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MET3A > Diarrhoea > Flashcards

Diarrhoea Flashcards

1
Q

How do patients commonly present in the context of diarrhoea?

A

irregular bowel habits

Change in bowel habits

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2
Q

What are the red flag signs for cancer in someone presenting with diarrhoea?

A
  • Change in bowel habit
  • Bleeding
  • Unintentional weight loss
  • Family history of bowel or ovarian cancer
  • > 50 years
  • Symptoms lasting >6 weeks
  • Anaemia
  • Abdominal or rectal mass
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3
Q

What should you do if a patient presents with red flag cancer symptoms?

A

Refer 2ww cancer pathway

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4
Q

What are the 2 main definitions of diarrhoea?

A

> 200g stool / 24h

3+ stool/ day and loose

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5
Q

What is the definition of acute and chronic diarrhoea?

A

Acute= < 2 weeks

Chronic= >4 weeks

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6
Q

List the common causes of acute diarrhoea and how long each takes to present?

A

Dietary indiscretion (few hours)
• Viral infection (24-48 hours)
• ‘Food poisoning’
• Travellers’ diarrhoea (2-5 days)

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7
Q

When is oral rehydration therapy used in acute diarrhea?

A

When it is sever

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8
Q

Which viruses causes acute diarrhoea?

A

Rota virus
Adenovirus
Norovirus
SRSV

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9
Q

Which parasites causes acute diarrhoea?

A 
G. intestinalis
C. parvum
Microsporidium 
I. Belli 
Cyclospora 
E.histolytica
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10
Q

Which bacteria causes acute diarrhoea?

A 
Shigella 
Salmonella 
Campylobacter 
Enterohemorrhagic Escherichia coli
Enteroinvasive Escherichia coli 
V.Cholerae
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11
Q

Which 2 bacteria are the most common cause of acute diarrhoea and where are they found?

A

Salmonella
Campylobacter

Found in poultry, eggs and milk

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12
Q

How is acute diarrhoea treated?

A

First line-
Observation
Oral rehydration therapy

If its sever-
IV fluids/ antibiotics

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13
Q

What is the composition of the oral rehydration therapy used for diarrhoea?

A 
1L water
3.5g sodium chloride
2.5g sodium bicarbonate
1.5g potassium chloride
20g glucose
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14
Q

Under which circumstances would a patient be treated with IV fluids and antibiotics?

A 
If condition gets worse 
Elderly or immunocompromised
Frequent bloody stools
Severe abdominal pain
Temp > 38.5 oc
Hypovolaemia
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15
Q

What are the causes of steatorrhea (fatty diarrhoea)?

A

Gastric causes
Post-gastrectomy (dumping syndrome)

Small bowel causes
Coeliac disease
Crohn’s disease
Small bowel resection

Pancreatic causes (loss of digestive enzymes)
Chronic pancreatitis
Pancreatic cancer
Cystic fibrosis

Hepatobiliary pathway causes
Primary biliary cirrhosis
Ileal resection (failure of bile acid absorption at the terminal ileum)

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16
Q

How is Pancreatic insufficiency diagnosed and which imaging tests can be run?

A

Normal red cell folate

Stool assessment-
• Faecal fat > 20g / 24h (N <7g)
• Faecal elastase

imaging
• Plain abdominal radiograph / US
• Abdominal CT, EUS, MRI, MRCP
ERCP

17
Q

How is small intestinal disease diagnosed and which imaging tests can be run?

A
  • Low red cell folate
  • Anti - TTG antibodies
  • Duodenal / jejunal/ TI biopsy
  • Small bowel imaging – CT, MRE
18
Q

When taking someone’s history on diarrhoea, which systemic medical conditions should you ask about which could cause diarrhoea?

A

diabetes, thyrotoxicosis, systemic sclerosis

19
Q

In assessing someone’s family history in those with chronic diarrhoea which conditions should you ask about?

A

IBD, malignancy, coeliac

20
Q

Which medications should you ask about in someone with diarrhoea?

A

NSAIDS
Antibiotics
PPI’s
Laxatives

21
Q

If someone as rapid onset symptoms of diarrhoea (<6h), which infective causes should you be considering?

A

Toxin-producing organism (B. cereus, S. aureus)

22
Q

If someone has fever and diarrhoea, which infective causes should you be considering?

A
  • Invasive bacteria (Salmonella, Shigella, Campylobacter)
  • Enteric viruses
  • Cytotoxic organism (C. difficile, E. histolytica)
23
Q

If someone has bloody stool and diarrhoea, which infective causes should you be considering?

A 
Invasive bacteria (Salmonella, Shigella, Campylobacter, E.coli)
- Amoebic dysentery (travel history)
24
Q

If someone develops diarrhoea after taking antibiotics which infective cause should be considered?

A

C difficile

25
Q

Which 8 drugs can cause chronic diarrhoea?

A 
Alcohol
Antibiotics
Anti-depressants (lithium, SSRIs)
Anti-hypertensives
Cholesterol lowering agents
GI drugs (Mg++, H2RA, PG analogs, 5-ASA)
NSAIDs
Oral hypoglycemics (biguanides)
26
Q

Which conditions in a patients medical history should be asked about when they present with chronic diarrhoea?

A

pancreatic disease or abdominal surgery

27
Q

What is the cause of osmotic diarrhoea?

A

nonabsorbable substance

  • high concentration of solute in malabsorption
  • specific defect eg: disaccharidase deficiency
28
Q

What is the cause of secretory diarrhoea?

A

inflammation eg: IBD

  • infection eg: salmonella
  • enterotoxins from eg: E. coli, V. cholera
  • hormones eg: neuroendocrine tumours
  • bile salts and fatty acids
29
Q

What is the cause of motility related diarrhoea?

A

thyrotoxicosis, IBS, DM autonomic neuropathy

30
Q

How is mild, moderate, sever, complicated, and life threatening C. difficile infections categorised?

A

Mild: 3 tools (Bristol Stool Char 5-7)
Normal WCC

Moderate: 3-5 stools per day
Raised WCC (<20 x10(9)/l)

Sever- WCC > 20 x10(9)/l, T > 38.5 oC, > Cr
Abdo pain or XR acute colitis

Complicated: Hypotension, partial ileus (lack of movement some where in the intestines)
Evidence of severe disease on CT

Life threatening: Complete ileus or Toxic megacolon

31
Q

How is mild, moderate, sever, complicated, and life threatening C. difficile infections treated?

A 
Mild: Oral metronidazole 
Moderate: Oral metronidazole 
Sever: oral vancomycin
Complicated: Oral vancomycin +
iv metronidazole
Life threatening: Oral vancomycin +
iv metronidazole
Faecal microbiota transplant
Consider colectomy
32
Q

When a patient comes in with diarrhoea, which blood test should you order?

A 
Blood tests-
- FBC - anaemia
- Inflammatory markers
wcc, platelets, CRP,
- U&E - dehydration/ AKI
- Albumin/Ca/P - nutritional status
- Haematinics
-  TTG antibodies and IgA
- TFTs
33
Q

When a patient comes in with diarrhoea, which stool and other test should you order? (not blood tests)

A
  • Stool weight
  • MC&S, CDT, cysts, ova, parasites
  • Faecal calprotectin- IBD- indicates the migration of neutrophils to the intestinal mucosa
  • FIT (faecal immunochemical test for Hb) (guides referrals for those with suspected colorectal cancer without rectal bleedingblood in stool is not always visible so this test helps in identifying it)
  • Faecal alpha-1-antitrypsin (Fecal clearance of plasma alpha-1-antitrypsin is used as a measure of protein leakage into the intestinal tract)
  • Stool pH/ electrolytes/ reducing substances
  • BMI and nutritional status
34
Q

When a patient comes in with diarrhoea, which investigations should be order? (not blood tests or stool tests)

A

Colonoscopy and biopsies

others if required-
• Duodenal biopsy- Gold standard for coeliac disease
• Small bowel MRI- (IBD, inflammation, bleeding sources, vascular abnormalities, tumours)
• Video-capsule endoscopy- used to search for a cause of bleeding in small intestines e.g. polyps, IBD, ulcers, tumours
• Cross-sectional imaging- done with contrast if fistula is suspected, IBD and proximal small bowel activity assessments

MET3A (14 decks)

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