Diahorrhea

Question 1

How does WHO define diarrhoea?

Answer 1

3 or more loose or liquid stools per day
OR
more frequent passage than is normal for the individual

Faecal weight more than 200g/day

Question 2

How do we distinguish chronic/acute diarrhoea?

Answer 2

Acute is less than 2 weeks in duration

Chronic more than 4 weeks

Question 3

What should you ask about regarding diarrhoea?

Answer 3

Frequency
Consistency
Presence of blood/mucus
Associated symptoms
- pain
- vomiting
- fever
BO at night?
Urgency?
Any incontinence?
Do the stools flush away - steathorrea as a result of malabsorption typically do not

Question 4

How do we classify stool?

Answer 4

Bristol stool chart

Question 5

What are the different mechanisms of diarrhoea?

Answer 5

Secretory e.g. cholera
Osmotic e.g. hypolactasia, drugs, malabsorption
Exudative e.g. IBD
Abnormal Motility e.g. IBS
Mixed
Overflow

Question 6

What is dysentery?

Answer 6

Diarrhoea associated with blood

Also fever, abdominal pain and vomiting

Caused by bacteria commonly e.g. shigella, salmonella

Question 7

Which amoeba can cause dysentery?

Answer 7

Entamoeba histolytica
Need for ‘hot’ stool sample
Straight to the lab

Question 8

How do you ellicit that is a GI infection causing diarrhoea?

Answer 8

Short history
Precipitating event e.g. food, personal contact or travel
Fever, abdo pain and vom

Question 9

What is the treatment for GI infection diarrhoea?

Answer 9

AB treatment and rehydration

Question 10

What are the main features of C. diff diarrhoea?

Answer 10

Can cause pseudomembraneous colitis

Concern in healthcare settings

Associated with AB use

Can lead to sig mortality in elderly

Question 11

What is the treatment for c. diff diarrhoea?

Answer 11

Rehydration
Oral metronidazole or vancomycin
In resistant cases - FMT

Question 12

How does malabsorption cause diarrhoea?

Answer 12

Failure to secrete digestive enzymes - pancreatic disease
OR
Failure to absorb through gut wall - mucosal disease

Question 13

What are the features of malabsorption diarrhoea?

Answer 13

Steatorrhoea
Pale, bulky, offensive stools
Difficult to flush

Weight loss
Lethary
Anorexia
Abdo discomfort and bloating

Question 14

How do we assess malabsorption in the lab?

Answer 14

Stool sample for fat globules
3 day faecal fat estimation
Look at FBS for B12, Fe, Ferritin

Question 15

What diseases can cause malabsorption?

Answer 15

Pancreatic
Coeliac
Crohn's
Infective/Post-infective
Bacterial overgrowth
Biliary obstruction

Question 16

What should you do if you want to know if it is pancreatic or intestinal malabsorption?

Answer 16

Faecal elastase

CT scan/ERCP

Trial therapy e.g. pancreatic enzymes and monitor success

Give antibodies to check for coeliac

Question 17

What is tTG?

Answer 17

tTG
Tissue Transglutaminase
>90% sensitivity and specificity for coeliac disease
Reduces when GF diet is adhered to
Diagnostic of coeliac

Question 18

What complications can arise if a GF diet is not stuck to in coeliac?

Answer 18

Small bowel lymphoma

Osteoporosis

Question 19

What is IBD?

Answer 19

Chronic relapsing inflammatory disorders of the GI tract

UC and Crohn’s

Question 20

UC? main features

Answer 20

Continuous - starts in rectum
Sharp demarcation
Confined to mucose
M=F
25-35 years typically 
More common in non-smokers

Question 21

Crohn’s? main features

Answer 21

Discontinuous (skip lesions)
Can start anywhere from mouth to anus
Transmural inflammation
Young adults but also children and older
F>M
Fistulae and strictures common
Granulomas in roughly 60%

Question 22

What is the cause of IBD?

Answer 22

Complex
Disordered immune response to luminal bacteria

UC - mixed Th1 and Th2 and Th17 response

CD - Th1 and Th17 response

Question 23

What are the symptoms of IBD affecting the colon?

Answer 23

Bleeding
Mucus
Urgency
Diarrhoea

Question 24

What are the symptoms of IBD affecting the small bowel?

Answer 24

Abdo pain
Wt. loss
Lethargy
Diarrhoea
Abdo mass

Question 25

What are the symptoms of IBD affecting the perianal region?

Answer 25

Anal pain
Leakage
Difficulty passing stool

Question 26

What are the other symptoms of IBD?

Answer 26

Arthritis: axial
- ankylosing spondylitis

Skin: Erythema nodosum, pyoderma gangrenosum

Eyes: Anterior uveitis, episceleritis

Liver: PSC, auto immuni hepatitis

Question 27

How do we diagnose active IBD?

Answer 27

Stool cultures
Inflammatory markers
Consider rectal biopsy
Colonoscopy

Question 28

What do you do if acute severe colitis is suspected?

Answer 28

Admit pt
AXT
Is there dilatation? 
Is there evidence of perforation?
Call surgeon
Fluids, steroids and consider ABs

Question 29

What is the treatment for acute severe colitis?

Answer 29

Iv hydrocortisone
Monitor clinical status
No better after 2-3 days = Biologic medication
No better after 5-7 days = colectomy

Question 30

What is infectious colitis?

Answer 30

diarrhea with evidence of colonic inflammation

Question 31

What can cause infectious colitis?

Answer 31

Parasites
Viruses
Bacteria

Question 32

What are the symptoms of infectious colitis?

Answer 32

Diarrhea 3 or more times in a day
Bowel movements that contain blood or mucus
Headache or body aches
Low-grade fever (less than 101.0 F)
Abdominal pain, bloating, and cramps

Question 33

What is C. Diff?

Answer 33

Clostridium difficile is a Gram positive rod

Found in hospitals

Question 34

What does C. diff cause?

Answer 34

Exotoxin production that causes intestinal damage and pseudomembranous colitis

Question 35

What is the treatment for life-threatening C. diff infection?

Answer 35

oral vancomycin AND IV metronidazole

specialist advice - surgery may be considered