CCC - GI - Diarrh, IBS, Haemorrhoids

Question 1

what is diarrhoea and what are some sommon symptoms?

Answer 1

Frequent passing of watery stools.

• cramps, abdominal pain, vomiting, headache.

Question 2

What are some common pathogenic causes of diarrhoea?

Answer 2

campylobacter
e coli
salmonella
shigella
cryptosporidium

Question 3

Can infective diarrhoea cause death?

Answer 3

Yes in

• very old and very young
• renal problems
• severely dehydrated.

Question 4

What 7 symptoms require urgent referral to GP?

Answer 4

• drowsiness/confusion
• passing little urine
• dry mouth and tongue
• sunken eyes
• weakness
• cold hands/feet
• sunken fontanelle in babies/young infants.

Question 5

After how long should adults and older children be referred to GP?

Answer 5

about 3 days

Question 6

Are kaolin and morphine preparations recommended for diarrhoea?

Answer 6

No - lack efficacy?

Question 7

What are the 2 main Tx for diarrhoea?

Answer 7

Oral rehydration

loperamide

Question 8

How should ORT be used?

Answer 8

Sachets made up to 200ml with boiled and cooled water.
Drunk after each loose stool along with other fluids throughout day.
Can be stored in fridge for 24h.

Question 9

How much potassium does ORT contain?

Answer 9

200 m/mol

Question 10

Who should be particularly careful when suffering diarrhoea and using ORT?

Answer 10

Diabetic patients.

Question 11

How does loperamide work?

Answer 11

Agonist at mu-opioid receptors to slow gut motility and stool frequency.

Question 12

What is the age limit for loperamide?

Answer 12

12y

Question 13

What is the max dose for loperamide?

Answer 13

8 caps/day

Question 14

List 3 points of top tips for diarrhoea?

Answer 14

• drink plenty fluids
• eat as normally as possible, include fruit juices and soups.
• always wash hands after going to toilet.

Question 15

What 4 symptoms alongside diarrhoea in adults would require quicker referral to GP?

Answer 15

• persistent vomiting
• blood in vomit/diarhoea
• drowsiness/confusion
• concern about dehydration

Question 16

After what time should diarrhoea in babies and children <3y be referred?

Answer 16

babies - >24h

children <3y - >48h

Question 17

Should you dilute the feed for bottle0fed babies with diarrhoea?

Answer 17

no - feed as normal.

Question 18

Can you supply loperamide for prevention of travellers diarrhoea on PF?

Answer 18

No

Question 19

What are 3 areas of high risk for travellers diarrhoea?

Answer 19

Africa
Asia
South America

Question 20

What should you avoid to try to prevent travellers diarrhoea?

Answer 20

• ice in drinks
• unwashed salad/fruit
• drinking water not safe.

Question 21

What are the “Medicine Sick Day” rules?

Answer 21

Stop meds if vomiting/diarrhoea and resume once eating and drinking as normal for 24/48h. 
Medicines included: 
- Metformin 
- ACE-I/ARB
- NSAIDs
- Diuretics

Question 22

List 5 drugs which commonly cause diarrhoea?

Answer 22

• iron
• antibiotics
• magnesium salts
• NSAIDs
• diuretics

Question 23

What defines IBS?

Answer 23

Recurrent abdominal pain associated with a change in bowel habit.

Question 24

List some common symptoms of IBS?

Answer 24

• Alternating constipation/diarrhoea
• abdominal discomfort
• mucus
• bloating and constipation

Question 25

Is IBS more prevalent in women or men?

Answer 25

Women

Question 26

When are most cases of IBS reported?

Answer 26

30-50 years

Question 27

When should rectal bleeding be referred and when should it not?

Answer 27

Referred

• associated with change in bowel habit
• severe rectal bleeding
• systemic symptoms

Not referred
- due to haemorrhoids

Question 28

What are 3 types of Tx for IBS?

Answer 28

Bulk-forming laxatives
Anti-diarrhoeal agents - loperamide
Anti-spasmodic agents - mebeverine

Question 29

List some common trigger foods for IBS?

Answer 29

• spicy fatty or fried foods
• citrus fruits
• cheese
• onions and leeks
• alcohol, coffee, milk, red meat
• refined carbs

Question 30

What can often be a major trigger for IBS symptoms?

Answer 30

Stress

Question 31

What symptoms are associated with haemorrhoids?

Answer 31

• pain + discomfort
• mucous discharge
• itching
• bleeding

Question 32

What factors increase the risk of haemorrhoids occurring?

Answer 32

Pregnancy 
Diarrhoea
Constipation 
Prolonged straining 
Hereditary factors

Question 33

At what age and time should you refer someone with haemorrhoids and rectal bleeding?

Answer 33

40 or > = longer than 3 weeks with change in bowel habit.

60 or > = longer than 3 weeks if symptoms are alone or in combination.

Question 34

When should you be concerned about blood in the stool?

Answer 34

Blood mixed with stool rather than on surface - cancer.

Question 35

Depending on age what other diagnoses should be considered?

Answer 35

• local dermatitis
• irritation
• threadworm infection - depending on age.

Question 36

What types of treatments are available for haemorrhoids?

Answer 36

Cream/ointment - if external haemorrhoids which can be felt

Supps - internal haemorrhoids

Question 37

What 4 types of drugs are commonly contained in haemorrhoid preparations?

Answer 37

Soothing agents - zinc oxide

Local anaesthetics - lidocaine, benzocaine

Topical steroids - hydrocortisone.

Astringents - witch hazel, bismuth subgallate.

Question 38

is haemorrhoids common in pregnancy?

Answer 38

Yes - due to pressure from uterus, and increased incidence of constipation.

Question 39

When would you use anusol plus?

Answer 39

Contains steroid - if there is local irritation or itching.