20. Diarrhoea Flashcards
What is the definition of diarrhoea?
Increase in amount of stool passed daily to > 300g- usually accompanied by increased frequency + loosening of the stools
What can cause diarrhoea?
Infection
Inflammation: IBD, Diverticular disease
Increased bowel motility: Hyperthyroidism, anxiety, IBS
Malabsorption: Coeliac, pancreatic insufficiency
Obstruction only allowing fluid through
Medications: laxatives, colchicine, digoxin, metformin, thiazide diuretics + some Abx
What are the most likely causes of diarrhoea in a young adult?
Going from most to least likely
Infective diarrhoea IBS Coeliac disease Crohn's disease UC Medications Hyperthyroidism
What are the most likely causes of diarrhoea and elderly patients?
Neoplastic disease Diverticular disease Overflow diarrhoea secondary to constipation Ischaemic colitis Microscopic colitis Bacterial overgrowth IBD
What questions would you ask to characterise the stool?
Is it jelly like/ got mucus in it?
Are they foul smelling + floating?
Are the faeces unusually pale?
Blood?
What might mucoid diarrhoea suggest?
Salmonella
What does foul smelling/ floating diarrhoea suggest?
Malabsorption
What does pale diarrheoa suggest?
Biliary obstruction (lack of bile salts)
What would you ask about the patient’s bowel habit if they are presenting with diarrhoea?
Nocturnal diarrhoea? Do you rush to the toilet? Tenesmus? Varbaility in bowel habit How frequently do you open your bowels?
What does urgency in opening bowel suggest?
Infection
IBD
What does tenesmus suggest?
space occupying lesion in the rectum- carcinoma
What associated symptoms will you ask about in someone with diarrhoea?
FLAWS
vomiting
abdo pain
eye, skin, joint symptoms- IBD
What will you ask about in the social history of someone with diarrhoea?
Travel
Close contacts
Changes in diet
Stress
What are the blood markers for coeliac disease?
TTG
IgA
What signs of IBD should you look for on examination of a patient with diarrhoea?
Clubbing Iritis Mouth ulcers (Crohn's) Erythema nodosum Anal ulcers/ fistulae (Crohn's) Abdominal mass in RLQ (Crohn's)
What signs of coeliac disease may be found on examination
Clubbing
Dermatitis herpetiformis
What signs of malignancy should you look for on examination of a patient with diarrhoea?
Virchows lymphadenopathy
Abdominal masses
What can predispose you to C. difficile?
Antibiotics
Why should patients with UC be offered regular colonoscopies?
They have an increased risk of colon cancer
What is the most likely infective organism in an outbreak of vomiting and diarrhoea in an old persons nursing home?
Norovirus
What is the most likely infective organism in an outbreak of bloody diarrhoea at a primary school?
Shigella
E. Coli
What is the most likely infective organism in a student with watery diarrhoea a few days after a BBQ?
Campylobacter jejuni
What is the most likely infective organism in a group of people with sudden onset diarrhoea a few hours after a party?
Staphylococcus aureus
Bacillis cereus
What causes the rapid or slow onset of diarrhoea in infection?
Rapid: bacteria have excreted active toxins
Slow: Bacterial growth in the bowel
What is the most likely infective organism in an elderly patient in hospital receiving antibiotics for pneumonia?
Clostridium difficile
What is the most likely infective organism in a young woman who has just returned from Ghana and has right iliac fossa pain?
Yersinia enterocolitica
What are the 3 possible outcomes of a fluid challenge?
No response: hasn’t received enough fluid or weren’t hypovolaemic to begin with
Transient response: haven’t given enough fluid or is losing them rapidly e.g. haemorrhage
Sustained response: restoration to normal fluid balance
