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Oxford Clinical Cases > Diarrhoea > Flashcards

Diarrhoea Flashcards

1
Q

What can patients mean when they say they have diarrhoea?

A

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

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2
Q

Causes of diarrhoea

Try and categorise

A

Most common = infectious

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

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

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3
Q

Acute diarrhoea in a young adult? Could be…

A 
Infective 
IBS
Coeliac 
Crohns
UC 
Medications 
Hyperthyroidism
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4
Q

Causes of diarrhoea in the elderly

A

Normal but more likely to be

Malignancy, diverticular disease, IBD (bimodal distribution)

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5
Q

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

A

Dehydration, make sure they are hydrated

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6
Q

What are early signs of dehydration?

A

Urine colour
Tachycardia
Dry lips and coated tongue
Thirsty patient

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7
Q

Diarrhoea can cause which electrolyte abnormalities?

A

Hypokalaemia
Hyponatraemia
Low Cl-
Low HCO3-

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8
Q

Mucous, jelly like stool =>

A

Salmonella

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9
Q

Pale stool =>

A

Gallstones or pancreatitis

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10
Q

Bloody stool =>

A 
IBD
Cancer
Haemorrhoids 
Anal fissure 
Dysentery
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11
Q

What makes IBS unlikely?

A

Nocturnal diarrhoea

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12
Q

If there is diarrhoea and vomiting, this suggests…

A

Many pathologies but in the context of diarrhoea this implies gastroenteritis

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13
Q

Pain relieved by passing motions =>

A

IBS

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14
Q

Extra intestinal symptoms of IBD

A

Anterior uveitis, erythema nodosum, pyoderma gangrenous,

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15
Q

Recent antibiotic and new onset diarrhoea =>

A

C. difficile (pseudomembranous colitis)

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16
Q

Most common cause of recurrent diarrhoea with few other symptoms?

A

IBS

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17
Q

Causes of chronic diarrhoea

A

IBS
IBD
Coeliac

Rarer = diabetes
Hyperthyroidism

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18
Q

Which node to check in an abdominal examination?

A

Virchow’s node

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19
Q

IBD blood test results

A

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

20
Q

What should you check alongside anti-TTG?

A

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

21
Q

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

A

Aspirin and warfarin

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

22
Q

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

A

Inflammatory bowel disease

23
Q

Symptoms of UC

A

Diffuse abdominal pain

Bloody diarrhoea

24
Q

Symptoms of Crohn’s disease

A

Often more systemic
RIF pain
Failure to thrive (fatigued)

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

25
Q

What is the management of IBD?

A

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

26
Q

Treatment of IBD

A

Immunosuppression (hopefully steroid sparing)
Infliximab
Azathioprine
Methotrexate

27
Q

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

A 
Toxins = food poisoning 
Pathogen = infective diarrhoea
28
Q

Management of infectious diarrhoea

A

Oral rehydration solution

Stay out of the office for 48hr after diarrhoea has stopped

29
Q

Management of IBS

A

Reassurance = important, think how you could do it

Herbal and diet remedies

30
Q

Management of c.diff

A 
ABC
Rehydration 
Isolation
Faeces analysis 
Oral vancomycin and metronidazole

In severe cases, need to monitor for toxic mega colon and perforation

31
Q

Painless, bloody diarrhoea implies

A

UC

32
Q

Which form of IBD really increases colonic adenocarcinoma risk?

A

UC

33
Q

UC is associated with which biliary condition?

A

Primary sclerosing cholangitis

34
Q

Management of UC

A

Mesalazine
Azathioprine
Infliximab
Corticosteroids

Disease monitoring (colonoscopy for adenocarcinoma)
Surgical therapy (removing the affected section of bowel)
35
Q

Does UC affect the distal or proximal colon usually?

A

Distal (rectum and goes proximal)

36
Q

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

A

Overflow diarrhoea

37
Q

Tremor, diarrhoea, heat intolerance =>

A

Hyperthyroidism

38
Q

Lid lag caused by…

A

Hyperthyroidism

39
Q

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

A

Uptake scan to look for toxic nodules

40
Q

Outbreak of vomiting and diarrhoea in a nursing home

A

Norovirus

41
Q

Diarrhoea after a bbq

A

Campylobacter

42
Q

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

A

Shigella

E.coli 0157

43
Q

Toxin diarrhoea is really quick or slow?

A

Really quick onset after eating

44
Q

What is a typical fluid challenge

A

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

45
Q

Examples of patients needing greater amount of fluid than normal maintenance

A

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

46
Q

How much urine/hr implies the patient is dehydrated

A

<30ml/hr

47
Q

Signs of fluid overload

A

Crackles on lungs
Raised JVP
Oedematous (puffy)

Oxford Clinical Cases (11 decks)

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