63. Diarrhoea Flashcards
What types of diarrhoea are there?
Acute Chronic fluctuating Bloody Mucus Pus Steatorrhoea- increased gas, offensive smell, floaty
What does the type of diarrhoea suggest about the cause?
Acute-gastroenteritis
Chronic fluctuating- IBS
Bloody- campylobacter, shigella, e.coli, IBD, colorectal cancer
Mucus- IBS, colorectal cancer, polyps
Pus-IBD, diverticulitis, fistula/abscess
Steatorrhoea- pancreatic insufficiency
What do you look for on your investigations of diarrhoea?
Dehydration Fever Weight loss Anaemia Oral ulcers Goitre/hyperthyroid signs PR exam for masses
How will bloods give an insight into the diarrhoea?
FBC: MCV lower- iron deficiency/coeliacs. MCV raised- alcohol, B12 low
Raised ESR/CRP- infective cause, UC, cancer
U&E’s- LOS potassium in severe D&V.
Low TSH in thyrotoxicosis.
Coeliac serology
What can stool tell you about the cause?
MC&S- pathogens
Faecal elastase- suspect chronic pancreatitis
How do you manage diarrhoea?
Oral rehydration if possible, rehydration salts
Codeine phosphate or loperamide to thicken stools (not in IBD, toxic megacolon)
Antibiotics is systemic upset
What are the non GI causes of diarrhoea
Thyrotoxicosis Autonomic neuropathy Addison’s disease Ischeamic colitis Topical sprue Gastrinoma Carcinoid Drugs
What are the four c’s that cause c.diff
Clindamyicn
Cephalosporins
Co-amoxiclav
Ciprofloxin
How do you treat c.diff?
Stop causative antibiotics
Metronidazole
Vancomycin in severe disease
Colectomy in toxic megacolon
How do you stop c.diff from recurring?
Fidaxomicin
Faecal transplantation
What are the signs of c.diff?
Raised CRP, WCC
Lowered albumin
A bad smell
Colitis, leading to toxic megacolon and multi organ failure
