Diarrhoea

Question 1

Steatorrhoea?

Answer 1

increase stool fat -> pale, floating, smelly stools

Question 2

causes of acute diarrhoea

Answer 2

gastroenteritistravel,

diet,

contact with infected people/pets?

Question 3

causes of chronic diarrhoea

Answer 3

IBS (diarrhoea alternating with constipation)

organic cause (anorexia, weight loss, nocturnal diarrhoea)

Question 4

causes of bloody diarrhoea

Answer 4

vascular (ischaemic colitis)

infective (campylobacter, shigella, salmonella, E.coli, amoeba, pseudomembranous colitis)

inflammatory (Crohn’s, UC)

Neoplastic (CRC, polyps)

Question 5

causes of mucous in faeces?

Answer 5

IBS,

diverticulitis,

abscess

Question 6

diarrhoea associated with medical disease

Answer 6

increase T4

autonomic neuropathy

carcinoid

Question 7

diarrhoea associated with drugs

Answer 7

Abx

PPI,

cimetidine

NSAIDs

Digoxin

Question 8

blood results in patients with diarrhoea

Answer 8

FBC: increase WCC, anaemia

U&Es: decrease potassium, dehydration

increase ESR -> IBD, Ca

increase CRP -> IBD, infection

Coeliac: anti-TTG or anti-endomysial Abs

Question 9

stool test in patients with diarrhoea

Answer 9

MCS

C.diff toxin

Question 10

Treatment of diarrhoea

Answer 10

Treat cause

oral/IV rehydration

Codeine phosphate or loperamide after each loose stool

anti-emetic if needed (e.g. prochlorperazine)Abx (e.g. cipro) in infective diarrhoea -> systemic illness

Question 11

pathogen in C.diff diarrhoea

Answer 11

Gram +ve spore-forming anaerobereleases enterotoxins A & B

spores are very robust and can survive for >40 days

Question 12

epidemiology of C.diff diarrhoea

Answer 12

commonest cause of Abx associated diarrhoea

stool carriage in 3% of healthy adults & up to 30% of hospitals pts

Question 13

risk factors for C.diff dirrhoea

Answer 13

Abx (e.g. clindamycin, cefs, augmentin, quinolones)

increasing age

hospital (increases with length of stay and contact with C.diff pts)

PPIs

Question 14

clinical presentations of C.diff diarrhoea

Answer 14

asymptomatic

mild diarrhoea

colitis w/o pseudomembranes

pseudomembranous colitis

fulminant colitis

may occur up to 2 months post Abx

Question 15

symptoms of pseudomembranous colitis

Answer 15

severe systemic symptoms (fever, dehydration)

abdominal pain,

bloody diarrhoea,

mucous PR

Question 16

complications of pseudomembranous colitis

Answer 16

paralytic ileus

toxic dilatation -> perforation

multi-organ failure

Question 17

investigations for C.diff diarrhoea

Answer 17

CDT Elisa stool culture

Question 18

definition of severe C.diff diarrhoea

Answer 18

> or equal to 1 of:

WCC >15

Cr >50% above baseline

Temp >38.5

clinical/radiological evidence of severe colitis

Question 19

treatment of C.diff diarrhoea

Answer 19

General (stop causative Abx, avoid antidiarrhoeals & opiates, enteric precautions)

1st line = metronidazole

2nd line = vancomycin (125mg QDS)

severe = urgent colectomy if toxic megacolon or increased LDH