Diarrhoea

Question 1

HPC questions to ask

Answer 1

SOCRATES for the diarrhoea
- in triggers is it triggered by any type of food

Any blood, mucus or pus in the stool?

What colour is the stool - pale steatorrhoea

Any vomiting?
Abdominal pain? (IBS, IBD, diverticular disease)
Bloating?

Any symptoms of dehydration?

Changes to urine habits?

Systemic features - weight loss, loss of appetite, tiredness, fever
(Weight loss may also be seen in Crohn’s and coeliac too)

Risk factors for gastroenteritis to ask about:

• Recent travel history
• Uncooked, poorly prepared food
• Household members unwell

Question 2

Differential diagnosis for diarrhoea

Answer 2

Gastroenteritis
Colorectal cancer
IBS
IBD
Coeliac or pancreatic insufficiency
Diverticular disease
C. Difficile

Question 3

Examination

Answer 3

BP and HR (to assess for dehydration)
Temperature

Abdominal examination
PR if suspect colorectal Ca

Question 4

Investigations

Answer 4

FBC
CRP/ESR
U+Es
LFTs
CEA (if suspect Colorectal Ca)
Anti-TTG and total IgA if consistent with coeliac

Faecal calprotectin (IBD)

Stool culture if suspect gastroenteritis and there is blood or pus in the stool and if suspect C. diff

Question 5

PMH -

Answer 5

Any IBD or coeliac
Any cancer
Anything else
Recently taken any antibiotics

Question 6

DH

Answer 6

Recently taken any antibiotics?

Question 7

SH

Answer 7

Smoking (protective for UC, exacerbates Crohn’s)

Question 8

Management of gastroenteritis

Answer 8

Leaflet/NHS choices website

Drink lots of Fluid
May need oral rehydration solution - available from the pharmacy
Hand hygiene to limit spread
Don’t share towels

Stay off work for at least 48h after D+V has stopped

Anti-diarrhoea medication e.g. Immodium is not usually needed but may provide shot term benefit

Anti-emetics not usually necessary but may be helpful if severe vomiting

Antibiotics usually not needed as most cases are viral

If in shock or severe dehydration - admit to hospital

Question 9

SN

Answer 9

If no improvement within 48h or symptoms worsen or severely dehydrated and vomiting come back

Question 10

Management if suspect colorectal cancer

Answer 10

2WW referral for colonoscopy

Question 11

Management of IBS

Answer 11

Investigations - FBC, CRP, Coeliac screen to rule out other causes

NHS choices/leaflet
Food diary to identify triggers
Reduce stress as symptoms linked to anxiety often

Question 12

Management of suspected IBD (/Coeliac)

Answer 12

Refer to gastroenterology

Question 13

Diverticular disease management

Answer 13

High fibre diet
High fluid intake
Paracetamol PRN

SN - if get fever, N+V (could be diverticulitis) - come back
FU in a month