Diarrhoea Flashcards
Diarrhoea first line
Loperamide - opioid agonist
Diarrhoea resolve after milk & products removed?
Coeliac disease - gluten, lactose
Hypomagnesaemia leads to?
high intestinal loses eg IBD, diarrhoea
Duration of diarrhoea why?
- longer = higher chance of dehydration
* differentiation of acute or chronic. Bacterial or viral.
Other association in Diarrhoea?
- blood in stool = IBS, UC, cancer
- bright red = burst blood vessel less concerning
- dark tar-like, coffee ground blood = UC, CD
Mucus in stool - diarrhoea?
• bacterial food poisoning, E-coli, shingella, salmonella
Actue diarrhoea duration?
<14 days
Chronic diarrhoea duration?
> 14 days
What is diarrhoea?
- change in normal bowel habit, => increased frequency of bowel movements & passage of salt watery stools
- osmotic pressure forces water into gut
Infants with diarrhoea - refer?
• refer to GP if >1 day due to dehydration risk
Children with diarrhoea - refer?
• refer to GP if >2 days - dehydration risk
older children/adults with diarrhoea - refer?
• refer to GP if >3 days
Referral for diarrhoea despite taking loperamide?
• 24h & it didn’t work
Bacteria causes diarrhoea by?
• invasive - attacks mucosal cells, cause diarrhoea with blood & pus
- non-invasive - doesn’t directly damage the gut, endotoxins produced disrupting secretion.
- more common
Recent travel & diarrhoea
abroad - unfamiliar bacteria, diff hygiene standards
diarrhoea caused by drugs?
antibiotics, NDAIS, Fe therapy, metformin. laxative misuse, alcohol increases bowel movement
Red flags in diarrhoea?
• sudden, unexplained kg loss
dehydration from diarrhoea symptoms
- skin spring back after pinch?
- dry mouth
- passing urine okay?
- urine output, colourless?
- dizziness
- confusion
- heart rate increase
- breathing rate increase
- unconscious
Mr XY, a 29-year-old male, visits your community pharmacy and asks if she can buy something for diarrhoea. Discuss the additional information you require from Mr XY explaining the rationale to aid your differential diagnosis.
- duration - acute, chronic, dehydration risk
- other association eg blood, mucus
- bacterial or viral - invasive or non-invasive
- travel?
- drugs - NSAIDs, antibiotics, Fe therapy, metformin
- drug abuse - alcohol, laxative
- food intolerance
- sudden kg loss - red flag
- dehydration - dry mouth, dizziness, confusion.
A simple case of acute diarrhoea following a BBQ at the weekend, what pharmacological and non-pharmacological advice you would give.
Pharma:
• Oral Rehydration Therapy - satches after passing stool
• electrolytes
• loperamide 4mg if they feel it would help, max 16mg
Non-pharma
• drink water, rest, hygiene
• dont share towels
• wash hands
• avoid spicy foods, caffeine, carbonated drinks, giving stomach more work
• give it a few days to pass. >week = consult GP
• stay off work 48h
• plain carbs, BRAT - banana, rice, apples, toast
• cook meat properly
Non - pharmacological advice in diarrhoea
- drink water, rest, hygiene
- dont share towels
- wash hands
- avoid spicy foods, caffeine, carbonated drinks, giving stomach more work
- give it a few days to pass. >week = consult GP
- stay off work 48h
- plain carbs, BRAT - banana, rice, apples, toast
- cook meat properly
Severe hydration therapy?
IV fluids & hospitalisation
Opioid pharmacology in diarrhoea
- acute diarrhoea
- short term use
- slows does peristalsis & opens anus to help store faeces better & decrease sensitivity
Loperamide pharmacology in diarrhoea
- reduce peristalsis & increase intestinal transit time
* decrease gut secretions & increase anal sphincter tone
Loperamide dose, time?
- 4mg initially
- 2mg for up to 5 days after
- 16mg max
Oral rehydration example
- Dioralyte - contains rice to make stool harder
- mixed with water
- 200ml in child
- 200-400ml in adult
If loperamide first line ineffective?
- codeine 30mg QDS
* loperamide & codeine combination therapy
children w diarrhoea treatment?
- normal milk
- plenty of fluid
- ORT
- prevent spread
- avoid school 48hours
- avoid swimming for 2 weeks
Diarrhoea causes
- infection
- drug SE
- acute IBD or IBS
- Mg2+ - laxative antacids
RED FLAGS in diarrhoea
- rectal bleeding
- unexplained kg loss
- persistent
- systemic illness
- newly started antibiotic/treatment
- travel
