Diarrhoea

Question 1

What is the definition of diarrhoea?

Answer 1

Three or more loose or liquid stools per day.

Question 2

How long is it until acute diarrhoea becomes chronic diarrhoea?

Answer 2

Two weeks

Question 3

What are the causes of bloody diarrhoea?

Answer 3

Infectious, IBD, colorectal cancer, polyps, ischaemia, diverticulitis, haemorrhoids.

Question 4

What are the causes of mucus diarrhoea?

Answer 4

IBS, colorectal cancer, polyps.

Question 5

What are the causes of pus in diarrhoea?

Answer 5

IBD, diverticulitis, fistula, abscess.

Question 6

What are the causes of explosive diarrhoea?

Answer 6

Infectious - cholera, rotavirus, Giardia, Yersinia.

Question 7

What are the causes of steatorrhoea?

Answer 7

Pancreatic insufficiency, biliary obstruction, coeliac.

Question 8

Which area of the GI tract do the pathogens in infectious diarrhoea affect, and what kind of diarrhoea do they cause?

Answer 8

1. Stomach and small bowel
2. Large-volume, watery diarrhoea (with vomiting)
3. Dysentery (campylobacter, shigella, E. coli)

Question 9

Which drugs can cause diarrhoea?

Answer 9

Laxatives, antibiotics (especially macrolides), alcohol, NSAIDs, metformin, PPIs, SSRIs, nicorandil.

Question 10

What is this a presentation of?

Diarrhoea, left lower quadrant pain, fever.

Answer 10

Diverticulitis

Question 11

What is an important cause of hospital-acquired diarrhoea?

Answer 11

Clostridium difficile

Question 12

In which patient group is constipation causing overflow diarrhoea more common and what can it lead to?

Answer 12

1. Frail, immobile or confused elderly patients.

2. Faecal incontinence in the elderly.

Question 13

What are the causes of chronic diarrhoea?

Answer 13

IBS, ulcerative colitis, Crohn’s, colorectal cancer, coeliac.

Question 14

What are the causes acute diarrhoea?

Answer 14

Infection, drugs, diverticulitis, antibiotic therapy, constipation causing overflow.

Question 15

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.

Answer 15

IBS

Question 16

What is this a presentation of?

Bloody diarrhoea with cramping lower abdominal pain, faecal urgency, tenesmus, mucus discharge, fever.

Answer 16

Ulcerative colitis

Question 17

What is this a presentation of?

Watery diarrhoea, abdominal pain, weight loss, faecal urgency, tenesmus, mucus discharge.

Answer 17

Crohn’s

Question 18

What is this a presentation of?

Weight loss, rectal bleeding, palpable mass, tenesmus, iron deficiency anaemia, anorexia, >50 years old.

Answer 18

Colorectal cancer

Question 19

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.

Answer 19

Coeliac disease

Question 20

How do you investigate diarrhoea?

Answer 20

1. Look for dehydration an hyperthyroid signs
2. Low MCV in coeliac/colon cancer
3. High MCV in chronic alcohol abuse
4. High ESR/CRP in IBD, cancer
5. Coeliac serology (anti-TTG)
6. Stool MCS, faecal elastase if chronic pancreatitis.
7. Colonoscopy

Question 21

What is the management for diarrhoea?

Answer 21

1. Treat cause
2. Oral rehydration better than IV
3. Codeine phosphate or loperamide after each loose stool, avoid in obstruction.