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Z Year3 Clinical Presentations > Diarrhoea > Flashcards

Diarrhoea Flashcards

1
Q

What is diarrhoea?

A

increase in the amount of stool passed daily to over 300g of stool per day + usually accompained by increased frequency and loosening of stools

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2
Q

What can patients confuse diarrhoea with?

A
  • melaena
  • steatorrhoea
  • haematochezia
  • Loose stools
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3
Q

What is melaena?

A

dark, tarry stools from digested blood

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4
Q

What is steatorrhoea?

A

pale, floating stools from undigested lipid

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5
Q

What is haematochezia?

A

bright red stools from frank blood

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6
Q

What are loose stools?

A

soft feaces but no increase in frequency or quantity

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7
Q

What can diarrhoea be caused by?

A
  1. Infection of bowel
  2. Inflammation of bowel
  3. Increased bowel motility
  4. Malabsorption of nutrients
  5. Obstruction overflow due to a mass allowing only liquid stool to pass beyond it
  6. Medications
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8
Q

What conditions cause infection of bowel?

A

infectious diarrhoea

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9
Q

What conditions cause inflammation of bowel and diarrhoea?

A
  1. IBD

2. diverticular disease

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10
Q

What conditions cause increased bowel motility and diarrhoea?

A
  1. hyperthyroidsim
  2. anxiety
  3. IBS
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11
Q

What conditions cause malabsorption of nutrients and diarrhoea?

A
  1. coeliac disease

2. pancreatic insufficiency

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12
Q

What conditions cause obstruction overflow due to a mass allowing only liquid stool to pass beyond it?

A

constipation from hard stool in elderly, colon cancer and ovarian cancer

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13
Q

What medications cause diarrhoea?

A
  1. laxative
  2. colchine
  3. digoxin
  4. metformin
  5. thiazide diuretics
  6. some antibiotics
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14
Q

If 3 day diarrhoea what are likely causes in a young female?

A
  1. Infective diarrhoea
  2. IBS
  3. Coeliac disease
  4. Crohn’s disease
  5. US
  6. Medications (e.g. antibiotics, laxatives)
  7. Hyperthyroidism
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15
Q

If 3 day diarrhoea what are likely causes in a elderly female?

A
  1. Neoplastic disease (villous polyps, colonic adenocarcinoma, pancreatic cancer)
  2. Diverticular disease
  3. Overflow diarrhoea secondary to constipation
  4. ischaemic colitis
  5. micrscopic colitis
  6. bacterial overgrowth (e.g. in patients with DM)
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16
Q

What age is IBD common at?

A

5-25 and 50-80 years

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17
Q

If someone comes in with acute diarrhoea what do you need to asses initially?

A
  1. ABC
  2. Dehydration status
  3. Electrolyte or pH disturbances
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18
Q

How can you tell if someone has dehydration (hypovolemia)?

A
  1. tachycardia?
  2. postural drop narrow MAP, low BP
  3. mucous membranes coated tounge, dry lips
  4. patient feel thirsty?
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19
Q

Why might you have electrolyte or pH disturbances in acute diarrhoea?

A
  1. due to excess loss (K+, HCO3-) in feaces
  2. or due to secondary to hypovolaemia or ischaemia (e.g. hyperkalaemia in response to metabolic acidosis caused by ischaemia)
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20
Q

How do you check electrolyte and pH disturbances?

A
  • quickest way to get is VBG or ABG

- VBG if patient ok

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21
Q

What are signs of shock with diarrhoea?

A

diarrhoea, tachycardia and hypotension

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22
Q

How can you tell if tachycardia is from anxiety or pathology?

A

anxiety causing tachycardia would also cause a rise in BP

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23
Q

What is pH of acidosis?

A

pH<7.35

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24
Q

If HCO3- is low what can this suggest?

A

consumption of bloods HCO3 buffer to compensate for acidosis (to reduce amount of H+)

25
Q

What can metabolic acidosis be due to?

A

rise in H+ or loss of HCO3-

26
Q

What does it mean if the anion gap is elevated?

A

presence of extra acids: e.g lactic acid, aspirin, ketone bodies

27
Q

What can happen to tissues that become ischaemic due to hypoperfusion?

A

rely of anaerobic glycolysis forming lactic acid

28
Q

Why can you get hypokalaemia is diarrhoea?

A

K+ loss if faeces (generally with diarrhoea lose a lot of ions)

29
Q

How do you correct hypokalaemia in diarrhoea?

A

patients kidneys ok can be corrected by fluid rehydration with electrolytes

30
Q

How do you acutely manage dehydration due to ongoing diarrhoea?

A
  1. Cannula placed
  2. Bloods taken
  3. Fluid given
31
Q

How can you administer IV fluid with dehydration?

A

could give ‘fluid challenge’: 500mL of crystalloid solution then reassess patients blood pressure after 30mins

32
Q

What are the two outcomes of fluid challenge?

A
  1. If BP stays low, needs more fluids

2. If BP improves can switch to providing maintenance fluids IV orally

33
Q

How is the metabolic acidosis corrected?

A

with adequate restroation of fluid balance, if kidney function normal

34
Q

What questions do you have to ask when someone has acute diarrhoea?

A
  1. Characterise stool
  2. Ask about bowel habit
  3. Assoicated symptoms
  4. RF for diarrhoea
  5. FHx
35
Q

What questions do you ask to characterise the stool?

A
  1. Feaces mucoid or jelly like?
  2. Foul smelling and floating?
  3. Feaces unusally pale
  4. Feaces bloody
36
Q

What would mucoid or jelly like feaces with diarrhoea suggest?

A
  1. infection by salmonella
  2. villous polyps in colon
  3. can also be seen in any condition causing inflammation of bowel wall
37
Q

What would foul smelling and floating diarrhoea suggest?

A
  1. malabsorption due to coeliac disease, pancreatic duct obstruction (pancreatic cancer, cystic fibrosis)
  2. or biliary insufficiency (recent cholecysectomy)
38
Q

What would unusally pale feaces with diarrhoea suggest?

A

obstruction biliary or pancreactic ducts (e.g. chronic pancreatitis, gallstones)

39
Q

What would bloody on paper or streaked feaces with diarrhoea suggest?

A
  1. anal fissure

2. heamorrhoids

40
Q

What would bloody red and mixed in with feaces with diarrhoea suggest?

A

colorectal path (colorectal carcinoma, dysentery, UC)

41
Q

What questions do you ask about bowel habit with diarrhoea?

A
  1. Nocturnal diarrhoea?
  2. Find herself having to rush to toilet to pass motions?
  3. After passing, feel havent full evacuated bowel (tenesemus)?
  4. Has she had a variable bowel habit?
  5. How often diarrhoea?
42
Q

What would nocturnal diarrhoea suggest?

A

organic aietology not functional (f:IBS)

43
Q

What would having to rush to toilet to pass motions?

A

urgency: IBD, infectious diarrhoea

44
Q

What would tenesemus suggest?

A

space occupying lesion in rectum (carcinoma)

45
Q

What would variable bowel habit suggest?

A
  1. IBS (younger patients)

2. colorectal cancer (older)

46
Q

What would chronic diarrhoea suggest?

A

infectious diarrhoea typically one off - pathologies reccurrent

47
Q

What associated symptoms do you ask about with diarrhoea?

A
  1. Vomiting
  2. Abdominal pain
  3. Signficant weight loss?
  4. Eye problems, joint pain, skin rashes?
48
Q

What would vomiting with diarrhoea suggest?

A

infectious gastroenteritis

49
Q

What would RIF pain with diarrhoea suggest?

A

terminal ileum inflammation e.g. Crohns, Yer.enter infection

50
Q

What would LIF pain with diarrhoea suggest?

A

diverticular disease

51
Q

What would pain relieved by passing motions and diarrhoea suggest?

52
Q

What would significant weight loss suggest?

A

over time, chronic e.g. IBD not acute e.g. infection

53
Q

What eye problems do you ask about?

A
  • Uveitis (painful red eye with loss of visions)
  • Scleritis (painful red eye with no loss of vision)
  • Episcleritis (uncomfortable red eye with no loss of vision)
54
Q

What skin rashes do you ask about?

A
  • Erythema nodosum (painful dark red nodules on shins)

- Pyoderma gangrenosum (ulcers with a surrouding purple halo)

55
Q

What conditions are associated with IBD (crohn’s and UC)?

A
  • Uveitis (painful red eye with loss of visions)
  • Scleritis (painful red eye with no loss of vision)
  • Episcleritis (uncomfortable red eye with no loss of vision)
  • Enteric arthritis
  • Erythema nodosum (painful dark red nodules on shins)
  • Pyoderma gangrenosum (ulcers with a surrouding purple halo)
56
Q

What are the risk factors for diarrhoea?

A
  1. Abroad recently? Eaten anything unusual? Know other people with similar symptoms?
  2. Stress of late? Diet? Stress and low fibre diet suggests IBS
  3. Medications? Changed recently?
57
Q

What are antibiotics and PPIs associated with?

A

c.diff diarrhoea

58
Q

What FHx do you ask about with diarrhoea?

A
  1. Crohn’s
  2. UC
  3. coeliac disease
  4. HNPCC

Z Year3 Clinical Presentations (37 decks)

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