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DIARRHOEA Flashcards

1
Q

Define diarrhoea

A
  1. Abnormal passage of loose or liquid stool more than 3 times daily
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2
Q

What is acute diarrhoea

A

Lasting less than 2 weeks

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3
Q

What is chronic diarrhoea

A

Lasting more than 2 weeks

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4
Q

What is acute diarrhoea caused by

A

Infection

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5
Q

How and why is acute diarrhoea diagnosed under certain circumstances

A
  1. Flexible sigmoidoscopy with colonic biopsy is performed if symptoms persist and no diagnosis has been made
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6
Q

How do we treat acute diarrhoea

A
  1. Maintain hydration + antidiarrhoeal agents for short-term relief and antibiotics for specific indications
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7
Q

Name an antidiarrhoeal agent

A

LOPERAMIDE HYDROCHLORIDE

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8
Q

What causes chronic diarrhoea

A

Organic causes:

Associated with changes in organ structure or tissue = symptoms (increased stool weights)

Functional causes:

Condition in which there is no physical cause for symptoms (frequent passage of low volume and weight stools such as IBS)

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9
Q

How is chronic diarrhoea distinguished from organic and functional causes

A

Faecal markers of intestinal inflammation

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10
Q

What points to an infective cause of diarrhoea

A

Sudden onset of bowel frequency associated with crampy abode pain and fever will point to an infective cause

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11
Q

What points to an inflammatory cause of diarrhoea

A

Bowel frequency with loose, blood-stained stools

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12
Q

What is STEATORRHEA

A

Passage of pale, offensive stools that float

Accompanied by loss of appetite and weight loss

Excess fat in stools

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13
Q

What causes decreased stool consistency

A
  1. Water
  2. Microscopic colitis
  3. Fat (Steatorrhoea)
  4. Inflammatory discharge
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14
Q

How does water reduce consistency of faeces

A
  1. Large quantities of non-absorbed hypertonic substances in bowel lame draw fluid into the intestines
  2. Diarrhoea stops when patient stops eating or malabsorptive state is discontinued

a) . Ingestion of non-absorbable substances
b) . Generalised malabsorption so that high conc. of solute (glucose remains in the lumen)
c) . Specific malabropstive defects

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15
Q

What is microscopic colitis

A
  1. Active intestinal secretion of fluid and electrolytes as well as decreased absorption
  2. Continues even when patient fasts
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16
Q

What three things cause microscopic colitis

A
  1. Enterotoxins (E.coli)
  2. Bile alts in colon following ileal disease, resection or idiopathic bile acid malabsorption
  3. Fatty acids in colon following ileal resection
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17
Q

What characterises stools in steatorrhoea

A
  1. Increased gas
  2. Offensive smell
  3. Floating hard-to-flush stools
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18
Q

What conditions can cause steatorrhoea

A
  1. Giardiasis

2. Coeliac disease

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19
Q

What is giardiasis

A

Infection of intestines by protozoa

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20
Q

How does inflammatory discharge effect stool consistency

A
  1. Damage to intestinal mucosal cells lead to a loss of fluid and blood and defective absorption of fluid and electrolytes
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21
Q

Causes of inflammatory discharge

A
  1. Infective (Salmonella or Shigella)

2. Inflammatory (UC or Crohn’s)

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22
Q

Where is infective diarrhoea most common

A

Africa and S. Asia

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23
Q

Risk factors for infective diarrhoea

A
  1. Foreign travel
  2. PPI or H2 antagonist use
  3. Crowded areas
  4. Poor hygiene
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24
Q

What virus causes infective diarrhoea in children

A
  1. Rotavirus - effects nearly ALL children by age of 4
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25
Q

What virus causes infective diarrhoea in adults

A
  1. Norovirus

2. Campylobacter

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26
Q

Other than rotavirus and norovirus, what other viruses can cause infective diarrhoea

A
  1. Adenovirus

2. Astrovirus

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27
Q

Most common cause of bacterial caused infective diarrhoea

A
  1. Campylobacter jejuni
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28
Q

How is campylobacter jejune acquired

A

Poultry

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29
Q

What bacteria are most common in children

A
  1. E.coli
  2. Salmonella
  3. Shigella spp.
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30
Q

What antibiotics can give rise to antibiotic-induced clostridium difficile diarrhoea

A
  1. Clindmycin
  2. Ciprofloxacin (Quinolones)
  3. Co-amoxiclav (Penicillins)
  4. Cephalosporins
31
Q

What kind of bacteria are clostridium difficile

A
  1. Gram-POSITIVE spore forming bacteria
32
Q

What disease can C.diff cause

A

PSEUDOMEMBRANOUS COILTIS

33
Q

Pathophysiology of pseudomembranous colitis

A

When normal gut flora die due to antibiotic use for example - resulting in dangerous diarrhoea

34
Q

Risk factors on C.difficile

A
  1. Elderly, antibiotics, long hospital admission, immunocompromised (HIV)
  2. Acid suppression can contribute (PPI, H2 receptor antagonist)
35
Q

How is c.diff treated

A
  1. METRONIDAZOLE
  2. ORAL ORAL VANCOMYCIN
  3. RIFAMPICIN/RIFAXIMIN
  4. Stool transplant
  5. Stop C antibiotic
36
Q

Parasitic causes of c.diff

A
  1. Giardia lamblia (most common)
  2. Entamoeba histolytica
  3. Cryptosporidium
37
Q

Clinical presentation of infective diarrhoea

A
  1. Blood (bacterial)
  2. Salmonella, E.coli, Shigella = BLOODY STOOLS
  3. Vomiting
  4. Abdominal cramping
38
Q

What are clinical presentations of viral-caused diarrhoea

A
  1. Fever
  2. Fatigue
  3. Headache
  4. Muscle pain
39
Q

Differential diagnosis of infective diarrhoea

A
  1. Appendicitis, volvulus, IBD, UTI, diabetes mellitus
  2. Pancreatic insufficiency, short bowel syndrome, coeliac disease
  3. Laxative abuse
40
Q

Blood test results in infective diarrhoea

A
  1. Low MCV or Fe deficiency (coeliac or colon cancer)
  2. High MCV if alcohol abuse or decreased B12 absorption (coeliac or Crohn’s)
  3. Raised EBC if parasitic
  4. Raised ESR and CRP indicate infection (Crohn’s, UC or cancer)
41
Q

Stool test in infective diarrhoea diagnosis

A
  1. Bacteria, parasites and c.diff (we culture stool)
42
Q

What biopsy do we perform for diagnosing infective diarrhoea

A

Sigmoidoscopy

43
Q

How is infective diarrhoea treated

A
  1. Oral rehydration and avoid high-sugar drinks in children
  2. Anti-emetics (treats vomiting)
  3. Antibiotics
  4. Anti-motility agents
44
Q

Name an anti-emetic

A

METOCLOPRAMIDE

45
Q

Name an anti-motility agent

A

LOPERAMIDE HYDROCHLORIDE

46
Q

Name some PPIs

A

Lansoprazole
Omeprazole
Pantoprazole

47
Q

When are PPIs given as first line prevention

A
  1. Prevent and treat peptic ulcer disease
  2. Symptomatic relief of dyspepsia and GORD
  3. Eradication of h.pylori infection with antibiotics
48
Q

Adverse effects of PPI

A
  1. GI disturbances and headaches
  2. Increasing gastric pH may reduce body’s host defence against infection, slightly higher risk of c.diff
  3. PPIs may disguise symptoms of gastric cancer
49
Q

How do PPIs effect elderly

A

Increased risk of fracture so use with care if osteoporosis is present

50
Q

How does omeprazole effect blood constituents

A

Reduce antiplatlet effect of clopidogrel

So do not prescribe omeprazole with clopidogrel (use a different one)

51
Q

Example of a H2 receptor antagonist

A

Ranitidine

52
Q

When are H2 antagonists given

A

Treat + prevent gastric/duodenal ulcers and NSAID associated ulcers if PPIs are contraindicated

Relieve symptoms of GORD and dyspepsia if mild

53
Q

Adverse effects of H2 antagonists

A
  1. Possible bowel disturbance, headache or dizziness
  2. Reduce dose in renal impairment
  3. Watch for symptoms of gastric cancer as H2 antagonist can disguise them
54
Q

Name some antacids

A

Gaviscon

Peptac

55
Q

When are antacids given

A
  1. GORD disease for symptomatic relief of heartburn

2. For short-term relief of indigestion and dyspepsia

56
Q

What is dyspepsia

A

indigestion

57
Q

How do antacids work

A

Increase viscosity of the stomach contents which reduces reflux of the stomach acid in to the oesophagus

After reacting with stomach acid they form a floating raft which separates the gastric contents from the gastro-oesophageal junction to prevent mucosal damage

58
Q

Side effect of magnesium in antacids

A
  1. Can cause diarrhoea
59
Q

Side-Erect of aluminium in antacids

A

Can cause constipation

60
Q

Side-effect of Na and K in antacids

A

Hyperkalaemia

Fluid overload

61
Q

What compounds do antacids effect the conc. of

A
  1. ACEI
  2. Antibiotics
  3. PPIs
  4. Bisphosphonates
  5. Digoxin
62
Q

Name two anti-motility drugs

A
  1. Loperamide

2. Codeine phosphate

63
Q

When are anti motility drugs given

A

As symptomatic treatment of diarrhoea (IBS)

64
Q

Mechanism of loperamide

A

Is an opioid but does not penetrate the CNS so has no analgesic effects, just an agonist of the opioid mu-receptor in the GI tract which increases non-propulsive contractions of the gust smooth muscle but reduces peristaltic contractions

  1. Slows bowel content movement and anal sphincter tone is increased

More water is absorbed from faeces so stools are hardened

65
Q

Difference between codeine phosphate and loperamide

A

codeine phosphate has analgesia

66
Q

Adverse effect of anti motility drugs

A
  1. Megacolon and perforation in acute ulcerative colitis

Should be avoided in infectious diarrhoea

67
Q

Name a bile acid

A

Ursodeoxycholic acid

68
Q

When are bile acids given

A

Primary biliary cirrhosis

69
Q

Effect of bile acids

A

Reduces jaundice, ascites and itching by slowing down liver biochemistry

70
Q

Mechanisms of bile acid

A

ursodeoxycholic acid reduces cholesterol absorption and is used to dissolve cholesterol gallstones
2. Helps regulate cholesterol by reducing rate at which intestines absorb cholesterol molecules while breaking up micelles containing cholesterol

71
Q

Why is surgery still preferred to ursodeoxycholic acid

A

Cause gallstones can recur

72
Q

Adverse effect of ursodeoxycholic acid

A
  1. Nausea
  2. Diarrhoea
  3. Gallstone calcification
73
Q

Where is ursodeoxycholic acid contraindicated

A
  1. Gallbladder impairment
  2. Calcium gallstones
  3. Severe liver impairment

Year 2 (155 decks)

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