Diarrhoea

Question 1

What are the differentials of acute diarrhoea?

Answer 1

Gastroenteritis
Ulcerative Colitis
Crohn’s Disease
Irritable Bowel Syndrome

Question 2

What are the features of rotavirus?

Answer 2

common in children from day care centres; may infect adults, immunocompromised people; fever, vomiting; diarrhoea: watery, yellow, no blood or mucus

Question 3

What are the features of norovirus?

Answer 3

consumption of shellfish, prepared foods, salads, sandwiches, fruit
symptoms: nausea, abdominal cramps, followed by diarrhoea and vomiting; diarrhoea is watery, moderate, contains no blood or mucus; fever, malaise, myalgia, headache common

Question 4

What are the features of enteric adenovirus?

Answer 4

common in infants, older adults, and immunocompromised people; secondary to contaminated food and water; common in day care centres and institutions; symptoms: mild, self-limiting diarrhoea, no fever

Question 5

What are the features of camylobacter Enteritis?

Answer 5

ingestion of undercooked poultry, raw milk, or cheese; diarrhoea either watery profuse or bloody with mucus, usually self-limiting, and resolves after 5 to 7 days; associated severe crampy periumbilical abdominal pain and fever; bloody diarrhoea can be present from third day of illness

Question 6

What are the features of Shigella?

Answer 6

usually in children attending day care centres; also acquired from eating vegetables; fever, then develops diarrhoea, watery becoming mucoid and bloody; stool: small in amount, ranges from 10 to 12 stools/day; fever and tenesmus in one third of patients

Question 7

What are the features of Salmonella?

Answer 7

source usually food (beef, pork, poultry, eggs, raw milk, ice cream, orange juice) and faecally contaminated water; common with pets (pet ducklings, reptiles, and lizards); symptoms of nausea, vomiting, fever, diarrhoea (can persist for 10 days), cramping; usually self-limiting

Question 8

What are the features of Escherichia Coli

Answer 8

occurs in travellers, children; dysentery; source usually contaminated food; depending on site and strain of infection, symptoms include profuse watery diarrhoea or bloody diarrhoea; abdominal pain but no fever

Question 9

What are the features of Clostridium Diffcile

Answer 9

history of antibiotic use, hospitalisation, chemotherapy, development of diarrhoea in 2 to 3 weeks (up to 3 months); acute watery diarrhoea; milder disease: 3 to 4 stools/day, mild lower abdominal pain; severe disease with pseudomembranous colitis: profuse diarrhoea, up to 15 times/day, lower abdominal crampy pain; fulminant colitis: fever, chills, diffuse abdominal pain, volume depletion

Question 10

What are the features of bacillus cereus?

Answer 10

classic history of eating reheated rice (Chinese food); within 6 hours develops nausea, vomiting, later followed by diarrhoea; also seen with consumption of beef, pork and vegetables; no fever present

Question 11

What are the symptoms of irritable bowel syndrome?

Answer 11

diarrhoea: small frequent loose stools, small to moderate volume, preceded by urgency, common after meals, no midnight waking, alternates with constipation; may be abdominal discomfort, pain, and bloating; may see mucus; blood is rare

Question 12

What are the signs of irritable bowel syndrome?

Answer 12

usually normal; may show abdominal distension and mild abdominal tenderness

Question 13

What are the first line investigations that you would carry out for irritable bowel syndrome?

Answer 13

none: clinical diagnosis made by exclusion

Question 14

What are the differentials for chronic diarrhoea?

Answer 14

Ulcerative Colitis
Irritable bowel syndrome 
Coeliac disease 
faecal impaction 
Crohn's disease  
Pancreatic insufficiency 
Alcohol
Hyperthyroidism
Diabetes Mellitus