Diarrhoea Flashcards
What are the causes of diarrhoea
- Infection of bowel
- Inflammation of bowel e.g. IBD, diverticular disease
- Increased bowel motility (e.g. hyperthyroidism, anxiety, IBS)
- Malabsorption of nutrients (coeliac disease, pancreatic insufficiency)
- Obstruction overflow
- Medications
What are ddx for diarrhoea
Young: Infective diarrhoea IBS Coeliacs Crohns UC Medications
In elderly - neoplastic disease, diverticular disease, overflow diarrhoea secondary to constipation, ischaemic colitis, microscopic colitis and bacterial overgrowth more common
How can you tell if a metabolic acidosis is being compensated for?
If acidotic with low HCO3-, suggests that bodies trying to compensate for acidosis to shift eqm to left
Mucoid/jelly like stools suggests?
Classically suggests Salmonella or villous polyps in the colon
Foul smelling and floating stools suggests
Malabsorption due to coeliacs, pancreatic duct obstruction or biliary insufficiency
Unusually pale faeces suggests?
Lack of bile salts to to biliary or pancreatic duct obstruction (e.g. chronic pancreatitis, gallstones)
Blood on paper when they wipe indicates?
Blood mixed in with stools suggests?
Anal pathology - anal fissure, haemorrhoids
UC, dysentery, colorectal carcinoma
Urgency to pass stools indicates?
Infectious diarrhoea or IBD
Tenesmus (incomplete emptying) suggests?
SOL in rectum (e.g. carcinoma)
Varying bowel habit between diarrhoea, normal stools and constipation suggests?
IBS if young patient
Colorectal cancer in elderly
infectious diarrhoea typically presents how often?
Once
What does diarrhoea with vomiting suggest?
Infectious Gastroenteritis
Diarrhoea with RIF pain could indicate?
Terminal ileum inflammation (e.g. Crohns)
Pain in LIF with diarrhoea indicates?
Diverticular disease
Pain relieved by passing motions suggests?
IBS
Eye problems, joint pains or skin rashes indicates?
Associated with IBD (UC and Crohns)
Antibiotics and PPIs can cause diarrhoea due to which organism
C difficile
Clubbing is a sign for which conditions
Crohns
UC
Hyperthyroidism
Iritis, episcleritis and scleritis are signs of which 2 diseases
Crohns
UC
Mouth ulcers are a sign of which condition
Crohns
Erythema nodosum is a sign of which pathologies
Crohns and UC
COCP can also cause erythema nodosum
Dermatitis herpetiformis is often found along the extensor surfaces of limbs. What is it a sign of
Coeliac disease
In Crohns disease, where is a mass often found?
RLQ
Masses in LLQ could indicate malignancy
Anal ulcers and fistulae are signs of which disease?
Crohns
What blood tests are done in someone with diarrhoea
- FBC - coeliacs, Crohns, UC all cause anaemia
- ESR - elevated ESR = Crohns or UC
- CRP - raised in infectious diarrhoea, UC or Crohns
- TTG and IgA levels - coeliac disease test
- TFTs
- U&Es
- Albumin - will be low if patient has chronic diarrhoea and malabsorption
- Capillary glucose
What faeces tests would you do in someone with diarrhoea
- Faeces microscopy and culture - nb pus cells indicate IBD
- C difficile toxin test - especially if patient has recent abx
- FOBT - detectable blood points towards UC or infection
Which 2 disease fall under IBD
Coeliacs and Crohns
Crohns includes RLQ pain and weight loss
UC may have bloody diarrhoea and diffuse pain
What investigations are done for suspected Crohns?
- AXR - bowel inflammation? Severe UC patients are also at risk for toxic megacolon which can perforate
- Colonoscopy
- DCBE radiograph - rarely used
Which medications may be given for Crohns patients
Methotrexate
Azathioprine
Infliximab
IBS is linked to which psychological triggers
Stress. anxiety and depression
What is given to treat C difficile infections
Metronidazole
Give vancomycin if severe
Painless, bloody diarrhoea with a clear cutoff between abnormal and normal bowel (on investigations) indicates what?
UC
UC has a strong association with primary sclerosing cholangitis (obstructive jaundice and liver failure) and cholangiocarcinoma
What medication is given for UC
Methotrexate, azathioprine, salicylate derivatives, corticosteroids, anti-TNF antibodies
Consider surgical resection
Which antibody is raised in Graves disease
Anti-TPO
