & electrolytes.

70
Q

Role of goblet cells in small intestine

A

Mucus secretion - protective role

71
Q

Role of crypt cells in small intestine

A

Site of new cell generation

72
Q

Role of paneth cells in small intestine

A

Contain eosinophilic secretory granules. Probably involved in intestinal barrier function.

73
Q

Role of M cells in small intestine.

A

Form peyers patches. Probably has a role in helping intestine respond to toxins.

74
Q

Role of large intestine

A

Carbohydrate absorption and digestion

75
Q

How is large intestine different to small intestine?

A

Less villi - fine tuning of ions not bulk water reabsorption.

76
Q

What is transit time?

A

Time for digestion. What is normal for patient? 3x day - 1 in 3 days is normal range.

77
Q

High volume diarrhoea indicates problem with

A

Small intestine - lack of bulk water reabsorption.

78
Q

Small volume diarrhoea indicates problem with

A

Large bowel - most water reabsorbed by small bowel

79
Q

Electrolyte absorption in osmotic diarrhoea is

A

Normal. Carbohydrate comprises most of osmotic gap.

80
Q

Electrolyte absorption in secretory diarrhoea is

A

Reduced. Less able to reabsorb electrolytes.

81
Q

Describe steatorrhoea

A

Pale, offensive, floating stool. Too much fat present.

82
Q

Investigations for diarrhoea

A

Stool sample,

Sigmoidoscopy and rectal biopsy in persistent cases

83
Q

Treatment of diarrhoea

A

Treat dehydration - fluids/ORT
Treat cause - antibiotics may be needed.
Stop diarrhoea - Imodium.

84
Q

Are antibiotics generally given for diarrhoea?

A

Not in simple gastroenteritis. Usually resolves quickly without antibiotics and in the UK diarrhoea generally has a viral cause.

85
Q

Young toddler recently started playschool

A

Rotavirus

86
Q

Elderly person recently treated with penicillin for chest infection

A

C.Diff

87
Q

Recently been travelling to Europe/Latin America

A

Travellers diarrhoea - E.Coli

88
Q

Rice water diarrhoea

A

Cholera

89
Q

Fatty stools

A

Giardia lambilia (Parasite)

90
Q

Eaten rice

A

Bacillus Cereus

91
Q

Eaten Chicken

A

Campylobacter (lasts 2-5 days) or Salmonella (Lasts 48hrs)

92
Q

What is Coeliac disease

A

Autoimmune disease - gluten intolerance.

93
Q

Mechanism of coeliac disease

A

Inflammatory response to gluten leads to villous atrophy

94
Q

Signs and symptoms of coeliac disease

A

Steatorhoea, Bloating, fat soluble vitamin malabsorption, Anaemia

95
Q

Treatment of coeliac disease

A

Gluten free diet
Dietary supplements
Rule out cancer/ulcerative jejunitis if no improvement

96
Q

What is the immediate priority for treating a sick child?

A

Assess to identify any compromised vital signs and stabilise condition (ABCDE)

97
Q

Impact of severe acute malnutrition on clinical signs of shock/dehydration.

A

Makes the clinical signs/symptoms unreliable.

98
Q

Impact of parental fluids in severe acute malnutrition

A

Can cause severe dehydration

Year 1 SBA revision (37 decks)

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