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SPM- Gastroenterology > Diarrhoea > Flashcards

Diarrhoea Flashcards

1
Q

What is diarrhoea?

A

3 or more liquidy stools in 24 hours

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2
Q

How long has acute diarrhea being going on for?

A

Less than 2 weeks

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3
Q

How long has persistent diarrhoea been going on for?

A

2-4 weeks

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4
Q

How long has chronic diarrhoea been going on for?

A

More than 4 weeks

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5
Q

How can diarrhea be classified?

A

Inflammatory or non-inflammatory

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6
Q

What causes inflammatory diarrhea?

A

Inflammatory bowel disease

GI infection with pathogenic bacteria

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7
Q

What causes non-inflammatory diarrhea?

A

Secretory
Osmotic

Do not cause systemic features like fever

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8
Q

How can you differentiate between inflammatory and noninflammatory diarrhea?

A

Presence of fever

ESR, CRP

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9
Q

What is happening in secretory diarrhoea?

A

There is secretion of electrolytes into the lumen which causes loss of water too

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10
Q

What causes osmotic diarrhoea?

A

Nutrients and osmotically active substances aren’t absorbed and they draw water into the lumen

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11
Q

What is the main cause acute diarrhoea?

A

Infection- bacterial, viral or parasites

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12
Q

What is the main cause of acute diarrhoea?

A

Viral infection

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13
Q

What are the features of viral GI infection?

A

Watery diarrhoea
Associated vomiting
Lethargy
Risk of dehydration

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14
Q

What are some bacterial causes of non-inflammatory diarrhoea?

A

Symptoms tend to within 16 hours of ingestion
Staph aureus
C.Perfringens

Enterotoxigenic E.Coli (Sx tend to occur 15 hours after ingestion)

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15
Q

What can cause bacterial gastroenteritis?

A

Ingestion of contaminated food

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16
Q

What features would suggest inflammatory diarrhoea?

A

Blood in the stool
Mucus in the stool
Fever
Abdominal pain

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17
Q

What are some causes of inflammatory bacterial diarrhoea?

A 
SSYCE
Salmonella
Shigella
Yersinia
Campylobacter
Enteroinvasive E.Coli
18
Q

What are the SSYCE organisms and what do they cause?

A

They cause inflammatory diarrhoea (watery, bloody, mucousy stools with systemic features of infection)

Salmonella
Shigella
Yersinia
Campylobacter
Enteroinvasive E.Coli
19
Q

What should you ask about if someone presents with diarrhea?

A

How long has it been going on for?
Blood
Mucus
Fever
Have they eaten anything that might have triggered it?
Is anyone else who ate the same foods ill?
Any recent travel?
Any recent contact with someone with D+V?

20
Q

What organism can cause diarrhoea after antibiotic use?

A

C.Difficile- causes pseudomembranous collitis

21
Q

What is the most important thing to assess in patients with diarrhoea illness?

A

Fluid status- they’re at risk of dehydration

Mucous membranes
CRT
Blood pressure
JVP
HR
Skin turgor
Sunken eyes
Urine output

Also fever, signs of thyroid disease
Abdo exam for tenderness or any masses

22
Q

What blood tests might you want to do?

A 
FBC
CRP, ESR
U&Es - Electrolyte abnormalities with severe diarrhoea 
Creatinine
eGFR
TFTs- Hyperthyroidism is associated with diarrhoea
Coeliac serology- if prolonged diarrhea
B12
23
Q

What stool tests might be done for someone with diarrhoea?

A 
Infectious causes-
Culture
C.Diff toxin
E.Coli toxin
Microscopy
Viral PCR
Faecal elastase- marker of pancreatitis

IBD-
Faecal calprotectin

24
Q

What are the causes of bloody diarrhoea?

A 
Salmonella
Shigella
Yersinia
Campylobacter
Enteroinvasive E.Coli
25
Q

How should you manage a patient is acute severe diarrhoea?

A

Fluid replacement- Saline or Hartmann’s (monitoring and adjust accordingly), around 1-2 litres
Diets- keep oral intake of simple food and liquids

Careful electrolyte monitoring and replace where necessary

Antimotility agents such as codeine phosphate or loperamide- but should be avoided in colitis as could precipitate toxic megacolon

26
Q

When should ABx be used in diarrhoeal illness?

A

If there is systemic upset and severely unwell
If at risk of complications such as elderly and frail

Empirical treatment may be given e.g. Azithromycin

27
Q

Name two antimotility agents?

A

Loperamide

Codeine phosphate

28
Q

When should anti-motlity agents be avoided?

A

If there is collitis as it could precipitate toxic megacolon

29
Q

What are some parasitic causes of infection?

A

Giardia

Cryptosporidium

30
Q

What type of diarrhoea does giardia cause?

A

Non-inflammatory secretory diarrhoea

31
Q

When should you consider parasitic causes of diarrhoea?

A

People who travel
Those who work in childcare
Those who work in health care

32
Q

How can you investigate for parasitic causes of diarrhoea?

A

Stool investigations

Stool culture

33
Q

What is dysentery?

A

Diarrhoea with visible blood

Due to inflammatory diarrhea- bacterial causes include
Shigella
Salmonella
Yersinia
Campylobacter
E.Coli (enteroinvasive)
34
Q

What is a common parasitic cause of diarrhea? What kind of diarrhoea does it cause?

A

Giardia- it’s a parasite that causes non-inflammatory secretory diarrhoea

35
Q

What is the leading cause of chronic diarrhoea in the developing world?

A

Inflammatory bowel disease
Coeliac

Can do coeliac serology, faecal calprotectin, bloods for inflammatory markers (CRP, ESR, WCC) and colonoscopy

36
Q

What should you consider if acute diarrhoea is prolonged?

A

Testing for HIV and other immunosuppressive causes

37
Q

What is the most common cause of diarrhoea in travelers?

A

E.Coli

Can cause both a bloody and non-bloody diarrhoea

38
Q

What is the most common viral cause of gastroenteritis

A

Rotavirus

39
Q

Patients who are very unwell may not be able to tolerate a full colonoscopy, what could be done?

A

A sigmoidoscopy might be better tolerated

40
Q

What type of malignancy can cause secretory chronic diarrhoea?

A

Carcinoid tumour- release of serotonin cause diarrhoea

Or a VIPoma- Vasoactive peptide releasing tumour

SPM- Gastroenterology (13 decks)

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