Diarrhoea

Question 1

Definition

Answer 1

Loose liquid stool
DEFINED AS 3+ WATERY STOOLS DAILY = 5-7 on BRISTOL STOOL CHART
Acute = less than 2 weeks
Subacute = 14-28 day
Chronic = > 28 weeks

Question 2

Types of diarrhoea

Answer 2

Osmotic = osmotic gap 100mOsm /kg due to active solutes in the lumen, relieved by fasting
Secretory = active secretion of water + electrolytes into lumen , no response to fasting
Exudative = inflammatory damage to intestinal mucosa = IBD
Diarrhoea due to altered motility = increased peristalsis and decreased time for resorption

Question 3

Aetiology

Answer 3

IBD (Crohn’s, UC)
Coeliac
Hyperthyroidism
Inflammation or malignancy
INFECTIVE
- Viral (MC) = rotavirus (kids < 3), norovirus (adults)
- Bacterial = C.diff, campylobacter (MC bact), E.coli, Salmonella, Shingella, Cholera
- Worms

Question 4

Signs and Symptoms

Answer 4

Dependant on cause:
< 3 = rotavirus
Abx = C.diff
GUILLIAN BARRE = campylobacter
rice water stool = cholera
bloody = dysentery
- e.g. e.coli, salmonella, shingella, amoebic
Infective = acute, often travellers
Non = longer Hx

Question 5

Diagnosis

Answer 5

FBC = leukocytosis
Anti a-gliadin Ab - coeliac
TFT
Stool culture
Flexible sigmoidoscopy

Question 6

Treatment

Answer 6

Viral = self limiting
Treat main complication = DEHYDRATION + ELECTROLYE LOSS
- Fluids
- DIURALITE
Anti-motility agent = LOPERAMIDE

Question 7

Abx which increase risk of c.diff

Answer 7

Clarithromycin
Co-amoxiclav
Ciprofloxacin
Cephalosporins