Diarrhoea Flashcards
What can patients mean when they say they have diarrhoea?
Steattorhoea (fatty)
Passing lots of stool
Melaena (blood)
Loose stools (normal amount but very runny)
Causes of diarrhoea
Try and categorise
Most common = infectious
Inflammation
Infection
Malabsorption (coeliac, pancreatic insufficiency)
Increased motility (IBS, hyperthyroidism)
Overflow
Medications
I’M MOMI
Infection, medication, motility, overflow, malabsorption, inflammation
Acute diarrhoea in a young adult? Could be…
Infective IBS Coeliac Crohns UC Medications Hyperthyroidism
Causes of diarrhoea in the elderly
Normal but more likely to be
Malignancy, diverticular disease, IBD (bimodal distribution)
What’s the main worry with severe diarrhoea and needs correcting and monitoring?
Dehydration, make sure they are hydrated
What are early signs of dehydration?
Urine colour
Tachycardia
Dry lips and coated tongue
Thirsty patient
Diarrhoea can cause which electrolyte abnormalities?
Hypokalaemia
Hyponatraemia
Low Cl-
Low HCO3-
Mucous, jelly like stool =>
Salmonella
Pale stool =>
Gallstones or pancreatitis
Bloody stool =>
IBD Cancer Haemorrhoids Anal fissure Dysentery
What makes IBS unlikely?
Nocturnal diarrhoea
If there is diarrhoea and vomiting, this suggests…
Many pathologies but in the context of diarrhoea this implies gastroenteritis
Pain relieved by passing motions =>
IBS
Extra intestinal symptoms of IBD
Anterior uveitis, erythema nodosum, pyoderma gangrenous,
Recent antibiotic and new onset diarrhoea =>
C. difficile (pseudomembranous colitis)
Most common cause of recurrent diarrhoea with few other symptoms?
IBS
Causes of chronic diarrhoea
IBS
IBD
Coeliac
Rarer = diabetes
Hyperthyroidism
Which node to check in an abdominal examination?
Virchow’s node
IBD blood test results
Anaemia of chronic disease or anaemia due to iron deficiency due to poor absorption
ESR due to inflammatory process
CRP raised
What should you check alongside anti-TTG?
IgA levels as if you are low in these, you may get a false negative because this what we are detecting with anti-TTG
Which drugs cause false positive results in faecal occult blood testing?
Aspirin and warfarin
Any drug that can cause increased bleeding e.g. Clopidogrel
Raised ESR, chronic diarrhoea, anaemia, erythema nodosum suggests…
Inflammatory bowel disease
Symptoms of UC
Diffuse abdominal pain
Bloody diarrhoea
Symptoms of Crohn’s disease
Often more systemic
RIF pain
Failure to thrive (fatigued)
Note: forms granulomas due to poor clearance of phagocytosed bacteria. Leads to chronic inflammation
What is the management of IBD?
Refer to gastroenterology
Abdominal radiograph
Colonoscopy and biopsy (looking for non-case acting granulomas of Crohn’s disease)
Treatment of IBD
Immunosuppression (hopefully steroid sparing)
Infliximab
Azathioprine
Methotrexate
Single, acute sudden onset diarrhoea after a risky meal can be due to pathogens or toxins, what are their respective names of disease?
Toxins = food poisoning Pathogen = infective diarrhoea
Management of infectious diarrhoea
Oral rehydration solution
Stay out of the office for 48hr after diarrhoea has stopped
Management of IBS
Reassurance = important, think how you could do it
Herbal and diet remedies
Management of c.diff
ABC Rehydration Isolation Faeces analysis Oral vancomycin and metronidazole
In severe cases, need to monitor for toxic mega colon and perforation
Painless, bloody diarrhoea implies
UC
Which form of IBD really increases colonic adenocarcinoma risk?
UC
UC is associated with which biliary condition?
Primary sclerosing cholangitis
Management of UC
Mesalazine
Azathioprine
Infliximab
Corticosteroids
Disease monitoring (colonoscopy for adenocarcinoma) Surgical therapy (removing the affected section of bowel)
Does UC affect the distal or proximal colon usually?
Distal (rectum and goes proximal)
Diarrhoea in someone with weight loss and mass in LIF =>
Overflow diarrhoea
Tremor, diarrhoea, heat intolerance =>
Hyperthyroidism
Lid lag caused by…
Hyperthyroidism
If antibodies are negative in hyperthyroidism (ruling out most common cause = Graves), what should you do?
Uptake scan to look for toxic nodules
Outbreak of vomiting and diarrhoea in a nursing home
Norovirus
Diarrhoea after a bbq
Campylobacter
Outbreaks of bloody diarrhoea implies dysentery, what is the most likely organism?
Shigella
E.coli 0157
Toxin diarrhoea is really quick or slow?
Really quick onset after eating
What is a typical fluid challenge
250ml of Crystalloid given over 30minutes to a patient who is hypoglycaemic (dry mucous membranes, tachycardia, narrow/low blood pressure).
Examples of patients needing greater amount of fluid than normal maintenance
Feverish patients
Burns
Stoma
Third space (a careful balance is needed), e.g. as cites and pulmonary oedema
How much urine/hr implies the patient is dehydrated
<30ml/hr
Signs of fluid overload
Crackles on lungs
Raised JVP
Oedematous (puffy)
