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csi > A case of diarrhoea > Flashcards

A case of diarrhoea Flashcards

1
Q

What is the definition of diarrhoea?

A
  • Three or more loose or liquid stools per 24 hours and or
  • Stools that are more frequent than usual for the individual lasting more than 14 days and or
  • Stool weight greater than 200g/day
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2
Q

How is diarrhoea classified?

A
  • Acute (<14 days)
  • Persistent (>14 days)
  • Chronic (>4 weeks)
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3
Q

Why does diarrhoea occur?

A

When there’s decreased absorption or increased secretion of fluid and electrolytes, or an increase in bowel motility meaning a greater than usual amount of fluid is excreted in the faeces

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4
Q

What are the two categories of diarrhoea?

A

Inflammatory and non-inflammatory

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5
Q

What is inflammatory diarrhoea?

A

Diarrhoea caused by the presence of an inflammatory process eg. bacterial, viral or parasitic infection or due to bowel ischaemia, radiation injury or IBD

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6
Q

What are the characteristics of inflammatory diarrhoea?

A
  • Mucoid and bloody stool
  • Tenesmus
  • Fever
  • Severe crampy abdominal pain
  • Small in volume with frequent bowel movements
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7
Q

What is the most common cause of infectious diarrhoea in the US?

A

Bacterial infection: campylobacter, salmonella, shigella, E.coli, C. difficile

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8
Q

What are common causes of acute diarrhoea in developing countries?

A

Protozoa and parasites

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9
Q

What would a stool examination of inflammatory diarrhoea show?

A

Leukocytes, positive faecal occult blood test

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10
Q

What would the histology of the GI tract in inflammatory diarrhoea look like?

A

Abnormal

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11
Q

What are the characteristics of non-inflammatory diarrhoea?

A
  • Watery
  • Large-volume
  • Frequent stool >10-20 per day
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12
Q

What is not present in non-inflammatory diarrhoea?

A
  • Tenesmus
  • Blood in the stool
  • Fever
  • Faecal leukocytes
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13
Q

What is the GI histology like in non-inflammatory diarrhoea?

A

Preserved

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14
Q

What can non-inflammatory diarrhoea be further sub-divided into?

A

Secretory and osmotic diarrhoea

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15
Q

What is secretory diarrhoea?

A

When there’s an altered transport of ions across the mucosa which results in increased secretion and decreased absorption of fluids and electrolytes from the GI tract

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16
Q

Does fasting decrease secretory diarrhoea?

A

No

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17
Q

What are some of the causes of secretory diarrhoea?

A
  • Enterotoxins: infections such as vibrio cholerase, staphylococcus aureus, E.coli, HIV and rotavirus
  • Hormonal agents: vaso-active intestinal peptide, small-cell cancer of the lung, neuroblastoma
  • Laxative use, intestinal resection, bile salts and fatty acids
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18
Q

What is osmotic diarrhoea?

A

Unabsorbed or poorly absorbed solute in the intestinal tract that causes an increased secretion of liquids into the gut lumen

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19
Q

What is the stool volume like in osmotic diarrhoea?

A

Stool volume is relatively small (compared with secretory diarrhoea) and diarrhoea improves with fasting

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20
Q

What can osmotic diarrhoea be further divided into?

A

Maldigestion and malabsorption

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21
Q

What is maldigestion?

A

Impaired digestion of nutrients within the intestinal lumen or at the brush boarder membrane of mucosal epithelial cells

Seen in pancreatic exocrine insufficiency and lactase deficiency

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22
Q

What is malabsorption?

A

Impaired absorption of nutrients

Seen in small bowel overgrowth, mesenteric ischaemia, post bowel resection (short bowel syndrome) and in mucosal disease (coeliac disease)

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23
Q

How much fluid should normally be excreted in faeces?

A

0.1L

24
Q

What are the enterocytes?

A

Cells lining the large and small intestines

25
Q

Give an overview of the different forms of diarrhoea and whether they’re enterocyte or luminal issues

A
  • Inflammatory diarrhoea: problem with the enterocytes meaning they’re unable to absorb compounds from the lumen, lots of fluid left in the lumen
  • Secretory diarrhoea: channels in the enterocytes are activated meaning solutes in the enterocytes will cross into the lumen therefore water will be retained in the lumen eg. cholera- cystic fibrosis transmembrane conductance regulator is activated meaning Cl- and Na+ pass into the lumen
  • Osmotic maldigestion: compounds aren’t digested (broken down) meaning they can’t be absorbed eg. lactose intolerance
  • Osmotic malabsorption: compounds aren’t absorbed properly eg. laxative effect of prunes, sorbitol present which isn’t absorbed by enterocytes meaning water is retained in the lumen
26
Q

How does oral rehydration solution work?

A

Insert a solution of 2:1 Na+:glucose into the colon which causes SGLT1 transporters to take the compounds across into enterocytes, leading to movement of water from the lumen into the enterocytes

27
Q

What does SGLT1 stand for?

A

Sodium glucose linked transporter 1

28
Q

Why does diarrhoea lead to death?

A

Due to massive dehydration

29
Q

What is a functional cause of diarrhoea?

A

There are no known structural changes causing the patient’s symptoms aka. IBS
Non-progressive and non-fatal

30
Q

What is an organic cause of diarrhoea?

A

There is a structural change causing diarrhoea eg. IBD, colon cancer, coeliac disease

31
Q

What are the symptoms of IBD?

A
  • Weight loss
  • Fever
  • Blood in the stool
32
Q

What are the symptoms of IBS?

A
  • Alternating constipation and diarrhoea
  • Mucus in stool
  • Bloating
33
Q

What are the symptoms of IBS and IBD?

A
  • Abdominal pain
  • Faecal urgency- feels the need to open their bowels
  • Fatigue
34
Q

What is the function of a FBC?

A

To look for anaemia and signs of inflammation/ infection

35
Q

What is the function of a urea and electrolytes test?

A

To check renal function and electrolyte status

36
Q

What is the function of examining CRP?

A

To look for infection/ inflammation

37
Q

What would red, fresh blood in the stool indicate?

A

A lower GI bleed

38
Q

What would darker blood in the stool indicate?

A

An upper GI bleed, as the blood has been digested

39
Q

How would the bleeding from stomach ulcers manifest?

A

Either in vomit or as darker blood in the stool

40
Q

What is the function of a fecal occult blood test?

A

A test that looks for traces of blood that aren’t visible to the human eye

41
Q

What is the function of a LFT?

A

A liver function test, albumin levels are also obtained: low albumin can indicate an acute inflammatory process, can also be used as a surrogate marker for malnutrition- low albumin suggests malnourishment

42
Q

How can thyroid function affect diarrhoea?

A

Hyperthyroidism can lead to diarrhoea

43
Q

Which antibody is screened for in coeliac disease?

A

Tissue transglutaminase antibody

44
Q

What do stool tests screen for?

A

Microbiology, ova and cysts associated with parasite disease, faecal calproctectin

45
Q

Why should stool samples be repeated even if an initial sample has come back negative?

A

Because ova a cysts are shed intermittently, need to take three samples two days apart

46
Q

What is faecal calproctectin?

A

A surrogate marker for inflammation in the bowel, it indicates migration of neutrophils into the intestinal mucosa

47
Q

When would faecal calproctectin be raised?

A

Coeliac, colon cancer and IBD as it doesn’t detail the site or extent of inflammation- non-specific test

48
Q

What is the difference in location between crohn’s disease and ulcerative colitis?

A

look up pic

Crohn’s can occur anywhere along the GI tract

49
Q

What are granulomas?

A

Collections of neutrophils

50
Q

Which tissue layers does Crohn’s disease affect?

A
  • Mucosa
  • Submucosa
  • Muscularis
  • Serosa
51
Q

Which tissue layers does ulcerative colitis affect?

A

Just the mucosa

52
Q

What can treatments for conditions be split into?

A
  • Conservative
  • Medical
  • Surgical
53
Q

Why does smoking worsen Crohn’s disease?

A

It causes small areas of infarction in the gut

54
Q

Why is smoking protective in ulcerative colitis?

A

It dampens the immune system

55
Q

What is the conservative management for Crohn’s disease?

A
  • Smoking cessation
  • Dietary advice
  • Psychological support
  • Patient support groups
56
Q

What is the medical management for Crohn’s disease?

A

Acute/ flare up:
- Corticosteroids

Long-term:
- Biologics: monoclonal antibodies

57
Q

What is the surgical management of Crohn’s disease?

A

Patients at risk of fistulas and strictures as all layers of the bowel are affected, often not used as a first line treatment as the chance of the patient needing surgery again later on is high
Bowel re-section

csi (2 decks)

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