Diarrhoea

Question 1

What is diarrhoea?

Answer 1

Increased stool water and increased stool frequency

Question 2

Steatorrhoea

Answer 2

increased fat in stool –> pale, float, smelly

Question 3

Causes of acute diarrhoea?

Answer 3

Suspect gastroenteritis

Ask in history about travel, diet, contacts

Question 4

Causes of chronic diarrhoea

Answer 4

Chronic diarrhoea/ constipation alternating = IBS

Chronic diarrhoea with weight loss, anorexia and noctural diarrhoea: organic cause e.g. malignancy

Question 5

Causes of bloody diarrhoea

Answer 5

Vascular causes: ischaemic colitis
Infective causes: campylobacter, shigella, salmonella, E.coli
Inflammatory causes: UC, Crohn’s
Neoplastic causes: CRC, polyps

Question 6

Causes of mucus in diarrhoea

Answer 6

IBS
Polyps
CRC (in older person without hx of IBD mucus should make you think of rectal pathology almost immediately)

Question 7

Causes of pus in diarrhoea

Answer 7

IBD
Diverticulitis
Abscess

Question 8

Diarrhoea associated with other medical diseases

Answer 8

Increased T4 - hyperthyroidism
Autonomic neuropathy - e.g. DM
Carcinoid

Question 9

Diarrhoea associated with drugs

Answer 9

Antibiotics - erythromycin, clarithromycin, ciprofloxacin
Colchicine - acute gout 
PPIs, H2RAs e.g. cimetidine 
NSAIDs
Digoxin

Question 10

Investigations for diarrhoea: Bloods

Answer 10

FBC - to see if anaemia/Hb low or WCC raised
U&Es - check electrolytes e.g. hyponatraemia or hypokalaemia
ESR - raised in IBD or Ca
CRP - raised in IBD and infection
Coeliac serology: anti-TTG or anti-endomysial Abs

Question 11

Investigations for diarrhoea: Stool sample

Answer 11

Stool sample
Send for MC&S
Faecal calprotectin
C.diff toxin

Question 12

Management of diarrhoea

Answer 12

Treat cause
Oral or IV rehydration
Codeine phosphate 30mg TDS-QDS max 60mg OR
Loperamide 4mg initially then 2mg after each loose stool for 5 days max dose 16mg/24h
If infective though, better to let the bacteria come out
Abx e.g. cipro in infective diarrhoea –> systemic illness