Diarrhoea

Question 1

Chronic Diarrhoea Aetiology

Answer 1

• IBS
• Bile acid malabsorption
• Colonic: diverticular disease, colonic neoplasia, UC/Crohn’s, microscopic colitis, ischaemic colitis, constipation with overflow
• Small bowel: coeliac, Crohn’s, BAM, lactose intolerance, small bowel overgrowth, mesenteric ischaemia
• Pancreatic: chronic pancreatitis, pancreatic carcinoma, CF
• Endocrine: hyperthyroidism, DM (neuropathy), hypoparathyroidism, Addisons
• Chronic infection
• C. diff
• Previous surgery
• Drugs

Question 2

Chronic Diarrhoea Presentation

Answer 2

• Organic: less than three months, predominantly nocturnal or continuous
• Functional: longer than three months with symptoms
• Malabsorption usually associated with steatorrhoea and passage of bulky foul-smelling stools

Question 3

Chronic Diarrhoea Assessment

Answer 3

Assess for red flags

• WL, rectal bleeding, over 60, FHx CA, abdominal/rectal mass, anaemia, raised inflammatory markers
• Recent travel, systemic disease (e.g. endocrine) , pancreatic symptoms
• Assess for features that indicate a diagnosis of IBS
• Always do DRE for those with unexplained symptoms

Question 4

Chronic Diarrhoea Ix

Answer 4

• Bloods: FBC, LFTs, vitamins, iron studies, TFTs, ESR and CRP, tTGA/EMA
• Stool culture and sensitivity

In secondary care
-Biopsies, endoscopy, CT scan if pancreatic

Question 5

Chronic Diarrhoea Referral

Answer 5

If red flag symptoms

• <40, rectal bleeding, change in bowel habit
• Right lower abdominal mass
• Palpable rectal mass
• > 60 with change in bowel habit with or without rectal bleeding
• Men with unexplained iron deficiency anaemia
• Post menopausal women with unexplained iron deficiency

Question 6

Chronic Diarrhoea Management

Answer 6

-Depends on cause

Question 7

Acute Diarrhoea Definition

Answer 7

-Lasting less than four weeks

Question 8

Acute Diarrhoea Aetiology

Answer 8

• Infection
• Drugs (allopurinol, antibiotics, digoxin, colchicine, metformin, NSAIDS, PPIs, SSRIs…)
• Overflow
• Anxiety, food allergy, acute appendicitis

Question 9

Acute Diarrhoea Infections That Present with Bloody Diarrhoea

Answer 9

• CMV
• Campylobacter jejuni
• Salmonella
• E. coli
• Shigella
• Yersinia
• C. difficile
• Schistosomiasis

Question 10

Acute Diarrhoea Assessment

Answer 10

• Determine about nature of diarrhoea
• Red flags (incl. recent hospital visits)
• Recent travel, contact, drugs, stress and anxiety
• Assess for complications such as dehydration: apathy, muscle cramps, dry tongue, sunken eyes, tachycardia, weakness, confusion
• Consider comorbidities that may increase risk of complications
• Consider rectal examination if older

Question 11

Acute Diarrhoea Ix

Answer 11

• Not always necessary

- Stool specimen if indicated (systemic, recent antibx, blood or pus in stool, persistent, after foreign travel)

Question 12

Acute Diarrhoea Management

Answer 12

• Supportive with attention to fluid intake and nutrition
• Treat cause
• Symptomatic treatment when clear diagnosis
• Loperamide (Imodium)

Question 13

Acute Diarrhoea Admission

Answer 13

• Vomiting and inability to retain oral fluids
• Features of severe dehydration or shock
• Older age, poor home circumstances, bloody diarrhoea, abdo pain and tenderness