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causes of diarrhoea Flashcards

1
Q

define diarrhoea?

A

passage of stool 3< a day

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2
Q

what are common associated symptoms of diarrhoea?

A
  • Dysphagia
  • Nausea and vomiting
  • Abdo pain/ bloating
  • Urine symptoms
  • Weight loss, reduced appetite, swellings, night sweats
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3
Q

what is steatorrhea?

A
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4
Q

what is usually the cause of steatorrhea?

A

malabsorption - hence it is pale

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5
Q

what is important with history with bloody diarrhoea?

A

clarify whether it is mixed with stool or just around sides of toilet/ toilet paper

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6
Q

what is dysentery diarrhoea?

A

water and bloody diarrhoea – usually die to infections

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7
Q

what is melena?

A

dark tarry, sticky, offensive smelling – upper GI bleed

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8
Q

how might someones faeces be if they take iron supplements?

A
  • Iron supplements can make blood dark and black – usually has a green tinge to it
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9
Q

what are common differentials in diarrhoea?

A
  • Coeliac
  • IBS – chrons and ulcerative colitis
  • Irritable bowel syndrome
  • Colorectal cancer
  • Infective gastroenteritis
  • Drugs – most meds cause GI problems
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10
Q

what common drugs cause diarrhoea?

A

Common: citrates, osmotic laxatives, magnesium containing antacids, sugar alcohols

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11
Q

what less common drugs targeting secretion cause diarrhoea?

A

quinine, augmentin, metformin, calcitonin, digoxin, NSAIDs, prostaglandins (misoprostol)

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12
Q

what motility targeting drugs can cause diarrhoea?

A

: macrolides, metoclopramide, stimulant laxatives

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13
Q

what drugs causing malabsorption can cause diarrhoea?

A

acarbose, aminoglycosides, orlistat (weight loss – prevents fat absorption – oily secretions), levothyroxine

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14
Q

what are the different pathology pathways causing gastroenteritis?

A

mucosal adherence
mucosal invasion
toxin production

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15
Q

how does mucosal adherence cause gastroenteritis?

A

attach to mucosa via receptors which causes effacement of intestinal mucosa – watery diarrhoea (enteropathogenic e.coli)

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16
Q

how can mucosal invasion cause gastroenteritis?

A

bacteria penetrate into intestinal mucosa and destroy epithelial cells – dysentery (enteroinvasive E.coli)

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17
Q

how can toxin production cause gastroenteritis?

A

produced by bacteria adhering to intestinal epithelium causing enterotoxin release – excess fluid release from mucosa –(enterotoxigenic E coli). Can be cytoxin by causing direct damage to mucosal cells – dysentery

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18
Q

where can salmonella causing water to dsyentry diarrhoea come form?

A

undercooked meat especially chicken

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19
Q

how long before salmonella occurs?

A

12-48hrs

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20
Q

what can occur elderly/ immunocompromised with salmonella?

A

overwhelming sepsis

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21
Q

what bacteria causing diarrhoea, previous history of attending a BBQ 2-4 days ago?

A

camplyobacter jejuni
linked to BBQ foods and undercooked meats

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22
Q

what type of diarrhoea is seen with campylobacter jejuni?

A

profuse watery diarrhoea sometime dsyentry

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23
Q

what is a rare complication of campylobacter jejuni?

A

guillan barre syndrome and reactive arthritis

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24
Q

what conditions would lead to to shigella causes diarrhoea?

A

poor hygiene - more likely in developing countries

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25
Q

what type of diarrhoea does shigella cause?

A

dysentery - less volume than others in compariosn

26
Q

how is shigella spread (form poor hygiene)

A

faecal oral route

27
Q

what shape is E coli

A

grame -ve rod/ bacillus

28
Q

what is most common cause of travellers diarrhoea?

A
  • Most common cause of travellers diarrhoea
  • Enteroinvasic E.coli – same as shigella symptoms
  • Enterohaemorrhagic: cattle transmission – dysentery with abdo pain
  • Enterotoxic E.coli: watery diarrhoea
29
Q

how is cholera spread?

A

faecal oral route - more in developed countries

30
Q

what occurs with cholera?

A

profuse watery diarrhoea
severe dehydration

31
Q

what is the pathology of staph. a?

A
  • Secretes various toxins, enterotoxin B causes massive secretion of intestinal fluid
32
Q

what is the most common cause of food-borne gastroenteritis in europe and USA?

A

staph. a

33
Q

how would ingest of staph. A present?

A

vomiting 2-4hrs post consumption then profuse watery diarrhoea

34
Q

what bacteria would be most likely from fried rice or left over chinese?

A

Bacillus ceres: gram +ve rod

35
Q

what is the shape of c.diff?

A

gram positive spore forming rod shaped

36
Q

is c.diff seen in healthy people?

A
  • 5% of pop have this in normal bowel commensal
37
Q

who is at risk of c.diff?

A
  • Risk factors: elderly, hospitalisations, acid suppression meds (PPI and H2 antagonists)
  • Common following antibiotics
38
Q

how do you treat c.diff infections?

A
  • Treatment: oral vancomycin/ IV metronidazole
    strongest AB
39
Q

what bacteria would be common from undercooked food or a hot buffet under lamp gone cold?

A

Clostridium pefringens

40
Q

what type of diarrhoea would clostridium perfringens?

A

watery diarrhoea

41
Q

what symptoms are seen in norovirus?

A
  • Diarrhoea and projectile vomiting, fever, abdo pain
42
Q

what is most common cause of gastroenteritis?

A

noronvirus

43
Q

when are outbreaks of norovirus most common?

A
  • Outbreaks common in semi-closed communities – wards, cruise ships , care homes
44
Q

what type of diarrhoea would rotavirus have?

A

sporadic and epidemic cases of diarrhoea
- Most common childhood diarrhoea

45
Q

what symptoms accompany rotavirus?

A
  • Watery diarrhoea, vomiting, fever and abdo pain
46
Q

when is rotavirus common?

A
  • Most common childhood diarrhoea
  • More common in winter
  • Common in elderly wards, nurseries
47
Q

where does giardiasis infect?

A
  • Infects duodenum, jejunum
48
Q

what are other symptoms of giardiasis?

A
  • Can be asymptomatic or bloating, flatulence, diarrhoea, steatorrhoea
  • Can have symptoms for months
49
Q

what are risk factors for giardiasis?

A
  • Risk factors: immune compromised, travellers, playgroups, swimming
50
Q

why can symptoms and durations vary in giardiasis?

A

depends on pathology - Malabsorption, lactose intolerance, weight loss

51
Q

where does crytosporoidosis arise?

A

cattle main reservoir

52
Q

what diarrhoea is seen in crytopspoirdosis? - cattle

A

watery

53
Q

what is ameobiasis?

A
  • Parasite invades colonic mucosa – ulceration
54
Q

what are complications of ameobiasis?

A

can enter portal vein  liver abscess, inflame ,asses and abscesses

55
Q

what symptoms are associated form chronic pancreatitis?

A

epigastric pain, radiates to back, eased lying forward, pain typically relapse and remit
- Symptoms of malabsorbtion – reduced pancreatic enzyme activity – bloating, steatorrhoea, weight loss

usually alcohol linked

56
Q

what are rare causes of chronic pancreatitis?

A
  • Rarer: cystic fibrosis, familial, haemochromatosis, pancreatic duct destruction (stones, tumour), hyperparathyroidism
57
Q

how do you investigate chronic pancreatitis?

A
  • Faecal elastase – enzyme secreted by pancreas – reduced in pancreatitis
  • Ultra-sound, CT, MRCP, AXR calcifications
58
Q

what are complications of chronic pancreatitis?

A

pseudocyst collection, diabetes, biliary obstruction, splenic vein thrombosis, pancreatic carcinoma

59
Q

how do you manage chronic pancreatitis?

A

Treatment:
1. Pain management: analgesia, coeliac nerve block
2. Supplements: creon (pancreatic lipase), fat soluble vitamins
3. Manage diabetes

60
Q

what is diverticulitis?

A

small round lesions in large intestine

GI (12 decks)

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