Diarrhoea Flashcards
What is diarrhoea?
Passing loose watery stools 3 or more times a day.
How long does acute diarrhoea last?
Less than one week and self-resolves.
What is persistent diarrhoea?
Diarrhoea that lasts longer than 2 weeks and less than 4 weeks.
Define chronic diarrhoea.
Diarrhoea that lasts at least 4 weeks and can be categorised into watery, fatty, or infectious.
What causes watery diarrhoea in lactose intolerance?
Decreased or absent lactase leads to unabsorbed lactose in the gut lumen, attracting water.
Symptoms of lactose intolerance include:
- Bloating
- Flatulence
- Watery diarrhoea
What typically causes fatty diarrhoea?
Malabsorptive diseases like coeliac disease and chronic pancreatitis.
What are the symptoms of fatty diarrhoea?
- Upper abdominal pain
- Flatulence
- Foul-smelling, bulky, pale stools
What is secretory diarrhoea caused by?
Bacterial and viral infections that injure the gut epithelium.
What indicates inflammatory diarrhoea?
Presence of leukocytes in the stool.
What are common pathogens in daycares causing diarrhoea?
- Rotavirus
- Shigella
- Campylobacter
- Cryptosporidium
What should bloody stools be tested for?
- Shiga toxin
- Lactoferrin
- C. difficile
What is the most common cause of acute diarrhoea?
Norovirus.
What are the risk factors for referral in children under 3 months with diarrhoea?
- Weighs less than 8kg
- History of premature birth
- Fever
- Grossly bloody stool
- Persistent vomiting
- Signs of dehydration
- Mental status alterations
What characterizes osmotic diarrhoea?
Occurs due to laxative use, carbohydrate malabsorption, or surgery.
What can cause secretory diarrhoea?
- Alcoholism
- Bile acid malabsorption
- Hyperthyroidism
- Non-osmotic laxatives
- Neuroendocrine tumours
Complications of chronic diarrhoea include:
- Malnutrition
- Anaemia
- Unintentional weight loss
- Dehydration leading to AKI
What diseases commonly cause chronic diarrhoea?
- Chronic infection with C. difficile
- Vibrio cholerae
- Salmonella
- Shigella
- Entamoeba histolytica
What findings indicate the need for endoscopy in chronic diarrhoea?
- Onset after age 50
- Rectal bleeding/melena
- Nocturnal pain or diarrhoea
- Progressive abdominal pain
- Unexplained weight loss
- Laboratory abnormalities
What is the ‘Sepsis Six’?
A bundle of interventions to manage sepsis, including blood cultures, urine output measurement, fluid intravenous, antibiotic prescribing, lactate level measurement, and high flow oxygen.
What pathogens cause acute watery diarrhoea?
- Enterotoxigenic E. coli
- Vibrio cholera
- Campylobacter
- Norovirus
- Rotavirus
What is the gold standard for diagnosing typhoid fever?
Bone marrow aspirate.
What is the first-line treatment for typhoid fever?
Cefotaxime or ceftriaxone.
What is Clostridium difficile?
A gram-positive bacillus that can cause inflammatory acute diarrhoea.
What are the clinical features of C. difficile infection?
- Watery diarrhoea
- Foul smelling stool
- Abdominal pain
- Nausea and vomiting
What are the risk factors for C. difficile infection?
- Recent antibiotic use
- Age over 65
- Recent hospital admission
- Immunosuppression
What are the diagnostic tests for C. difficile infection?
- Stool culture for PCR
- Immunoassay for toxins
- Glutamate dehydrogenase test
What is the treatment for severe C. difficile infection?
Vancomycin with metronidazole.
What is giardiasis intestinalis?
A zoonotic parasitic disease caused by protozoa infection.
What are common symptoms of giardiasis?
- Acute diarrhoea
- Malodorous greasy stool
- Flatulence
- Bloating
How is giardiasis diagnosed?
Stool ova and parasites analysis and stool antigen testing with ELISA.
What is the first-line treatment for giardiasis?
Metronidazole.
What is the primary cause of enteric fever?
Salmonella typhi or Salmonella paratyphi.
What are the transmission routes for enteric fever?
The 4Fs: flies, fingers, faeces, and fomites.
What are the symptoms of enteric fever?
- Fever
- Abdominal pain
- Diarrhoea or constipation
What is the typical incubation period for enteric fever?
5-21 days after ingestion.
What is the first-line treatment for severe C. diff infection?
Fidaxomicin when vancomycin is ineffective
Ideal for severe infections.
What combination is used for severe C. diff infections with complications?
IV metronidazole with vancomycin
Complications include ileum and toxic megacolon.
What should be done if a C. diff infection recurs within 12 weeks?
Fidaxomicin
This is the recommended treatment for early recurrence.
What is the treatment for life-threatening C. diff infections?
Vancomycin with metronidazole IV
Should be offered in such cases.
What is the recommended action for recurrent C. diff infections after the third occurrence?
Faecal microbiota transplant
This is considered after the third recurrence.
What is crucial for infection control in C. diff patients?
Isolation and appropriate PPE for staff
Environmental cleaning is essential after treatment.
True or False: Alcohol hand rubs are effective at removing C. diff spores.
False
Alcohol hand rubs are not effective for spore removal.
What is the treatment approach for non-typhoid Salmonella?
Supportive treatment with fluids and painkillers
Antibiotics are not recommended unless there is risk of sepsis.
What is the first-line antibiotic for Campylobacter enteritis in immunocompromised patients?
Clarithromycin
Erythromycin is for pregnant women; azithromycin if ineffective.
What is the first-line therapy for acute uncomplicated diverticulitis?
Co-amoxiclav with metronidazole
Alternatives include cefalexin with metronidazole.
What is cholera and how is it transmitted?
A gastrointestinal illness caused by Vibrio cholerae, transmitted through contaminated food and water
It can cause hypovolemic shock.
What characterizes severe cholera (cholera gravis)?
Loss of 1 liter of stool per hour, fishy odour, significant sodium and potassium loss
Can lead to death within 12 hours.
What are signs of severe dehydration in cholera patients?
Sunken eyes, decreased skin turgor, weak pulse, dry mucous membranes
Other signs include lethargy and hypotension.
What is the initial fluid replacement for cholera treatment?
350ml per kilogram of fluid in the first 24 hours
Isotonic oral fluids are preferred.
What is the treatment for E. coli infection causing HUS?
Supportive oral or intravenous fluid and electrolyte administration
Red cell transfusion may be necessary.
What is the causative agent of amoebic dysentery?
Entamoeba histolytica
Transmitted through ingesting cysts from faecal-oral contact.
What is the first-line treatment for Entamoeba histolytica infection?
Metronidazole
This is the recommended treatment.
What preventative measures should travelers take to avoid traveler’s diarrhea?
Drink bottled water, avoid raw fruits and vegetables, eat hot, well-cooked foods
Bottled water should also be used for brushing teeth.
What is the first-line therapy for chronic diarrhea?
Opioid agonists like loperamide
Other medications include bile acid-binding resins.
