Diarrhoea Flashcards
What is defined as Diarrhoea?
A change in normal bowel habit resulting in increased frequency of bowel movements and the passage of soft or watery stools
*May be accompanied by colicky pain
What is classed as Acute Diarrhoea?
*Abrupt onset of more than 3 loose stools a day and lasts no longer than 14 days
*Dietary intolerances/triggers - alcohol/spicy foods
*Bacterial/viral infection - 2-3 days should resolve
*Majority resolve within 2-3 days without specific treatment
What is classed as chronic diarrhoea?
*Pathological cause
*Lasts greater than 14 days
*Can flare up previously diagnosed condition IBS/UC/CD
*Needs further investigation
The younger the child the higher the risk of severe life threatening dehydration. True or False?
True
What happens within the body to cause diarrhoea?
There is a change in the balance between the absorption and secretion of water and electrolytes.
What changes the balance between absorption and secretion of water and electrolytes?
1) Osmotic force that drives water into the gut lumen, such as when ingesting of nonabsorbable sugars (Mannitol/sorbitol), this is proportional to the intake and is responsive to fasting.
2) Enterocytes in the gut cells lining the GI tract actively secret fluid (Enterotoxin-induced diarrhoea), this is not responsive to fasting as it is caused by a pathogen. Ion transporters are activated by bacteria resulting in pathogens.
This causes:
-Invasion of enterocytes or
-Production of enterotoxins which damage cells or
-Inducing cytokine secretion to produce prostaglandins which stimulate secretion
What does invasive bacteria do to cause diarrhoea?
*Directly attacks mucosal cells which cause diarrhoea, stools can contain blood and push. May be accompanied with a fever.
What are examples of Invasive diarrhoea?
Shigella, Salmonella, Yersinia, Entero-invasive E coli
What does non-invasive bacteria do to cause diarrhoea?
*Does not directly damage the gut, the bacteria produces enterotoxins that disrupt secretion of water and electrolytes.
*Causes watery diarrhoea
What are examples of non-invasive diarrhoea conditions?
S aureus, B cereus, C perfingens, Enterotoxigenic E coli
What is the mechanism of Virally-induced diarrhoea?
Not fully understood mechanism, enterocytes may become secretory resulting in watery diarrhoea.
-Loss of water and electrolytes.
What is used to diagnose Diarrhoea?
*Symptoms
*Triggers
*Time/intensity
*Faecal studies - travellers - may need antibiotic
*Serum albumin
*Faecal alpha 1 anti-trypsin - protein loss due to diarrhoea - damages Gi tract
*Intestinal biopsy - only if chronic issue
What is a cause of Diarrhoea in infants?
Infectious gastroenteritis
Toddlers Diarrhoea
Food intolerance
Coeliac disease
What is a cause of Diarrhoea in School aged children?
Infectious gastroenteritis
Drugs (Anti-biotics)
What is a cause of Diarrhoea in Adults?
Infectious gastroenteritis, IBS, IBD, Drugs, XS alcohol, Spicy food, Coeliac disease
What is a cause of Diarrhoea in older people?
Infectious gastroenteritis, large bowel cancer, faecal impaction, drugs, ischaemic colitis
What age is Rotavirus most likely to affect and the onset time?
<5 yrs (less than)
Onset -12-48 hours
*Can affect adults also
What age is Campylobacter likely to affect and the onset?
Adults
Onset 2-5 days,
What drugs can induce diarrhoea?
Antibiotics, Laxatives, Metformin, Ferrous sulphate, NSAIDS, Colestyramine, Antacids (Mg salts), B-blockers, Digoxin, Misoprostol
How to prevent Diarrhoea ?
Good hand hygiene
What should we consider when giving treatment for Diarrhoea?
Age, frequency, duration, assess dehydration risk
When does most Diarrhoea settle?
Within 72 hours
Dose of Loperamide for prescriptions?
POM - 12+, 4mg first, followed by 2mg after each loose stool, for 5 days max; usual sode is 6-8mg OD, max dose is 16mg OD (8 caps)
What is the dose of Loperamide for GSL/P?
12+, Initially 4mg followed by 2mg after each loose stool, (for up to 48 hours); Usual dose 6-8mg OD, max 12 mg per day!
