causes of diarrhoea

Question 1

define diarrhoea?

Answer 1

passage of stool 3< a day

Question 2

what are common associated symptoms of diarrhoea?

Answer 2

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

Question 3

what is steatorrhea?

Question 4

what is usually the cause of steatorrhea?

Answer 4

malabsorption - hence it is pale

Question 5

what is important with history with bloody diarrhoea?

Answer 5

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

Question 6

what is dysentery diarrhoea?

Answer 6

water and bloody diarrhoea – usually die to infections

Question 7

what is melena?

Answer 7

dark tarry, sticky, offensive smelling – upper GI bleed

Question 8

how might someones faeces be if they take iron supplements?

Answer 8

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

Question 9

what are common differentials in diarrhoea?

Answer 9

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

Question 10

what common drugs cause diarrhoea?

Answer 10

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

Question 11

what less common drugs targeting secretion cause diarrhoea?

Answer 11

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

Question 12

what motility targeting drugs can cause diarrhoea?

Answer 12

: macrolides, metoclopramide, stimulant laxatives

Question 13

what drugs causing malabsorption can cause diarrhoea?

Answer 13

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

Question 14

what are the different pathology pathways causing gastroenteritis?

Answer 14

mucosal adherence
mucosal invasion
toxin production

Question 15

how does mucosal adherence cause gastroenteritis?

Answer 15

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

Question 16

how can mucosal invasion cause gastroenteritis?

Answer 16

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

Question 17

how can toxin production cause gastroenteritis?

Answer 17

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

Question 18

where can salmonella causing water to dsyentry diarrhoea come form?

Answer 18

undercooked meat especially chicken

Question 19

how long before salmonella occurs?

Answer 19

12-48hrs

Question 20

what can occur elderly/ immunocompromised with salmonella?

Answer 20

overwhelming sepsis

Question 21

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

Answer 21

camplyobacter jejuni
linked to BBQ foods and undercooked meats

Question 22

what type of diarrhoea is seen with campylobacter jejuni?

Answer 22

profuse watery diarrhoea sometime dsyentry

Question 23

what is a rare complication of campylobacter jejuni?

Answer 23

guillan barre syndrome and reactive arthritis

Question 24

what conditions would lead to to shigella causes diarrhoea?

Answer 24

poor hygiene - more likely in developing countries

Question 25

what type of diarrhoea does shigella cause?

Answer 25

dysentery - less volume than others in compariosn

Question 26

how is shigella spread (form poor hygiene)

Answer 26

faecal oral route

Question 27

what shape is E coli

Answer 27

grame -ve rod/ bacillus

Question 28

what is most common cause of travellers diarrhoea?

Answer 28

- 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

Question 29

how is cholera spread?

Answer 29

faecal oral route - more in developed countries

Question 30

what occurs with cholera?

Answer 30

profuse watery diarrhoea severe dehydration

Question 31

what is the pathology of staph. a?

Answer 31

- Secretes various toxins, enterotoxin B causes massive secretion of intestinal fluid

Question 32

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

Answer 32

staph. a

Question 33

how would ingest of staph. A present?

Answer 33

vomiting 2-4hrs post consumption then profuse watery diarrhoea

Question 34

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

Answer 34

Bacillus ceres: gram +ve rod

Question 35

what is the shape of c.diff?

Answer 35

gram positive spore forming rod shaped

Question 36

is c.diff seen in healthy people?

Answer 36

- 5% of pop have this in normal bowel commensal

Question 37

who is at risk of c.diff?

Answer 37

- Risk factors: elderly, hospitalisations, acid suppression meds (PPI and H2 antagonists) - Common following antibiotics

Question 38

how do you treat c.diff infections?

Answer 38

- Treatment: oral vancomycin/ IV metronidazole strongest AB

Question 39

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

Answer 39

Clostridium pefringens

Question 40

what type of diarrhoea would clostridium perfringens?

Answer 40

watery diarrhoea

Question 41

what symptoms are seen in norovirus?

Answer 41

- Diarrhoea and projectile vomiting, fever, abdo pain

Question 42

what is most common cause of gastroenteritis?

Answer 42

noronvirus

Question 43

when are outbreaks of norovirus most common?

Answer 43

- Outbreaks common in semi-closed communities – wards, cruise ships , care homes

Question 44

what type of diarrhoea would rotavirus have?

Answer 44

sporadic and epidemic cases of diarrhoea - Most common childhood diarrhoea

Question 45

what symptoms accompany rotavirus?

Answer 45

- Watery diarrhoea, vomiting, fever and abdo pain

Question 46

when is rotavirus common?

Answer 46

- Most common childhood diarrhoea - More common in winter - Common in elderly wards, nurseries

Question 47

where does giardiasis infect?

Answer 47

- Infects duodenum, jejunum

Question 48

what are other symptoms of giardiasis?

Answer 48

- Can be asymptomatic or bloating, flatulence, diarrhoea, steatorrhoea - Can have symptoms for months

Question 49

what are risk factors for giardiasis?

Answer 49

- Risk factors: immune compromised, travellers, playgroups, swimming

Question 50

why can symptoms and durations vary in giardiasis?

Answer 50

depends on pathology - Malabsorption, lactose intolerance, weight loss

Question 51

where does crytosporoidosis arise?

Answer 51

cattle main reservoir

Question 52

what diarrhoea is seen in crytopspoirdosis? - cattle

Answer 52

watery

Question 53

what is ameobiasis?

Answer 53

- Parasite invades colonic mucosa – ulceration

Question 54

what are complications of ameobiasis?

Answer 54

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

Question 55

what symptoms are associated form chronic pancreatitis?

Answer 55

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

Question 56

what are rare causes of chronic pancreatitis?

Answer 56

- Rarer: cystic fibrosis, familial, haemochromatosis, pancreatic duct destruction (stones, tumour), hyperparathyroidism

Question 57

how do you investigate chronic pancreatitis?

Answer 57

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

Question 58

what are complications of chronic pancreatitis?

Answer 58

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

Question 59

how do you manage chronic pancreatitis?

Answer 59

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

Question 60

what is diverticulitis?

Answer 60

small round lesions in large intestine