diarrhoea Flashcards
faecal urgency suggests
rectal pathology
acute diarrhoea
causes
<14 days
> gastroenteritis
- travel history
- diet
- sick contacts
- Rotavirus
- Norovirus
- Enteric Adenovirus
> diverticulitis
antibiotic therapy
constipation overflow
chronic diarrhoea
causes
> 3 loose stools per day for more than 4 weeks
- IBS
- ulcerative colitis
- crohns
- drug effect
- coeliac disease
- faecal impaction (overflow diarrhoea)
bloody diarrhoea
causes
vascular: ischaemic colitis
infection: camyplobacter jejuni, shigella, salmonella, e.coli (enterotoxigenic e.coli).
inflammatory: UC, Crohn’s
neoplastic: colorectal cancer, polpys
mucus diarrhoea
causes
- IBS
- colorectal cancer
- polyps
pus mixed with diarrhoea
causes
- IBD
- diverticulitis
- abscess
diarrhoea
medical causes
- increased T4
- autonomic neuropathy (DM)
- carcinoid
- pancreatic insufficiency
diarrhoea
drug causes
- lactulose abuse
- antibiotics
- PPI, Cimetidine (H2 Antagonist)
- NSAIDS
- digoxin
diarrhoea
investigations
bloods
- FBC: increased WWC, anaemia
- U&Es: decreased K, dehydration (raised urea)
- increased ESR: IBD, oncological
- increased CRP: IBD, infection
- coeliac serology: anti-TTG or anti-endomysial Abx
stools:
- MCS and C.Diff
diarrhoea
management
- treat cause
- rehydration: oral or IV
- codeine phosphate or loperamide (4mg orally, then 2mg after each unformed stool) after each loose stool
- anti-emetic if associated with n/v e.g prochlorperazine
- abx (e.g ciprofloxacin 750mg) in infective diarrhoea –> systemic illness
clostridium difficile
- gram +ve spore-forming anaerobe
- releases enterotoxins A and B
- spores are very robust and can survive for >40d
clostridium difficile
causes
- antibiotics: clindamycin, cephalosporins, augmentin, quinolones
- increased age
- increased length of stay
- increased contact with c difficile +ve patients
-PPI
- 100% of Abx associated pseudomembranous colitis
clostridium difficile diarrhoea
presentation
- may be asymptomatic
- mild diarrhoea
- colitis
- pseudomembranous colitis
- fulminant colitis
- may occur up to 2 months after discontinuation of Abx
- post-surgery
- clean/contaminated surgery
- dirty or infected wounds.
pseudomembranous colitis
a non-specific pattern of injury to mucosa that can be triggered by a number of disease states.
it results from:
- decreased oxygenation
- endothelial damage
- impaired blood flow
to mucosa that can be triggered by a number of disease states.
pseudomembranes (yellow plaques) on a flexible sigmoidoscopy
whilst most patients will have this due to c diff, there may be other causes.
pseudomembranous colitis
complications
- paralytic Ileus (obstruction of the intestine due to paralysis)
- toxic dilatation –> perforation
- multi-organ failure
