Diarrhoea Flashcards
What time frame is classed as acute diarrhoea?
<2 weeks
What key symptoms should you ask a patient about with acute diarrhoea?
Recent travel
Diet change
Contact tracing
Any fever/pain?
What does chronic diarrhoea alternating with constipation suggest?
Irritable bowel syndrome
What would you be thinking in a patient with weight loss, nocturnal diarrhoea and anaemia?
Crohns/UC/Coeliacs
What are the main infective causes of bloody diarrhoea?
Shigella, Salmonella, Campylobacter and E. coli
What are the main non infective causes of bloody diarrhoea?
UC
Crohns
Colorectal cancer
Pseudomembranous colitis
Ischaemic colitis
What are the main causes of mucus in diarrhoea?
IBS
Colorectal cancer
Polyps
What are the main causes of explosive diarrhoea?
Giardia
Cholera
Rotavirus
What are the two main causes of Steatorrhoea
Biliary obstruction
Pancreatic insufficiency
Management of diarrhoea?
- Treat underlying cause
- Anyone that handles food should not be working until cultures are negative
- If non-infective cause can prescribe an anti-kinetic eg. Loperamide 2mg PO after each loose stool (max 16mg/day) or 30mg codeine phosphate/8hr PO.
- Oral rehydration therapy favoured over IV but IV sometimes indicated
Name some non-GI causes of diarrhoea?
Thyrotoxicosis
Autonomic neuropathy
Addisons disease
What is the main cause of pseudomembranous colitis?
Clostridium. difficile infection
How does Pseudomembranous colitis present?
- Pyrexia
- Colic
- High CRP, WCC, albumin
How do you run tests for Pseudomembranous colitis?
- Rapid screening test for C. diff protein (or PCR)
- Specific ELISA test for toxins
- AXR indicated for ?Toxic megacolon?
What is the management for Pseudomembranous colitis?
400mg Metronidazole/8hr PO for 10-14 days
Vancomycin 125mg/6hr PO is better in severe disease
Vancomycin IV and PR may be indicated in non-responding patients
