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Diarrhoea Flashcards

1
Q

What is diarrhoea?

A

Passing loose watery stools 3 or more times a day.

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2
Q

How long does acute diarrhoea last?

A

Less than one week and self-resolves.

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3
Q

What is persistent diarrhoea?

A

Diarrhoea that lasts longer than 2 weeks and less than 4 weeks.

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4
Q

Define chronic diarrhoea.

A

Diarrhoea that lasts at least 4 weeks and can be categorised into watery, fatty, or infectious.

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5
Q

What causes watery diarrhoea in lactose intolerance?

A

Decreased or absent lactase leads to unabsorbed lactose in the gut lumen, attracting water.

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6
Q

Symptoms of lactose intolerance include:

A
  • Bloating
  • Flatulence
  • Watery diarrhoea
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7
Q

What typically causes fatty diarrhoea?

A

Malabsorptive diseases like coeliac disease and chronic pancreatitis.

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8
Q

What are the symptoms of fatty diarrhoea?

A
  • Upper abdominal pain
  • Flatulence
  • Foul-smelling, bulky, pale stools
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9
Q

What is secretory diarrhoea caused by?

A

Bacterial and viral infections that injure the gut epithelium.

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10
Q

What indicates inflammatory diarrhoea?

A

Presence of leukocytes in the stool.

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11
Q

What are common pathogens in daycares causing diarrhoea?

A
  • Rotavirus
  • Shigella
  • Campylobacter
  • Cryptosporidium
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12
Q

What should bloody stools be tested for?

A
  • Shiga toxin
  • Lactoferrin
  • C. difficile
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13
Q

What is the most common cause of acute diarrhoea?

A

Norovirus.

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14
Q

What are the risk factors for referral in children under 3 months with diarrhoea?

A
  • Weighs less than 8kg
  • History of premature birth
  • Fever
  • Grossly bloody stool
  • Persistent vomiting
  • Signs of dehydration
  • Mental status alterations
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15
Q

What characterizes osmotic diarrhoea?

A

Occurs due to laxative use, carbohydrate malabsorption, or surgery.

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16
Q

What can cause secretory diarrhoea?

A
  • Alcoholism
  • Bile acid malabsorption
  • Hyperthyroidism
  • Non-osmotic laxatives
  • Neuroendocrine tumours
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17
Q

Complications of chronic diarrhoea include:

A
  • Malnutrition
  • Anaemia
  • Unintentional weight loss
  • Dehydration leading to AKI
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18
Q

What diseases commonly cause chronic diarrhoea?

A
  • Chronic infection with C. difficile
  • Vibrio cholerae
  • Salmonella
  • Shigella
  • Entamoeba histolytica
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19
Q

What findings indicate the need for endoscopy in chronic diarrhoea?

A
  • Onset after age 50
  • Rectal bleeding/melena
  • Nocturnal pain or diarrhoea
  • Progressive abdominal pain
  • Unexplained weight loss
  • Laboratory abnormalities
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20
Q

What is the ‘Sepsis Six’?

A

A bundle of interventions to manage sepsis, including BUFALO
blood cultures
urine output measuremen
fluid intravenous
antibiotic prescribing
lactate level measurement
high flow oxygen.

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21
Q

What pathogens cause acute watery diarrhoea?

A
  • Enterotoxigenic E. coli
  • Vibrio cholera
  • Campylobacter
  • Norovirus
  • Rotavirus
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22
Q

What is the gold standard for diagnosing typhoid fever?

A

Bone marrow aspirate.

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23
Q

What is the first-line treatment for typhoid fever?

A

Cefotaxime or ceftriaxone.

24
Q

What is Clostridium difficile?

A

A gram-positive bacillus that can cause inflammatory acute diarrhoea.

25
What are the clinical features of C. difficile infection?
* Watery diarrhoea * Foul smelling stool * Abdominal pain * Nausea and vomiting
26
What are the risk factors for C. difficile infection?
* Recent antibiotic use * Age over 65 * Recent hospital admission * Immunosuppression
27
What are the diagnostic tests for C. difficile infection?
* Stool culture for PCR * Immunoassay for toxins * Glutamate dehydrogenase test
28
What is the treatment for severe C. difficile infection?
Vancomycin with metronidazole.
29
What is giardiasis intestinalis?
A zoonotic parasitic disease caused by protozoa infection.
30
What are common symptoms of giardiasis?
* Acute diarrhoea * Malodorous greasy stool * Flatulence * Bloating
31
How is giardiasis diagnosed?
Stool ova and parasites analysis and stool antigen testing with ELISA.
32
What is the first-line treatment for giardiasis?
Metronidazole.
33
What is the primary cause of enteric fever?
Salmonella typhi or Salmonella paratyphi.
34
What are the transmission routes for enteric fever?
The 4Fs: flies, fingers, faeces, and fomites.
35
What are the symptoms of enteric fever?
* Fever * Abdominal pain * Diarrhoea or constipation
36
What is the typical incubation period for enteric fever?
5-21 days after ingestion.
37
What is the first-line treatment for severe C. diff infection?
Fidaxomicin when vancomycin is ineffective ## Footnote Ideal for severe infections.
38
What combination is used for severe C. diff infections with complications?
IV metronidazole with vancomycin ## Footnote Complications include ileum and toxic megacolon.
39
What should be done if a C. diff infection recurs within 12 weeks?
Fidaxomicin ## Footnote This is the recommended treatment for early recurrence.
40
What is the treatment for life-threatening C. diff infections?
Vancomycin with metronidazole IV ## Footnote Should be offered in such cases.
41
What is the recommended action for recurrent C. diff infections after the third occurrence?
Faecal microbiota transplant ## Footnote This is considered after the third recurrence.
42
What is crucial for infection control in C. diff patients?
Isolation and appropriate PPE for staff ## Footnote Environmental cleaning is essential after treatment.
43
True or False: Alcohol hand rubs are effective at removing C. diff spores.
False ## Footnote Alcohol hand rubs are not effective for spore removal.
44
What is the treatment approach for non-typhoid Salmonella?
Supportive treatment with fluids and painkillers ## Footnote Antibiotics are not recommended unless there is risk of sepsis.
45
What is the first-line antibiotic for Campylobacter enteritis in immunocompromised patients?
Clarithromycin ## Footnote Erythromycin is for pregnant women; azithromycin if ineffective.
46
What is the first-line therapy for acute uncomplicated diverticulitis?
Co-amoxiclav with metronidazole ## Footnote Alternatives include cefalexin with metronidazole.
47
What is cholera and how is it transmitted?
A gastrointestinal illness caused by Vibrio cholerae, transmitted through contaminated food and water ## Footnote It can cause hypovolemic shock.
48
What characterizes severe cholera (cholera gravis)?
Loss of 1 liter of stool per hour, fishy odour, significant sodium and potassium loss ## Footnote Can lead to death within 12 hours.
49
What are signs of severe dehydration in cholera patients?
Sunken eyes, decreased skin turgor, weak pulse, dry mucous membranes ## Footnote Other signs include lethargy and hypotension.
50
What is the initial fluid replacement for cholera treatment?
350ml per kilogram of fluid in the first 24 hours ## Footnote Isotonic oral fluids are preferred.
51
What is the treatment for E. coli infection causing HUS?
Supportive oral or intravenous fluid and electrolyte administration ## Footnote Red cell transfusion may be necessary.
52
What is the causative agent of amoebic dysentery?
Entamoeba histolytica ## Footnote Transmitted through ingesting cysts from faecal-oral contact.
53
What is the first-line treatment for Entamoeba histolytica infection?
Metronidazole ## Footnote This is the recommended treatment.
54
What preventative measures should travelers take to avoid traveler's diarrhea?
Drink bottled water, avoid raw fruits and vegetables, eat hot, well-cooked foods ## Footnote Bottled water should also be used for brushing teeth.
55
What is the first-line therapy for chronic diarrhea?
Opioid agonists like loperamide ## Footnote Other medications include bile acid-binding resins.

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