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Digestive System > Diarrhoea > Flashcards

Diarrhoea Flashcards

1
Q

Why is there little clinical value in ‘standard measures’ of normal and abnormal stools?

A

It is hard to determine what is normal, many people are different, so instead look at what is normal for the PATIENT.

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2
Q

medical aid designed to classify poop consistency?

A

Bristol Stool Chart.

This is helpful for the patient.

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3
Q

How can you determine acute vs chronic diarrhoea? How do their causes differ?

A

Acute= upto 14 days
95% infectious cause
Chronic = over 14 days
many different causes

Therefore it’s important to ask patient for TIME FRAME

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4
Q

Causes of Acute Diarrhoea?

A

INFECTION
1) Bacteria- salmonella, E.Coli, campylobacter

2) Viruses- norovirus(rest homes), rotovirus
3) Protozoa

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5
Q

Infective causes can have different mechanisms, give examples of this.

A

Campylobacter > INFLAMMATORY diarrhoea

Glardia > OSMOTIC diarrhoea
mild villous atrophy> carb malabsorption> osmotically active sugars> water drawn in

E.Coli > SECRETORY
toxin stimulates fluid secretion

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6
Q

Causes of Chronic diarrhoea

A

There are many causes that can be grouped into…
Inflammatory: damaged epithelium lead to exudate, eg) IBD

Osmotic: osmtically active compound draws water in

Secretory: stimulation of excessive fluid secretion

Fatty: Fat malabsorption

These are classifications of BOTH acute and chronic, and there is often overlap

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7
Q

Inflammatory diarrhoea is often due to

A
  • IBD
  • Diverticulitis (diverticula > stool filled > infection > inflamm)
  • SIBO (direct inflammation of enterocytes)
  • Radiation colitis
  • Ischaemic colitis (lack of BF to colon)
  • colon cancer
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8
Q

Osmotic Diarrhoea is often due to

A

Carb malabsorption: lactase intolerance, IBS

Coeliac disease

SIBO:: malabsoption of proteins, carbs fats and other osmotically active by-products of bacteria metabolism

Laxative Abuse: (can be OSMOTIC or stimulative)

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9
Q

Types of Lactose intolerance

A

Primary LI: due to lactase deficiency

Secondary LI: due to enterocytes that produce lactase being damaged

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10
Q

Secretory Diarrhoea can be caused by

A
  • Terminal Ileal Resection
  • Cholecystectomy: GB removed, bile flows straight into SI
  • Microscopic Colitis
  • IBD
  • Diverticulitis
  • Neuroendocrine Tumors
  • SIBO
  • Disordered motility (IBS, post-vagotomy)
  • Colon cancer
  • Laxative abuse- stimulatory type
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11
Q

Neuroendocrine tumors

A

Rare increase in hormones that can drive water secretion (gastrinoma- excess gastrin, carinoid- excess serotonin)

-secretory diarrhoea

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12
Q

How does TI resections cause Secretory diarrhoea

A

Where BAs are normally absorbed, post-surgery they enter colon (malabsorb), irritate it = fluid response

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13
Q

Fatty diarrhoea can be caused by

A
  • Pancreatic Exocrine insufficiency (esp. LIPASE)
  • Bile acid malabsorption (not enough bile)
  • SIBO
  • Coeliacs disease
  • Short bowel syndrome (too much SI removed, not enough surface)
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14
Q

What is SIBO? Symptoms?

A

Small Intestine Bacterial Overgrowth
-Excessive amounts of LI bacteria in the SI

Symptoms (siimilar to IBS): bloating/abdo discomfort, diarrhoea, flatulence, steatorrhea, malabsorption

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15
Q

Predisposers of SIBO

A

Impaired motility- usually a motor complex prevents SIBO by clearing debris eg) scleroderma, diabetes

Anatomical Disorders- lead to SI stasis. eg) strictures, adhesions, SI diverticula, blind loops

  • metabolic/systemic diseases
  • immune deficiency
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16
Q

How does SIBO affect MALDIGESTION

A
  • bacteria deconjugate BAs leading to impaired micellar formation and fat digestion (FATTY DIR.)
  • Bacterial degradation of carbs in the intestinal lumen > osmo active byproducts (OSOTIC DIR.)
  • bacterial degradation of protein precursors
17
Q

How does SIBO affect MALABSORPTION

A 
bacteria can directly damage enterocytes by direct adherence > enterotoxins (INFLAMMATORY DIR)
leads to malabsorption of
-BAs
-fats
-carbs
-proteins
-B12 (bacteria competes with B12 for nutrition)
(SECRETORY DIR)
18
Q

what type of diarrhoea can SIBO cause

A

all four types

19
Q

Maelena

A

Black stools. indicates bleeding from upper GI track (SI). Digested blood is altered by acid

20
Q

Delayed vomiting after meals suggests?

A

Pyloric obstruction

21
Q

Ulcers around the pylorus

A

eg) pre-pyloric or duodenal
cause a distrotion of the normal pylorus, this can lead to a change in gastric emptying, pain and eventually fibrosis.

Over months a pyloric stenosis can formed, blocking food.

if an ulcer gets deep enough, active bleeding > maelena

22
Q

Pyloric Stenosis (obstruction) is treated with?

A

1) Endoscopic balloon dilation (temp fix)
2) gastro-jejunostomy and truncal vagotomy (cut bits out)
eg) billroth 1 & 2 -distal stomach and prox duodenum removed

3) now lots of successful drugs (surgery uncommon)

23
Q

What can happen post gastro-jejunostomy and truncal vagotomy?

A

Upper Abdo discomfort after eating.

  • rapid gastric emptying as no pylorus
  • High osmotic load pulls fluid into jejunum

Diarrhoea

  • Osmotic diarrhoea
  • vagotomy leads to increased SI motility
24
Q

Why is the symptoms bleeding with diarrhoea helpful?

A

Because it only occurs with inflammatory diarrhoea.

Therefore excludes many other potential causes

25
Q

Colectomy

A

Surgical procedure to remove all or part of the colon. Can sometimes be avoided with instead using some drugs.
However, if people fail to respond to medication, a colectomy and/or ileostomy may be done

26
Q

Ileostomy is?

A

Usually done in parr with a colonoscopy, where all or part of the LI is removed. SI taken to the skin at the mid-portion of the abdomen, usually on the right, contents emptied into a bag. Patients empty this bag several times a day.

When your ileostomy is temporary it most often means all of your large intestine was removed but you still have at least part of your rectum.
Some are permanent

27
Q

Usual Ileostomy output

A

0.6-1L/day
thick fluid
dark green/brown
-no odour (no bacteria)

Contains electrolyes, increased sodium loss. Kidneys usually adapt to this and increase sodium reabsorption.
Increase sodium intake

28
Q

How can you decrease small bowel motility?

A

With medication
loperamide (anti-diarrhoea agent)
so absorption is increased

29
Q

Crohns Disease

A

Chronic inflammatory condition that can occur at any part of the GI tract (usually colon or TI). Over time fibrous/scarring occurs, and this can lead to strictures.
The narrowing of the SI is a common complication, there are drugs to fix BUT once it becomes a fibrotic stricture the meds wont work (they only target inflamm). Then an operation would be needed

30
Q

Two common consequences of Crohns disease.

A

1) B12 malabsorbtion- loss of TI’s specialised receptors for B12/IF

2) Bile salt malabsorption- reduced reuptake of bile salts via enterohepatic circ, instead lost thrugh colon/faeces, where they irritate the colon > water and electrolyte sectretion (secretory dir.)
Also the lack of BAs leads to fat malabsorbtion (Fatty dir.)
Usually one of the two dirrhoeas will predominate/drive

31
Q

A drug that binds BAs (used for Crohns)

A

Cholestryamine

32
Q

Short Bowel Syndrome

A

Too much SI removed, complication of SI surgery, leads to malsborption of everything.

  • vitamins, minerals
  • water, electrolytes
  • proteins, fats, carbs
  • bile acids

People with colon and illeocaecal valve do better.
colon reabsorbs water
valve acts as brake

33
Q

Adaption to Short bowel syndrome. If this doesn’t work, how is it managed?

A

Ileal adaption: villi hypertrophy
Colon increases water absorption

Dietary (iso-osmotic)
Anti-motility drugs (slow down)
Acid suppressant meds
Cholestyramine
TPN (IVF)

Digestive System (27 decks)

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