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Y1 - Gatrointestinal > Diarrhoea > Flashcards

Diarrhoea Flashcards

1
Q

What does sudden onset of increased bowel frequency associated with crampy abdominal pains and a fever point to?

A

Infective cause of diarrhoea

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2
Q

What does increased bowel frequency with loose blood stained stools point to?

A

IBD

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3
Q

What does the passage of pale, offensive stools that float, often accompanied by loss of appetite and weight loss point to?

A

Steatorrhoea

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4
Q

What does increased nocturnal bowel frequency and urgency point to?

A

Organic cause of diarrhoea

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5
Q

What does the passage of frequent, small volume stools (often formed) point to?

A

Functional cause of diarrhoea

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6
Q

What is osmotic diarrhoea?

A

Large quantities of non-digestible substances in the bowel cause water to move into the lumen, causing diarrhoea

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7
Q

What is secretory diarrhoea?

A

The secretion of electrolytes into the lumen in response to a signal, which are followed by water

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8
Q

What is inflammatory diarrhoea?

A

Where damage to mucosal cells leads to loss of blood and fluid
The decrease in absorptive function causes a build up in malabsorbed substances

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9
Q

What are examples of causes of osmotic diarrhoea?

A

Certain purgatives

Malabsorptive conditions

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10
Q

What are examples of causes of secretory diarrhoea?

A

Enterotoxin from e. coli, c. diff and cholera

Hormones

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11
Q

What are examples of causes of inflammatory diarrhoea?

A

IBD

Coeliac

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12
Q

What are examples of diarrhoea caused by abnormal motility?

A

Diabetes
Post-vagotomy
Hyperthyroidism

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13
Q

What can acute diarrhoea be accompanied by?

A

Fever
Abdominal pain
Vomiting
Dehydration

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14
Q

When are investigations necessary for acute diarrhoea?

A

If it is lasting longer than 5-7 days

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15
Q

What investigations should be done if needed for acute diarrhoea?

A

Stool culture with c. diff toxin assay

If diagnosis still not made: sigmoidoscopy and rectal biopsy

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16
Q

If diarrhoea lasts longer than 7-10 days, what is then the most likely cause?

A

IBD because viral and bacterial infective diarrhoea do not last that long

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17
Q

What is the management for acute diarrhoea if needed?

A

Oral fluid and electrolyte replacement
Rehydration sachets
Anti-diarrhoea drugs may be necessary for short term relief
Antibiotics in gastroenteritis depending on the organism

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18
Q

In chronic diarrhoea with blood what investigation is done?

A

Colonoscopy with biopsy

Blood tests

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19
Q

In chronic diarrhoea with blood, what will a colonoscopy with biopsy diagnose?

A

Colonic lesions such as:
UC
CD
Carcinoma

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20
Q

What blood tests are done in chronic diarrhoea as an initial investigation?

A

FBC
Albumin
Folate B12
Inflammatory markers

21
Q

What can blood tests diagnose in chronic diarrhoea?

A

Malabsorption

22
Q

What further blood tests are done if malabsorption is determined in chronic diarrhoea?

A 
MCV
Hb
B12
Folate
Auto-antibodies
23
Q

What investigation is done if there is high MCV, low folate and positive auto-antibodies?

A

Jejunal biopsy

Smear for giardia

24
Q

What will a jejunal biopsy diagnose in malabsorption with chronic diarrhoea?

A

Small bowel lesions such as:
Coeliac disease
Tropical sprue

25
Q

What investigation is done if haemoglobin is low?

A

MRI or CT

26
Q

What will an MRI or CT diagnose in malabsorption with chronic diarrhoea?

A

Small bowel lesions such as:

CD

27
Q

What investigation is done after further blood tests are normal in malabsorption with diarrhoea?

A

Pancreatic tests
CT scan/US
Function tests
MRCP/MRI

28
Q

What can be diagnosed by pancreatic tests in chronic diarrhoea with malabsorption?

A

Chronic pancreatitis

Carcinoma

29
Q

What are the initial investigations in chronic diarrhoea without blood?

A

Flexible sigmoidoscopy
Colonoscopy
Biopsies

30
Q

What can abnormal colonoscopy and biopsies diagnose in chronic diarrhoea?

A

Colonic lesions such as:
IBD
Pseudomembranous colitis

31
Q

What are the next investigations when colonoscopy and biopsies are normal in chronic diarrhoea without blood?

A 
Small bowel imaging
Colonoscopy and ileal biopsies
Serum VIP
Thyroxine
SeHCAT
32
Q

What are the conditions that can be diagnosed by further investigation in chronic diarrhoea without blood when colonoscopy and biopsies are normal?

A 
Bile acid malabsorption
Thyrotoxicosis
Diabetes
VIPoma
Parasites
Colonic carcinoma
33
Q

What further investigation is done when melanosis coli is found after colonoscopy and biopsy in chronic diarrhoea without blood?

A

Look for purgatives

34
Q

What conditions can be diagnosed after finding melanosis coli and looking for purgatives?

A

Purgative abuse

Dilutional diarrhoea

35
Q

What is usually the first investigation if stool cultures are negative and small bowel disease is not suspected?

A

Colonoscopy with biopsy

36
Q

What is c. diff associated colitis also known as?

A

Pseudomembranous colitis

37
Q

What are the clinical features of c. diff associated colitis?

A

Diarrhoea ranges from mild to profuse, watery, haemorrhage colitis
Abdominal pain
Colonic mucosa is inflamed and ulcerated
Can cause intractable diarrhoea leading to toxic megacolon and deaths

38
Q

What are markers of severity of c. diff associated colitis?

A 
High temperature
WCC > 15x10^9
Serum creatine 50% above baseline
Raised serum lactate
Severe abdominal pain
39
Q

How is diagnosis of c. diff associated colitis made?

A

The detection of c. diff A or B toxins in the stools using ELISA or PCR

40
Q

What is the management of mild and severe c. diff associated colitis?

A

Metronidazole for mild to moderate

Oral vancomycin for severe or relapsing

41
Q

What is bile acid malabsorption?

A

The terminal ileum fails to reabsorb bile acids
This leads to diarrhoea, reducing absorption of water and electrolytes
If bile salts are at higher concentrations in the lumen, secretions are also induced and colonic motility is increased, causing more diarrhoea

42
Q

What are causes of bile acid malabsorption?

A 
Ileal resection
Ileal disease (e.g. CD)
Primary bile acid diarrhoea
Post-infective gastroenteritis
Rapid small bowel transit
Post-cholecystectomy
43
Q

How is diagnosis of bile acid malabsorption made?

A

SeHCAT tests

44
Q

What is the treatment for bile acid malabsorption?

A

Bile salt sequestrates (cholecystramine)

45
Q

What are the features of purgative abuse causing factitious diarrhoea?

A

High volume diarrhoea
Low serum potassium
Often occurs in association with eating disorders

46
Q

What can help to diagnose laxative abuse

A

Biochemical analysis

47
Q

What is dilutional diarrhoea?

A

Raised stool weights as a consequence of patients deliberately diluting their stool with urine or tap water

48
Q

How is diagnosis made for dilutional diarrhoea?

A

Measurement of stool osmolality and electrolyte concentrations

Y1 - Gatrointestinal (31 decks)

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