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9. GI system > Diarrhoea > Flashcards

Diarrhoea Flashcards

1
Q

Define diarrhoea.

A

The abnormal passage of loose or liquid stool more than 3 times daily.

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2
Q

What is classed as acute diarrhoea?
What is classed as chronic diarrhoea?

A
  • Acute diarrhoea is defined as that lasting less than 2 weeks.
  • Chronic diarrhoea is defined as lasting more than 2 weeks.
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3
Q

What are the 2 main classes that cause diarrhoea?

A
  1. Infective diarrhoea
  2. Inflammatory diarrhoea
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4
Q

What points to an infective cause of diarrhoea?

A

Sudden onset of bowel frequency associated with crampy abdominal pains and a fever will point to an infective cause.

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5
Q

What points to an inflammatory cause of diarrhoea?

A

Bowel frequency with loose, blood-stained stools will point to an inflammatory cause.

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6
Q

What causes the decrease in stool consistency?
Name 3 and explain them.

A
  1. Water
  2. Fat (steatorrhoea)
  3. Inflammatory discharge
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7
Q

Give 5 infective causes of diarrhoea.

A
  1. Traveller’s diarrhoea.
  2. Viral e.g. rotavirus, norovirus.
  3. Bacterial e.g. E.coli.
  4. Parasites e.g. helminths.
  5. Nosocomial e.g. c.diff.
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8
Q

Give 5 non-diarrhoeal GI infections.

A
  1. PUD - H.pylori
  2. Acute cholecytitis
  3. Peritonitis
  4. Typhoid/Paratyphoid - Salmonella
  5. Amoebic liver abscess
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9
Q

Give 5 non-infective causes of diarrhoea.

A
  1. Neoplasm.
  2. Inflammatory.
  3. Irritable bowel.
  4. Anatomical.
  5. Chemical.
  6. Hormonal.
  7. Radiation.
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10
Q

Give 2 infective causes of non-bloody diarrhoea.

A
  1. Rotavirus.
  2. Norovirus.
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11
Q

What is the leading cause of diarrhoeal illness in young children?

A

Rotavirus.

There is a vaccine - rotarix.

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12
Q

What is the main cause of diarrhoea in adults?

A

Norovirus - most common in adults
(cruise ships, hospital, restaurants)

Campylobacter

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13
Q

What are the risk factors for infective diarrhoea?

A
  1. Foreign travel
  2. PPI or H2 antagonist use
  3. Crowded area
  4. Poor hygiene
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14
Q

Give 4 viral causes of infective diarrhoea.

A
  1. Rotavirus
  2. Norovirus
  3. Adenovirus
  4. Astrovirus
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15
Q

Give 4 bacterial causes of infective diarrhoea.

A
  1. Campylobacter jejuni

More common in children:
2. E.Coli
3. Salmonella
4. Shigella spp

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16
Q

What is the most common cause of bacterial infective diarrhoea?

A

Campylobacter jejuni

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17
Q

Give 5 antibiotic causes of infective diarrhoea relating to C.difficile.

A

Antibiotic rule of Cs:
* In general, antibiotics beginning with C can give rise to antibiotic-induced Clostridium difficile diarrhoea:

  1. Clindamycin
  2. Ciprofloxacin (Quinolones)
  3. Co-amoxiclav (Penicillins)
  4. Cephalosporins
  5. Carbapenems
18
Q

Give 3 parasitic causes of infective diarrhoea.

A
  1. Giardia lamblia - most common
  2. Entamoeba histolytica
  3. Cryptosporidium (Helminth parasite)
19
Q

Name a helminth responsible for causing diarrhoeal infection.

A

Schistosomiasis.

20
Q

Briefly describe the reproductive cycle of schistosomiasis.

A
  1. Fluke matures in blood vessels and reproduces sexually in human host.
  2. Eggs expelled in faeces and enter water source.
  3. Asexual reproduction in an intermediate host.
  4. Larvae expelled and penetrate back into human host.
21
Q

Give 5 symptoms of helminth infection.

A
  1. Fever.
  2. Eosinophilia.
  3. Diarrhoea.
  4. Cough.
  5. Wheeze.
22
Q

Give 3 infective causes of dysentery.

A
  1. Shigella.
  2. Salmonella.
  3. Campylobacter.
  4. E.coli 0157.
23
Q

What is the diagnostic criteria for traveller’s diarrhoea?

A

> 3 unformed stools per day and at least one of:

  • Abdominal pain.
  • Cramps.
  • Nausea.
  • Vomiting.

It occurs within 3 days of arrival in a new country.
Bloody stools during a trip abroad.
Self-limiting illness lasting 3 to 5 days.
Usually no treatment required.

24
Q

Give 3 causes of traveller’s diarrhoea.

A
  1. Enterotoxigenic e.coli (ETEC).
  2. Campylobacter.
  3. Norovirus.
25
Q

Describe the pathophysiology of traveller’s diarrhoea.

A

Heat labile ETEC modifies Gs and it is in a permanent ‘locked on’ state.
Adenylate cyclase is activated and there is increased production of cAMP.
This leads to increased secretion of Cl- into the intestinal lumen, H2O follows down as osmotic gradient -> diarrhoea.

26
Q

Which type of e.coli can cause bloody diarrhoea and has a shiga like toxin?

A

Enterohaemorrhagic e.coli (EHEC) aka e.coli 0157.

27
Q

What does EIEC stand for?

A

Enteroinvasive e.coli.

28
Q

Which type of e.coli is responsible for causing large volumes of watery diarrhoea?

A

Enteropathogenic e.coli (EPEC).

29
Q

What does EAEC stand for?

A

Enteroaggregative e.coli.

30
Q

What does DAEC stand for?

A

Diffusely adherent e.coli.

31
Q

Why is C.diff highly infectious?

A

It is a spore forming bacteria.
Gram-positive.

32
Q

Give 5 risk factors for c.diff infection.

A
  1. Increasing age.
  2. Co-morbidities.
  3. Antibiotic use.
  4. PPI.
  5. Long hospital stays.
33
Q

Describe the treatment for c.diff infection.

A

Metronidazole and vancomyocin (PO).

34
Q

Describe the management of c.diff infection.

A
  1. Control antibiotic use.
  2. Infection control measures.
  3. Isolate the case.
  4. Case finding.
  5. Test stool samples for toxin.
35
Q

Give the signs + symptoms for diarrhoea.
What more signs would be seen for viral causes?

A

Diarrhoea: Blood in stool hints at bacterial infection
Vomiting
Abdominal cramps
Viral causes = + fever, fatigue, headache, muscle pain

36
Q

Investigations for diarrhoea.

A
  1. Bloods
    - Raised WCC (eosinophils) = parasite?
    - Raised ESR + CRP + anaemia = infection, Crohn’s, UC or cancer?
    - Low MCV and or Fe deficiency = coeliac disease or colon cancer?
    - High MCV if alcohol abuse or decreased B12 absorption = coeliac disease or Crohn’s?
  2. Stool culture: bacteria, parasites
    = If suspect bacteria, parasites or C.diff toxin
  3. PCR: viruses, C. diff or campylobacter
  4. Sigmoidoscopy with biopsy
37
Q

Treatment of diarrhoea.

A
  1. Treat causes
  2. Oral rehydration and avoid high-sugar drinks in children (increases diarrhoea)
  3. Anti-emetics - treat vomiting e.g. METOCLOPRAMIDE
  4. Antibiotics
  5. Anti-motility agents e.g LOPERAMIDE HYDROCHLORIDE
38
Q

Differential diagnosis for diarrhoa.

A

Differential diagnosis:
- Appendicitis, volvulus, IBD, UTI, diabetes mellitus
- Pancreatic insufficiency, short bowel syndrome, coeliac disease
- Laxative abuse

39
Q

Give 3 ways in which diarrhoea can be prevented.

A
  1. Access to clean water.
  2. Good sanitation.
  3. Hand hygiene.
40
Q

List 5 important questions a GP should ask when taking a history to establish a cause of diarrhoea.

A
  1. Blood or mucus in the stools.
  2. Family history of bowel problems?
  3. Abdominal pain.
  4. Recent foreign travel history.
  5. Bloating.
  6. Weight loss.
41
Q

List two blood tests a GP might perform to help differentiate between the different causes of diarrhoea.

A
  1. FBC.
  2. ESR/CRP.

9. GI system (15 decks)

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