Diarrhoea Flashcards
Commonest cause of acute diarrhoea
rotaviral gastroenteritis-most common
acute=<2wks, chronic=>2wks
Causes of bloody diarrhoea (5)
IBD
HUS-E.Coli
Campylobacter, shigella, amoeba
intussusception
NEC
Causes of chronic diarrhoea (5)
infective:
- giardiasis
- amoebiasis
IBD
Food allergy/intolerance
- cow’s milk protein intolerance
- lactose intolerance
malabsorption:
- coeliac
- CF
Other: toddler’s diarrhoea
Features of toddler’s diarrhoea (4)
delay in intestinal maturation> periodic, explosive, smelly diarrhoea
affects thriving <5yro
=/>2 watery stools for =/>10d
may become temporarily lactose intolerant
Mx of toddler’s diarrhoea (3)
dietary advice to avoid:
- refined sugars/sweeteners
- fruit juices
- high fibre diet
- excess fluid
high fat diet helps slow down passage of food
reassure that child will grow out of it
Ex and when to Ix for child w. diarrhoea (5)
hydration status Ex is vital
Ix if:
- chronic
- bloody
- painful
- faltering growth
General Ix for diarrhoea (6)
general obs and hydration status
for malabsorption: anaemia, wt., abdo distention, buttocks wasting
Tests for reducing substances and foecal fat if considering malabsorption
coeliac Abs: anti-TTG, anti-endomysial
foecal calprotectin to differentiate between inflammation and IBS
endoscopy/colonoscopy for IBD
Principles of rehydration therapy (4)
if possible, give oral rehydration-dioralyte:
- must contain Na, Cl and glucose
- avoid fruit juice
- continue breast feeding
if in shock, give bolus of 20ml/kg 0.9% saline
don’t correct Na too quickly>central pontine myelinolysis
continue IV fluid therapy assessing % dehydration
Causes gastroenteritis (8)
viral:
- rotavirus-oral vaccine available
- norovirus
Bacterial:
- campylobacter: bloody, can cause pseudo-appendicitis
- salmonella: egg yolk
- shigella: bloody, abdo pain (due to ulcers)
- E.coli
- salmonella typhi: starts w. rose spot on abdomen
parasites:
-giardia: Rx w. metronidazole/tinidazole
Hx questions for gastroenteritis (5)
sudden change in stool consistency
recent contacts
travel
medications
farm visit? (E.coli O157)
Complications of gastroenteritis (6)
dehydration
malnutrition
HUS: suspect if bloody diarrhoea+severe dehyration> do FBC
ketoacidosis from starvation state
temporary sugar intolerance due to stripping of lactase
intussusception:
- suspect if vomitting restarts 3d after
- due to excess peristalsis
- mainly ileo-coecal
- can>bowel ischaemia>death
- redcurrant jelly stool is late sign
Ix for gastroenteritis (2)
only Ix if bloody/chronic
stool: look for bacteria, ova, cysts, parasites, C. diff toxin
General Mx of gastroenteritis (2)
rehydration
try and feed them milk ASAP afterwards to reduce risk of transient lactose intolerance
When to consider Abx in gastroenteritis (7)
risk of disseminated disease
presence of artificial implants
severe systemic illness
enteric fever
severe colitis
cholera (azithromycin)
E.coli O157
Abx for gastroenteritis (2)
erythromycin if cambylobacter
metronidazole/vancomycin if C.diff
Features of Crohn’s disease (12)
General:
- anywhere in GI tract
- skip lesions
- smoking makes it worse
- no blood
- right-sided pain/mass
- peri-anal abscess/skin tags/fistulae
Genetics:
-HLA-B27 linked
- transmural
- fissures and fistulae
- cobblestoning
- non-caseating granulomas
- rose thorn ulcers
Features of UC (11)
General:
- confined to colon
- starts as ulcerative proctitis
- smoking makes it better
- bloody diarrhoea
- left-sided pain/mass
- PSC
- increased risk of colon ca.
genetics:
-HLA-B27 linked
- mucosal inflammation
- continuous inflammation
- crypt abscesses
Extra-GI signs of IBD (8)
erythema nodosum
pyoderma gangrenosum
apthous ulcers
anterior uveitis
polyarthritis
osteoporosis
clubbing
ank. spond
Maintenance therapy for Crohn’s (2)
azathiaprine
metronidazole for peri-anal features
Maintenance therapy for UC
mesalazine
Rx of flares in Crohn’s (3)
prednisolone/hydrocortisone
48hrs>infliximab
48hrs>surgery
Rx of flares in UC (3)
prednisolone/hydrocortisone or rectal mesalazine
48hrs>infliximab/ciclosporin
48hrs>surgery
Features of coeliac disease (4)
immune reaction to gluten
T-cell mediated
HLA-DQ2/8
found in wheat, barley, rye
Presentation of coeliac disease (12)
Presents around 6mo when weaning and can present at an older age
steatorrhoea
wasted buttocks
abdominal distension/pain
dermatitis herpetiformis: blistering rash on extensor surfaces, Rx w. dapsone
faltering growth/short stature
diarrhoea
constipation
fatigue
B12+iron deficiency: normal MCV with greater mean distribution width
amenorrhoea
mouth ulcers and angular stomatitis
Dx of coeliac disease (4)
IgA anti-TTG
anti-endomysial Abs
if test +ve, need jejunal biopsy which shows:
- mucosal blunting
- intra-epithelial WBCs
- crypt hyperplasia
- Sx also need to improve after exclusion of gluten: lowered IgA and regrowth of jejunal mucosa on re-biopsy
Bloods
(NB coeliac assoc. w. IgA deficiency so TTG may be -ve)
Blood test results for coeliac (4)
raised RCDW
low Hb
low ferritin
low B12
Mx and associations of coeliac disease (4)
gluten free diet
associations:
- other autoimmune disease e.g. thyroid disease
- small bowel T-cell lymphoma
- osteoporosis
