Diarrhoea

Question 1

What can patients mean when they say they have diarrhoea?

Answer 1

Steattorhoea (fatty)
Passing lots of stool
Melaena (blood)
Loose stools (normal amount but very runny)

Question 2

Causes of diarrhoea

Try and categorise

Answer 2

Most common = infectious

Inflammation
Infection
Malabsorption (coeliac, pancreatic insufficiency)
Increased motility (IBS, hyperthyroidism)
Overflow
Medications

I’M MOMI
Infection, medication, motility, overflow, malabsorption, inflammation

Question 3

Acute diarrhoea in a young adult? Could be…

Answer 3

Infective 
IBS
Coeliac 
Crohns
UC 
Medications 
Hyperthyroidism

Question 4

Causes of diarrhoea in the elderly

Answer 4

Normal but more likely to be

Malignancy, diverticular disease, IBD (bimodal distribution)

Question 5

What’s the main worry with severe diarrhoea and needs correcting and monitoring?

Answer 5

Dehydration, make sure they are hydrated

Question 6

What are early signs of dehydration?

Answer 6

Urine colour
Tachycardia
Dry lips and coated tongue
Thirsty patient

Question 7

Diarrhoea can cause which electrolyte abnormalities?

Answer 7

Hypokalaemia
Hyponatraemia
Low Cl-
Low HCO3-

Question 8

Mucous, jelly like stool =>

Answer 8

Salmonella

Question 9

Pale stool =>

Answer 9

Gallstones or pancreatitis

Question 10

Bloody stool =>

Answer 10

IBD
Cancer
Haemorrhoids 
Anal fissure 
Dysentery

Question 11

What makes IBS unlikely?

Answer 11

Nocturnal diarrhoea

Question 12

If there is diarrhoea and vomiting, this suggests…

Answer 12

Many pathologies but in the context of diarrhoea this implies gastroenteritis

Question 13

Pain relieved by passing motions =>

Answer 13

IBS

Question 14

Extra intestinal symptoms of IBD

Answer 14

Anterior uveitis, erythema nodosum, pyoderma gangrenous,

Question 15

Recent antibiotic and new onset diarrhoea =>

Answer 15

C. difficile (pseudomembranous colitis)

Question 16

Most common cause of recurrent diarrhoea with few other symptoms?

Answer 16

IBS

Question 17

Causes of chronic diarrhoea

Answer 17

IBS
IBD
Coeliac

Rarer = diabetes
Hyperthyroidism

Question 18

Which node to check in an abdominal examination?

Answer 18

Virchow’s node

Question 19

IBD blood test results

Answer 19

Anaemia of chronic disease or anaemia due to iron deficiency due to poor absorption
ESR due to inflammatory process
CRP raised

Question 20

What should you check alongside anti-TTG?

Answer 20

IgA levels as if you are low in these, you may get a false negative because this what we are detecting with anti-TTG

Question 21

Which drugs cause false positive results in faecal occult blood testing?

Answer 21

Aspirin and warfarin

Any drug that can cause increased bleeding e.g. Clopidogrel

Question 22

Raised ESR, chronic diarrhoea, anaemia, erythema nodosum suggests…

Answer 22

Inflammatory bowel disease

Question 23

Symptoms of UC

Answer 23

Diffuse abdominal pain

Bloody diarrhoea

Question 24

Symptoms of Crohn’s disease

Answer 24

Often more systemic
RIF pain
Failure to thrive (fatigued)

Note: forms granulomas due to poor clearance of phagocytosed bacteria. Leads to chronic inflammation

Question 25

What is the management of IBD?

Answer 25

Refer to gastroenterology Abdominal radiograph Colonoscopy and biopsy (looking for non-case acting granulomas of Crohn’s disease)

Question 26

Treatment of IBD

Answer 26

Immunosuppression (hopefully steroid sparing) Infliximab Azathioprine Methotrexate

Question 27

Single, acute sudden onset diarrhoea after a risky meal can be due to pathogens or toxins, what are their respective names of disease?

Answer 27

``` Toxins = food poisoning Pathogen = infective diarrhoea ```

Question 28

Management of infectious diarrhoea

Answer 28

Oral rehydration solution | Stay out of the office for 48hr after diarrhoea has stopped

Question 29

Management of IBS

Answer 29

Reassurance = important, think how you could do it | Herbal and diet remedies

Question 30

Management of c.diff

Answer 30

``` ABC Rehydration Isolation Faeces analysis Oral vancomycin and metronidazole ``` In severe cases, need to monitor for toxic mega colon and perforation

Question 31

Painless, bloody diarrhoea implies

Answer 31

UC

Question 32

Which form of IBD really increases colonic adenocarcinoma risk?

Answer 32

UC

Question 33

UC is associated with which biliary condition?

Answer 33

Primary sclerosing cholangitis

Question 34

Management of UC

Answer 34

Mesalazine Azathioprine Infliximab Corticosteroids ``` Disease monitoring (colonoscopy for adenocarcinoma) Surgical therapy (removing the affected section of bowel) ```

Question 35

Does UC affect the distal or proximal colon usually?

Answer 35

Distal (rectum and goes proximal)

Question 36

Diarrhoea in someone with weight loss and mass in LIF =>

Answer 36

Overflow diarrhoea

Question 37

Tremor, diarrhoea, heat intolerance =>

Answer 37

Hyperthyroidism

Question 38

Lid lag caused by...

Answer 38

Hyperthyroidism

Question 39

If antibodies are negative in hyperthyroidism (ruling out most common cause = Graves), what should you do?

Answer 39

Uptake scan to look for toxic nodules

Question 40

Outbreak of vomiting and diarrhoea in a nursing home

Answer 40

Norovirus

Question 41

Diarrhoea after a bbq

Answer 41

Campylobacter

Question 42

Outbreaks of bloody diarrhoea implies dysentery, what is the most likely organism?

Answer 42

Shigella | E.coli 0157

Question 43

Toxin diarrhoea is really quick or slow?

Answer 43

Really quick onset after eating

Question 44

What is a typical fluid challenge

Answer 44

250ml of Crystalloid given over 30minutes to a patient who is hypoglycaemic (dry mucous membranes, tachycardia, narrow/low blood pressure).

Question 45

Examples of patients needing greater amount of fluid than normal maintenance

Answer 45

Feverish patients Burns Stoma Third space (a careful balance is needed), e.g. as cites and pulmonary oedema

Question 46

How much urine/hr implies the patient is dehydrated

Answer 46

<30ml/hr

Question 47

Signs of fluid overload

Answer 47

Crackles on lungs Raised JVP Oedematous (puffy)