Diarrhoea Flashcards

1
Q

Define?

What would the score be on the bristol stool chart?

When is it classed as chronic?

A

> 3 loose stools per day

5-7

> 4 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What should be suspected if it is acute D?

What questions should you ask?

What should you expect if chronic?

A

Gastroenteritis

Recent travel?
Diet change?
Contact with D&V?
Fever/pain
HIV?
IBS
Weight loss 
Nocturnal diarrhoea 
Anaemia 
IBD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Bloody diarrhoea - causes - 3

Mucusy diarrhoea - causes

Pussy diarrhoea - causes - 3

A

E.coli
IBD
Colorectal cancer
Polyps

IBS
Colorectal cancer
Polyps

IBD
Diverticulitis
Fistula/abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Explosive diarrhoea - causative pathogen

Steatorrhoea - features - 4
What does it suggest? - 2

A

Cholera
Giardia
Rotavirus

Increased gas
Offensive smell
Floating
Hard to flush

Pancreatic insufficiency
Biliary obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Differential diagnosis:

GI:

  • infection - 2
  • Inflammation - 2
  • Intolerances - 2
  • One thing that changes bowel habit
  • Diagnosis of exclusion
  • Might happen after this
A

GE, tropical infections

IBD, diverticulitis

Coeliac disease or lactose intolerance

Colorectal carcinoma

IBS

Constipation with overflow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Differential diagnosis:

Endocrine - 2 issues which cause D

Drugs - 6

A

Thyrotoxicosis (hyperthyroidism)
Addison’s

ABs
PPIs
Metformin 
Laxatives
CV: digoxin, propanalol 
Alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Signs you’d look for:

Dehydration - 3

Sign of thyrotoxicosis

A

Dry mucous membranes
Reduced skin turgor
Raised CRT

Goitre/hyperthyroid signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Investigations:

What will dictate the direction of inv?

The basic approach to inv:

  • Bloods
  • Other thing that needs to be ruled out
  • What can be measured in the stool to differentiate between IBS and IBD?
A

Severity
Chronicity
Red flags

FBC and inflammatory markers (ESR/CRP)

Coeliac disease - Coeliac serology needed

Faecal Calprotectin - done initially to rule out or in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Investigations:

MAIN RED FLAG FOR 2WW

What red flags for further testing or when a referral is needed? - 5

What is done when they are referred?

A

New-onset change in bowel habit > 55 yrs old

Anaemia or PR bleeding 
Continuous or nocturnal D
Raised CRP/ESR/faecal calprotectin
FH of bowel or ovarian cancer 
Weight loss 

Endoscopy to check for malignancy or precancerous lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Further investigations:

Stool - what tests can you do on stool samples? - 3

What can you look for in the stool that will indicate chronic pancreatitis?

What can be measured in the stool to differentiate between IBS and IBD?

Test for H.pylori causing D?

Test for lactose intolerance?

A

MC+S
Ova cysts and parasites
C. diff

Faecal elastase - malabsorption and steatorrhoea

Faecal calprotectin

13C breath test

Hydrogen breath test

Fermenting lactose in the intestines (a sign of lactose intolerance) creates lactic acid, which can be detected in stool.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Further investigations - blood:

FBC:

  • What does a low MCV (mean corpuscular volume) indicate? - 2
  • What does a high MCV indicate? - 1
  • What does low B12 absorption suggest?

What does raised inflammatory markers to suggest? - 4

What in U&E’s would suggest severe D&V?

What endocrine disease can you also test for and how?

How would you test for coeliac disease?

A

Iron deficiency from coeliac/colon cancer

Alcohol abuse

Coeliac and Crohn’s disease

Infection - GE
Crohns
UC
Cancer

Hypokalaemia

Low TSH indicating thyrotoxicosis

Coeliac serology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management - usually treat the cause

What happens in the majority of cases?

What needs to be done if severe and acute?

What medication can be given to help? - 2

When should ABs be given?

What can be suggested for AB associated D

A

Self-resolving

Oral rehydration therapy - IV + electrolyte replacement

Loperamide
Codeine

Infective D causing systemic symptoms

Probiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Loperamide

MOA

Indications - 3

A

Reduces smooth muscle tone

Water D that interferes with life
IBS
Travellers diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Common causes of D

A

GE

Travellers D

C.diff

IBS

Cancer

IBD

Coeliac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Uncommon causes of D

A

Microscopic colitis

Chronic pancreatitis

Bile salt malabsorption

Laxative abuse

Lactose intolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Drugs that can cause D

A

ABs

Propranolol

Laxatives

PPI

NSAIDs

Digoxin

Alcohol