1.1. Diarrohea Flashcards
What is the difference between Diarrhoea and Gastro-enteritis?
- Diarrhoea - subjective (A change in pattern indicated Diarrhoea)
- Gastro-enteritis - objective (Diarrhoea + other symptoms)
What changes during Diarrhoea?
- Fluidity of the stool
- Frequency of the stool
What are the features of Gastro-enteritis?
- 3+ loose stools per day
- Accompanying features
Is a positive stool culture needed to have Gastro-enteritis?
No, but need to have 3+ loose stools per day the other symptoms
Note - It is an objective finding but clinical, not always biological
What is Dysentery?
Large bowel inflammation due to infection
What is present with Dysentery?
- Bloody stools
- A lot of pain
Note - it is quite obvious when someone has contracted Dysentery
What is the name of the chart which stools are measured against?
The Bristol Stool Chart:
1 - Separate hard lumps, hard to pass
4 - Sausage / Snake like, smooth and soft
7 - Watery, no solid pieces, entirely liquid
What are the types of Diarrhoea?
- Non-inflammatory Diarrhoea (e.g. cholera)
- Inflammatory Diarrhoea (e.g. Shigella Dysentery)
- Mixed-picture Diarrhoea (e.g. C. Difficile)
What mediates Non-inflammatory Diarrhoea?
It is secretory-toxin mediated - the toxin affects the way you transport Cl and Na:
1. Cholera - increases cAMP levels and therefore Chloride secretions (Salt shifts into the gut and takes the fluid with it)
2. Enterotoxigenic E. Coli (Travelers’ Diarrhoea)
What is the clinical signs / symptoms of Non-inflammatory Diarrhoea?
- Frequent watery stools
- Little abdominal pain
What is the mainstay of therapy for Non-inflammatory Diarrhoea?
Re-hydration Therapy
What mediates Inflammatory Diarrhoea?
Inflammatory toxin damage and mucosal destruction
What causes Inflammatory Diarrhoea?
- Bacterial infection
- Amoebic dysentery
What is assessed in Inflammatory Diarrhoea?
- Symptoms and their duration (History)
Note - If > 2/52, unlikely to be infective cause - Risk of food poisoning (Dietary, Contact, Travel History)
- Hydration (Postural B.P. (will drop by 20mmHg), Skin Turgor, Pulse)
- Features of inflammation (SIRS/Sepsis) (Fever, Raised WCC)
What needs to be assessed if there is a lot of fluid loss, due to Inflammatory Diarrhoea?
Hyponatraemia
What investigations would you perform in Inflammatory Diarrhoea?
- Stool culture (Most important)
- Blood culture
- Renal function (Assess the Na and K loss)
- Blood count (Neutrophilia, Haemolysis)
- Abdominal X-Ray (if the abdomen is distended and tender)
Note - The X-Ray would be looking for toxic dilation of the bowel