Diarrhoea Flashcards
What is the definition of diarrhoea?
Three or more loose or liquid stools per day.
How long is it until acute diarrhoea becomes chronic diarrhoea?
Two weeks
What are the causes of bloody diarrhoea?
Infectious, IBD, colorectal cancer, polyps, ischaemia, diverticulitis, haemorrhoids.
What are the causes of mucus diarrhoea?
IBS, colorectal cancer, polyps.
What are the causes of pus in diarrhoea?
IBD, diverticulitis, fistula, abscess.
What are the causes of explosive diarrhoea?
Infectious - cholera, rotavirus, Giardia, Yersinia.
What are the causes of steatorrhoea?
Pancreatic insufficiency, biliary obstruction, coeliac.
Which area of the GI tract do the pathogens in infectious diarrhoea affect, and what kind of diarrhoea do they cause?
- Stomach and small bowel
- Large-volume, watery diarrhoea (with vomiting)
- Dysentery (campylobacter, shigella, E. coli)
Which drugs can cause diarrhoea?
Laxatives, antibiotics (especially macrolides), alcohol, NSAIDs, metformin, PPIs, SSRIs, nicorandil.
What is this a presentation of?
Diarrhoea, left lower quadrant pain, fever.
Diverticulitis
What is an important cause of hospital-acquired diarrhoea?
Clostridium difficile
In which patient group is constipation causing overflow diarrhoea more common and what can it lead to?
- Frail, immobile or confused elderly patients.
2. Faecal incontinence in the elderly.
What are the causes of chronic diarrhoea?
IBS, ulcerative colitis, Crohn’s, colorectal cancer, coeliac.
What are the causes acute diarrhoea?
Infection, drugs, diverticulitis, antibiotic therapy, constipation causing overflow.
What is this presentation of?
Alternating between diarrhoea and constipation, relieved by defecation, change in stool frequency, form or appearance. Abdominal bloating or subjective distention.
IBS
What is this a presentation of?
Bloody diarrhoea with cramping lower abdominal pain, faecal urgency, tenesmus, mucus discharge, fever.
Ulcerative colitis
What is this a presentation of?
Watery diarrhoea, abdominal pain, weight loss, faecal urgency, tenesmus, mucus discharge.
Crohn’s
What is this a presentation of?
Weight loss, rectal bleeding, palpable mass, tenesmus, iron deficiency anaemia, anorexia, >50 years old.
Colorectal cancer
What is this a presentation of?
Pale, greasy, offensive stools that float and are difficult to flush. Diarrhoea. Failure to thrive and abdominal distension in children. Lethargy, anaemia, and weight loss in adults.
Coeliac disease
How do you investigate diarrhoea?
- Look for dehydration an hyperthyroid signs
- Low MCV in coeliac/colon cancer
- High MCV in chronic alcohol abuse
- High ESR/CRP in IBD, cancer
- Coeliac serology (anti-TTG)
- Stool MCS, faecal elastase if chronic pancreatitis.
- Colonoscopy
What is the management for diarrhoea?
- Treat cause
- Oral rehydration better than IV
- Codeine phosphate or loperamide after each loose stool, avoid in obstruction.
