Bowel Changes Flashcards
How can you define changes in bowel habits?
Alteration in frequency, consistency, or appearance of stools compared to a person’s usual pattern. Normal bowel pattern would be:
1) Frequency- 3 times a day to 3 times a week
2) Consistency- Bristol stool chart types 3-4 (soft, well-formed stools)
3) Color- brown due to bile pigments
Describe the different types of bowels using the Bristol stool chart.
1) Type 1- separate hard lumps, like nuts (hard to pass)
2) Type 2- sausage-shaped but lumpy
3) Type 3- like a sausage but with cracks on the surface
4) Type 4- like a sausage or a snake but smooth and soft
5) Type 5- Soft blobs with clear cut edges (passed easily
6) Type 6- Fluffy pieces with ragged edges, a mushy stool
7) Type 7- watery, no solid pieces. Entirely liquid.
What are the red flag bowel changes?
- persistent change that has lasted more than 4 weeks
- blood in the stool
- stools that are black and tarry, clay-colored or pale
- unintentional weight loss
- unexplained fatigue
What is acute vs chronic diarrhoea?
Acute- less than 2 weeks
Chronic- more than 4 weeks
What are some causes of diarrhoea?
1) Infections- viral (viral gastroenteritis caused most commonly by norovirus in adults, rotavirus in children), bacterial (campylobacter, salmonella, e.coli), parasitic (Giardia)
2) Medications- antibiotics, chemotherapy drugs, magnesium laxatives
3) Food intolerance- gluten in coeliac disease
4) Digestive disorders- IBD, IBS, functional bowel disorder
5) Surgery- stomach or gall bladder surgery
What are the causes of the following stool characteristics:
1) Watery
2) Bloody
3) Fatty
1) lactose intolerance, cholera
2) shigella, IBD
3) Coeliac disease, pancreatic insufficiency
What is constipation defined as?
less than 3 bowel movements per week or hard stools with difficulty passing
What are the causes of constipation?
1) Diet- not eating enough fiber, found in fruits, vegetables, whole grains
2) Fluids- not drinking enough water
3) Medications- opioids, antidepressants, and iron supplements
4) lifestyle changes- travelling, pregnancy
5) metabolic- hypothyroidism
6) Obstruction- strictures, cancer
7) Neurological- MS or Parkinson’s
What are the complications of constipation, and describe what they mean.
1) hemorrhoids- swollen veins in the anus or lower rectum that can cause discomfort, pain, itching, or bleeding.
2) Anal fissures- small tear in the lining of your bottom (anus)
What do different stool colors indicate?
1) Black (melena)- Upper GI bleed
2) Red- lower GI bleed
3) Pale- biliary obstruction
What are the causes of changes in Bowel Habits?
GI causes:
1) IBS
2) IBD
3) Colorectal cancer
4) Diverticulitis
5) Coeliac disease
Systemic Causes:
1) Endocrine- Diabetes (autonomic neuropathy- people with diabetes-related diarrhea also experience fecal (bowel) incontinence, especially at night. That’s because nerve damage (neuropathy) due to diabetes affects the anal sphincter), hypothyroidism
2) Neurological- MS, Parkinson’s
3) Medications- ABs, Opoids
Dietary Causes:
1) High-fat diets (mat cause diarrhoea
2) Fiber deficiency- constipation
3) Intolerances- lactose, gluten
What investigations would you do on a patient with bowel changes?
1) Stool tests:
- Occult blood test- detects hidden blood
- culture- identifies pathogens (bacteria, parasites)
- calprotectin/lactorferrin- elevated in IBD
- Fat analysis- steatorrhea (malabsorption)
2) Blood tests:
- FBC- anemia in bleeding or chronic disease
- CRP- inflammation
- Thyroid function- Hypothyroidism
3) Imaging:
- Abdominal X-ray or CT- Obstruction or perforation
- US- Biliary pathology
4) Endoscopy:
- Colonoscopy- Cancer, IBD
- Biopsies- Coeliac disease, IBD
What is the treatment for diarrhea?
1) General:
- Identify and treat the underlying cause (e.g., infection, inflammation, malabsorption).
2) Fluid and Electrolyte:
- ORS
- IV fluids
3) Dietary adjustments:
- BRAT diet (Bananas, Rice, Applesauce, Toast (easy-to-digest, low-fiber foods)
- Avoid: Lactose and high-fat foods (may worsen diarrhea in malabsorption).
High sugar (osmotic diarrhea risk).
4) Medications:
- Loperamide (slows intestinal motility and increases absorption), counterindication- infectious diarrhoea, especially if blood present
- Diphenoxylate/atropine: Reduces motility, used in chronic diarrhea.
- Bile Acid Sequestrants (e.g., cholestyramine): For bile salt diarrhea, e.g., post-cholecystectomy or Crohn’s disease.
- ABs: in bacterial infections. Ciprofloxacin or azithromycin for traveler’s diarrhea. Vancomycin or fidaxomicin for C.difficile.
5) Disease-specific therapies:
- IBD-related diarrhea: Corticosteroids, mesalamine, or biologics (e.g., infliximab).
Malabsorption syndromes: Enzyme supplementation (e.g., pancreatic enzymes for chronic pancreatitis).
Endocrine causes (e.g., carcinoid syndrome): Somatostatin analogs (octreotide).
What is the treatment for constipation?
1) Diet:
- Increase dietary fiber
- increase water intake
2) Medications:
- Bulk-forming laxatives- psyllium, methylcellulose (absorb water into stool, making it bulkier and easier to pass)
- osmotic laxatives- polythylene glycol (PEG), lactulose, mg hydroxide (draws water into bowel, softening stool)
- stimulant laxatives- senna, bisacodyl (stimulated colonic muscle contraction
- Stool softeners- docusate sodium (lowers stool surface tension, allowing water penetration
- prokinetics- prucalopride
- secretagogues- linaclotide (increase intestinal fluid secretion and motility)
- enemas/suppositories- phosphare enemas, glycerin suppositories
3) Disease-specific therapies:
- opoid-induced constipation- Peripheral opioid antagonists: Methylnaltrexone, naloxegol.
- neurological causes (eg. Parkinsons)- Prokinetics or laxatives with regular monitoring
- colonic inertia- may require surgery if refractory
