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Diahorrea Flashcards

1
Q

How can diarrhoea be defined?

A

Three or more loose or liquid stools per 24 hours, and/or

Stools that are more frequent than what is normal for the individual lasting <14 days, and/or

Stool weight greater than 200 g/day.

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2
Q

How can diarrhoea be classified?

A

Acute (≤14 days)
Persistent (>14 days), or
Chronic (>4 weeks)

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3
Q

Describe the basic pathophysiology of diarrhoea?

A

10L of fluid enters GI tract daily

Small intestine responsible for reabsorbing (99%)

0.1L excreted in faeces

In diarrhoea there is decreased reabsorption or increased secretion

Or increase in bowel motility

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4
Q

From where is fluid secreted into the GI tract?

A 
Food 
Drink
Salivary glands
Stomach
Pancreas
Bile ducts
Duodenum
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5
Q

What are the two types of diarrhoea?

A

Inflammatory

Non-inflammatory

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6
Q

What can cause inflammatory diarrhoea?

A

Material
Viral
Parasitic

Or early bowel ischaemia, radiation injury or IBD

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7
Q

What are the associated symptoms of inflammatory diarrhoea?

A

Mucoid and bloody stool
Tenesmus
Fever
Severe crampy abdominal pain

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8
Q

What are the main features of the diarrhoea in inflammatory diarrhoea?

A

Small in volume

Frequent bowel movements

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9
Q

What are the most common causes of inflammatory diarrhoea?

A

Campylobacter, Salmonella, Shigella, Escherichia coli, or Clostridium difficile

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10
Q

In who is virus related diarrhoea common in?

A

Children who attend day care centres

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11
Q

What are the most common causes of acute diarrhoea in developing countries?

A

Protozoa and Parasites

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12
Q

What findings might be found in inflammatory diarrhoea?

A

Examination of the stool may show leukocytes, and tests for faecal occult blood may be positive.

The test for faecal leukocytes is plagued by a high rate of false-negative results leading to low sensitivity, but a positive test is very informative.

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13
Q

Why does fluid enter enterocytes?

A

There are lots of solutes in enterocytes

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14
Q

What happens in inflammatory diarrhoea (enterocytes)?

A

Destruction of the epithelium due to inflammation

Enterocytes cannot absorb fluids

Excess fluid in lumen

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15
Q

What drug could help inflammatory?

A

Anti-cytokines e.g. Anti-TNF

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16
Q

What do you acutely want to do for all types of diarrhoea?

A

Rehydration

e.g. Oral rehydration solution

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17
Q

How does ORS work?

A

SGLT-1 = sodium glucose linked transporter

Give 1 glucose and 2 sodium takes both in

Pump into enterocytes

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18
Q

Why does diarrhoea kill?

A

Dehydration

ORS essential especially in children

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19
Q

What is chronic diarrhoea?

A

Symptoms for more than 6 weeks

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20
Q

What is IBS?

A

Functional cause of diarrhoea

No known structural changes

Symptoms are unexplained

Non-progressive and will not kill patient

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21
Q

What are the symptoms of IBS?

A 
Tiredness
Stomach pain
Bloating
Diarrhoea
Constipation 
Mucus in stool
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22
Q

What are the symptoms of IBD?

A

Abdominal pain
Diarrhoea
Fatigue

Weight loss
Fever
Blood in stool

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23
Q

What are some organic causes of diarrhoea?

A

IBD
Coeliac
Bowel Cancer

Organic = we can find a cause

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24
Q

What are the two types of blood in stool?

A

Blood on toilet paper

Blood mixed in stool

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25
What further investigation should be conducted?
``` Faecal Occult Blood Stool antigen Faecal calprotectin Colonoscopy LFTs ```
26
What stool tests should be conducted?
Eggs + Cysts (associated with parasites) shed intermittently in the stool 3 separate stool samples, 2 days apart Faecal calprotectin
27
What stool tests should be conducted?
Eggs + Cysts (associated with parasites) shed intermittently in the stool 3 separate stool samples, 2 days apart Faecal calprotectin - indicated migration of neutrophils into intestinal mucosa Non-specific but looks for evidence of inflammation
28
What tells us it is Crohn's disease?
``` Non- continuous Cobbelstone appearance Caecum to splenic flexure Granulomas - collection of neutrophils Changes to mucosa, submucosa, muscularis and serosa (transmural changes) ```
29
What would ulcerative collitis look like on a colonscopy?
``` Continuous areas of inflammation Starts at rectum and continues Does not extend beyond large bowel (illeum potentially in severe disease) Crypt processes Affects only mucosa and submucosa ```
30
What are some complications of Crohn's?
Can get a whole (fistula) forming due to transmural involvement
31
What are some complications of UC?
High predisposition to Colon Cancer
32
What treatments can be used for Crohn's? (conservative)
Stopping smoking - referral to cessation clinic Exercise Dietary advice to prevent malnourishment Psychological support - groups
33
What treatments can be used for Crohn's? (medical)
Corticosteroids to induce remission | Azothiprine or bilogica (Mabs) long term to dampen down immune system
34
What treatments can be used for Crohn's? (surgical)
Bowel resection May need ileostomy for a few months post-op Mainly due to strictures and fistulas Leave as late as possible due to the chance of further surgeries
35
When should you see a GP re crohn's?
blood in your poo diarrhoea for more than 7 days frequent stomach aches or cramps lost weight for no reason, or your child's not growing as fast as you'd expect
36
What causes Crohn's disease?
your genes – you're more likely to get it if a close family member has it a problem with the immune system smoking a previous stomach bug an abnormal balance of gut bacteria
37
What are the other symptoms of Crohn's?
``` a high temperature feeling and being sick joint pains sore, red eyes patches of painful, red and swollen skin – usually on the legs mouth ulcers children grow more slow than usual ```
38
How can steroids help with Crohn's?
can relieve symptoms by reducing inflammation in your digestive system – they usually start to work in a few days or weeks are usually taken as tablets once a day – sometimes they're given as injections may be needed for a couple of months – do not stop taking them without getting medical advice
39
What are the side effects of steroids?
``` weight gain indigestion problems sleeping an increased risk of infections slower growth in children ```
40
What immunosuppressants might be taken with Crohn's?
azathioprine, mercaptopurine and methotrexate
41
What can immunosuppressants do in Crohn's?
can relieve symptoms if steroids on their own are not working can be used as a long-term treatment to help stop symptoms coming back are usually taken as a tablet once a day, but sometimes they're given as injections may be needed for several months or years
42
What are the side effects of Immunosuppressants?
feeling and being sick, increased risk of infections and liver problems
43
What biological medicines are used in Crohn's?
adalimumab, infliximab, vedolizumab and ustekinumab
44
What can biological medicines do in Crohn's?
can relieve symptoms if other medicines are not working can be used as a long-term treatment to help stop symptoms coming back are given by injection or a drip into a vein every 2 to 8 weeks may be needed for several months or years
45
What are the side effects of biological medications?
increased risk of infections and a reaction to the medicine leading to itching, joint pain and a high temperature
46
When might surgery be recommended?
the benefits outweigh the risks or that medicines are unlikely to work
47
What does a resection involve?
1. Making small cuts in your tummy (keyhole surgery). 2. Removing a small inflamed section of bowel. 3. Stitching the healthy parts of bowel together.
48
What might you need to careful about with Crohn's?
Triggers e.g. certain foods pharmacy medicines
49
What's the deal with Crohn's and vaccinations?
Flub jab yearly | Avoid live vaccines e.g. MMR
50
What might be more difficult during a flare up?
Getting pregnant
51
What might not work as well when you have Crohn's?
Some contraceptives | e.g. the Pill
52
What are possible complications of Crohn's?
Damage to bowel e.g. scarring, narrowing, ulcers, fistulas Difficulty absorbing nutrients - osteoporosis, iron deficiency anaemia Bowel cancer
53
How does the risk of bowel cancer change with Crohn's?
after 10 years the risk is about 1 in 50 after 20 years the risk is about 1 in 10 after 30 years the risk is about 1 in 5
54
What should people with Crohn's do?
Have regular colonoscopies
55
What can cause infectious diarrhoea?
``` Norovirus E. coli Shigella Campylobacter Cholera ```
56
What are the features of campylobacter infection?
Flu-like prodome Crampy abdo pain Diarrhoea +/- blood
57
What is the most common cause of infective diarrhoea?
E. Coli Esp amongst travellers Watery stools Abdo cramps and nausea
58
How do you treat infective diarrhoea?
Rehydration | Correction of electrolyte imbalance
59
What kind of bacteria is E. coli?
gram-negative, rod-shaped bacterium
60
What investigations are done for infectious diarrhoea?
Stool cultures FBS Renal function and electrolytes

Year 3 Gastro (39 decks)

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