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MET3a > Diarrhoea > Flashcards

Diarrhoea Flashcards

1
Q

What is the second commonest cause of death in children under 5?

A

Diarrhoea obvs

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2
Q

Red flags for cancer relating to diarrhoea

A 
Change in bowel habit
Bleeding
Weight loss unintentional
FH bowel or ovarian cancer
>50 and for >6 weeks
Anaemia
Abdominal or rectal mass
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3
Q

Define diarrhoea

A

> 200g stool in 24 hours
OR
more than 3 stools a day and loose stools

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4
Q

What is the normal bowel output?

A

3 x a day to 3 x a week

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5
Q

How much fluid goes into the GI tract in a day?

A

9L

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6
Q

How much fluid goes out of the GI tract in a day?

A

1L

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7
Q

What are the sources of fluid input?

A 
saliva - 1L
intestine - 1L
bile - 1L
pancreatic secretions = 2L
gastric secretions - 2L
diet - 2L
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8
Q

What are the source of fluid output?

A

faeces - 0.1L
colon - 1.5L
ileum - 3.4L
jejunum - 4L

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9
Q

Where does absorption in the intestines occur?

A

Intestinal villi

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10
Q

Where does excretion occur in the intestines?

A

Crypts

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11
Q

What is absorbed in the intestines?

A

Nutrients
Water
Electrolytes

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12
Q

What is excreted in the intestines?

A

Water

Electrolytes

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13
Q

What to ask about in a history of diarrhoea?

A

Duration
Type of stool and frequency
Organic features: BO at night, fever, blood
Systemic disease: diabetes, thyrotoxicosis, systemic sclerosis
H/O pancreatic disease or abdominal surgery
FH: IBD, malignancy, coeliac
Travel
Dietary indiscretion (including alcohol)
Meds: NSAIDs, ABs, PPIs, laxatives

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14
Q

Define acute diarrhoea

A

Less than 2 weeks

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15
Q

Define chronic diarrhoea

A

More than 4 weeks

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16
Q

Symptoms of acute vs. chronic diarrhoea

A

Watery/bloody
vs.
Watery, blood, steatorrhea

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17
Q

Define indeterminant diarrhoea?

A

In between 2w and 4w

Between acute and chronic

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18
Q

What is the common cause of diarrhoea?

A

Infection

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19
Q

Acute diarrhoea features

A

Mild

Self limiting

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20
Q

Causes of acute diarrhoea

A

Dietary indiscretion (few hours)
Viral infection (24-48 hours)
Food poisoning
Traveller’s diarrhoea (2-5 days)

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21
Q

Treatment for acute diarrhoea

A

Watch and wait
ORS - oral rehydration therapy if severe
Culture if severe and persists

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22
Q

What is the most common cause for acute traveller’s diarrhoea?

A

ETEC - enterotoxicigenic E coli

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23
Q

What are the causes for acute travellers diarrhoea?

A

ETEC - enterotoxicigenic E coli (50%)
Other bacteria (25%)
Parasites (15%)
Viruses (10%)

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24
Q

What other bacteria can cause acute travellers diarrhoea?

A 
Shigella spp
Salmonella spp
Campylobacter spp
EHEC
EIEC
V. cholerae & other vibrios
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25
Q

What parasites can cause acute travellers diarrhoea?

A 
G. intestinalis
C parvum
Microsporidia
I. belli
Cyclospora
E. histolytica
26
Q

What viruses can cause acute travellers diarrhoea?

A

Rotavirus
Adenovirus
SRSVs
Norovirus - in schools/hospitals/cruise ships

27
Q

Oral rehydration for acute diarrhoea

A 
1L water
3.5 sodium chloride
2.5 sodium bicarbonate
1.5g potassium chloride
20g glucose
28
Q

When to consider IV fluids and ABs in acute diarrhoea?

A 
Elderly
Immunocompromised
Frequent bloody stools
Severe abdominal pain
Temp>38.5 degrees
Hypovolaemia
29
Q

Causes of watery chronic diarrhoea?

A

Secretory

osmotic

30
Q

Causes of bloody chronic diarrhoea

A

Colonic disease
Infection/inflammation
Neoplasia

31
Q

Causes of fatty/steatorrhea like chronic diarrhoea?

A

Pancreatic
Small bowel
(failure of fat absorption)

32
Q

Features of pancreatic insufficiency causing steatorrhea

A 
Normal red cell folate
Faecal fat >20g in 24 hours (normal is <7g)
Faecal elastase favoured over faecal fat
Plain abdominal radiograph/US
Abdominal CT, EUS< MRI, MRCP
ERCP
33
Q

Features of small intestinal disease causing steatorrhea

A

Low red cell folate
Anti-TTG AB
Duodenal/jejunal/TI biopsy
Small bowel imaging - CT/MRI

34
Q

What do you need to be sure of when measuring anti-TTG AB?

A

Measure IgA to make sure there is no IgA deficiency as this will cause a false negative test

35
Q

Clues to toxin producing organism causing diarrhoea

A

Rapid onset of symptoms after food <6h = (S. aureus, B. cereus)

36
Q

B. cereus source

A

Rice

37
Q

S. aureus source

A

Creamy products

38
Q

What can fever be indicative of in diarrhoea?

A 
Invasive bacteria (Salmonella, Shigella, Campylobacter)
Enteric viruses
Cytotoxic organism (C. difficile, E. histolytica)
39
Q

What can bloody diarrhoea be indicative of in diarrhoea?

A 
Invasive bacteria (Salmonella, Shigella, Campylobacter, E. coli)
Amoebic dysentery (travel history)
40
Q

If a patient is on ABs and they get diarrhoea what might cause it?

A

C. difficile

41
Q

What drugs can cause chronic diarrhoea?

A 
Alcohol
ABs
Anti-depressants (lithium, SSRIs)
Anti-hypertensives
Cholesterol lowering agents
GI drugs (Mg2+, H2RA, PG analogs, 5-ASA)
NSAIDs
Oral hypoglycaemics (biguanides)
42
Q

Osmotic diarrhoea causes

A

Nonabsorbable substance
High concentration of solute in malabsorption
Specific defect e.g. disaccharide deficiency

43
Q

Secretory diarrhoea causes?

A 
Inflammation = IBD
Infection = salmonella
Enterotoxins from e.g. E coli, cholera
Hormones e.g. neuroendocrine tumours
Bile salts and fatty acids
44
Q

Motility related causes of diarrhoea

A

Thyrotoxicosis
IBS
DM autonomic neuropathy

45
Q

What is the most commonest cause of maldigestion?

A

Lactose intolerance

Important cause of diarrhoea

46
Q

FODMAP related diarrhoea

A 
Poorly absorbed substances in diet
F = fermentable
O = oligosaccharides
D = disaccharides (lactose)
M = monosaccharides (fructose)
P = polyols

(eliminate items then slowly introduce one by one can cause resolution of symptoms)

47
Q

Clostrium Difficile

A 
Anaerobic
Gram positive
Spore forming
Faecal oral route
Toxins A &amp; B which cause disease
Associated with AB use
Elderly
IBD patients more prominent
Life threatening
48
Q

Mild C difficile define

A

3 stools per day

Normal WCC

49
Q

Moderate C difficile define

A

3-5 stools per day

Raised WCC

50
Q

Severe C difficile define

A

WCC>20
Temperature >38.6
Raised Cr
Abdo pain or XR acute colitis

51
Q

Complicated C. difficile define

A

Hypotension, partial ileus

Evidence of severe disease on CT

52
Q

Life threatening C difficile define

A

Complete ileus or toxic megacolon

53
Q

Mild C difficile Tx

A

Oral metro

54
Q

Moderate C. difficile Tx

A

Oral metro

55
Q

Severe C. difficile Tx

A

Oral vanco

56
Q

Complicated C. difficile Tx

A

Oral vanco + IV metro

57
Q

Life threatening C. difficile Tx

A

Oral vanco + IV metro
Faecel microbiota transplant
Consider colectomy

58
Q

Blood test for diarrhoea Ix

A 
FBC = anaemia
Inflammatory markers = WCC, platelets, CRP
U&amp;E = dehydration/AKI
Albumin, Ca, P = nutritional status
Haematinics
TTG AB and IgA
TFTs
59
Q

Stool and other tests for diarrhoea

A

Stool weight
MC&S, C. difficile toxin, cysts, ova, parasites
Faecal calprotectin (increased in inflammation so IBD/infection)
FIT (faecal immunochemical test for Hb)
Faecal elastase
Stool pH/electrolytes/reducing substances
BMI/nutritional status

60
Q

Other imaging for diarrhoea

A 
Duodenal biopsy
Colonoscopy
Small bowel MRI
Video capsule endoscopy
Cross sectional imaging with CT
61
Q

Prevention of diarrhoea

A

Hand washing - soap and water!

MET3a (38 decks)

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