Diarrhea

Question 1

Define Diarrhea

Answer 1

Diarrhoea: > 3 loose or watery stool per day
Acute diarrhoea < 14 days
Chronic diarrhoea > 14 days

Question 2

What are the causes of acute diarrhea

Answer 2

Gastroenteritis
Diverticulitis
Antibiotic therapy
Constipation causing overflow

Question 3

Tell me about diarrhea in Gastroenteritis

Answer 3

May be accompanied by abdominal pain or nausea/vomiting

Question 4

Tell me about diarrhea in Diverticulitis

Answer 4

Classically causes left lower quadrant pain, diarrhoea and fever

Question 5

Tell me about diarrhea in Antibiotic therapy

Answer 5

More common with broad spectrum antibiotics

Clostridium difficile is also seen with antibiotic use

Question 6

Tell me about diarrhea in Constipation causing overflow

Answer 6

A history of alternating diarrhoea and constipation may be given

May lead to faecal incontinence in the elderly

Question 7

Causes of Chronic Diarrhea

Answer 7

Irritable bowel syndrome
Ulcerative colitis
Crohn's disease
Colorectal cancer
Coeliac disease

Question 8

Tell me about diarrhea in Irritable bowel syndrome

Answer 8

Extremely common. The most consistent features are abdominal pain, bloating and change in bowel habit. Patients may be divided into those with diarrhoea predominant IBS and those with constipation-predominant IBS.

Features such as lethargy, nausea, backache and bladder symptoms may also be present

Question 9

Tell me about diarrhea in Ulcerative colitis

Answer 9

Bloody diarrhoea may be seen. Crampy abdominal pain and weight loss are also common. Faecal urgency and tenesmus may be seen

Question 10

Tell me about diarrhea in Crohn’s disease

Answer 10

Crampy abdominal pains and diarrhoea. Bloody diarrhoea less common than in ulcerative colitis. Other features include malabsorption, mouth ulcers, perianal disease and intestinal obstruction

Question 11

Tell me about diarrhea in Colorectal cancer

Answer 11

Symptoms depend on the site of the lesion but include diarrhoea, rectal bleeding, anaemia and constitutional symptoms e.g. Weight loss and anorexia

Question 12

Tell me about diarrhea in Coeliac disease

Answer 12

In children may present with failure to thrive, diarrhoea and abdominal distension

In adults lethargy, anaemia, diarrhoea and weight loss are seen. Other autoimmune conditions may coexist

Question 13

Name other conditions associated with Diarrhea

Answer 13

thyrotoxicosis
laxative abuse
appendicitis
radiation enteritis

Question 14

Drugs that may cause diarrhea

Answer 14

antibiotics, cytotoxics, PPIs and NSAIDs, may cause acute diarrhoea.

Question 15

What is the most common cause of chronic or relapsing diarrhea

Answer 15

IBS
Diarrhea most severe before or after breakfast
the stool often contains mucus but never blood
negative investigations for other causes suggest IBS